Dr Richa Sharma, Dr Amit Basnotra
Infertility is a bad dream turned reality for a couple awaiting cry of a baby in their barren lives.Due to so much of advancement and definitely good accessibility, sometimes it may not prove sufficient to get the results.Instead of jumping on to final conclusions and taking high tech decisions may be somewhere we may be missing the minor things.This happens more so in a conservative and reserved society where still Infertility is considered as a stigma.People take years to come out of that block in mind they have and reaching out to the treatment provider.To add to it hesitation in approach at either end may land up with unnecessary costly wok ups.So its better to be more transparent and express your problems clearly as its going to bear good outcomes then that too in a simplified and correct way.
May be some minor issues have been forming mountain mental blocks in the minds of childless couples.So as clinical phyisican and as patient, its important that we identity and share those issues with the treating doctor.Ultimately aim is to have a healthy baby !!
Lets discuss few issues which may fill the gaps while we are on road of Infertility to Parenthood
Chronic pelvic pain is defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months duration. Chronic pelvic pain accounts for 13-20% of gynaecology consultations and up to 52% of diagnostic laparoscopies. One third to one half of diagnostic laparoscopies will be negative. Much of the pathology identified is not the cause of the pain.
These can result in significant complications and if negative may leave the patient feeling disappointed and disengaged with the medical process.
So its better to rule out first whether the condition is treatable or not- As there may or may not be organic causes of pain such as-
It is important to consider and exclude treatable physical causes of pelvic pain and deep dyspareunia in addition to adopting a concurrent psychosexual approach. Differential organic diagnoses include:
Endometriosis
Infections (urinary tract infection, pelvic inflammatory disease, acute appendicitis)
irritable bowel syndrome/constipation/inflammatory bowel disease
Ovarian cysts, polycystic ovarian disease
Ectopic pregnancy(esp chronic one)
Pelvic adhesions
Mittelschmerz or premenstrual syndrome
Referred pain from hip disease.
After organic causes are excluded, such patients often have a characteristic psychological pattern:
Difficult childhood
Little parental interest and affection.
Person may have certain suppressed feelings which may over a period of time has piled up due to lack of expression and certain trigger factors may be adding to it like-
suppressed fear
“I watched my mother die of cervical cancer”
repressed grief from a termination of pregnancy
“perhaps they left the scissors in there that they cut my baby out with?”
anger or anxiety from previous sexual assault or child abuse (this can present as recurrent urinary or vaginal infections, dyspareunia or unexplained pelvic pain)
Childhood physical or sexual abuse can be a contributing factor to symptoms. Abuse can be difficult for women to disclose and consultants must enable ways to aid this confidently and with empathy. Women expect their doctors to feel comfortable discussing sexual issues; the intimacy and vulnerability of the examination means that such women will often disclose information that they would not otherwise feel comfortable talking about.
Being the recipient of such information can be daunting but allowing a woman a few moments to express themselves can aid recovery. Patients chose people they feel safe to disclose to and a doctor who has many disclosures is already exhibiting early skills in psychosexual medicine.
Conclusions- All what we see may not be a pathology.We should see there may be other coincidental issues which may be affecting couple and resulting into infertility !!
(The authors are Senior IVF consultant and Senior Gastroentrologist)
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