Counselling – Primary Subfertility due to Male factor

Question :

A couple attends the subfertility clinic. The woman is 30 years of age and the male partner is 34 years. They have been wanting a child for 2 years. All the routine investigations have been performed in the woman and the results are normal (tests for ovulation and tubal patency tests).

She is getting regular 28 day cycles. The male partner’s sperm concentration is 5 million/ml with 30% active motility.

They are very worried and asking you about all the possibilities that are available for them to conceive.

You are expected to answer patients questions and explain .

You will be assessed for your communication skills as well as the correctness of the technical details you are discussing with the patient.

Role player

I am 30 years of age and my partner is 35 years. We were trying for a child for 2 years. All the routine investigations have been performed on me and the results are normal. I was told that my partner’s seminal fluid analysis abnormal.

Role player’s question

Doctor can you explain what is wrong with my husband’s test?

Answer (20 marks)

Introductions: environment/siting/ Greeting/Self/Knowing client/Explaining the purpose of the meeting/

It is on the low side. He has only 5 million/ml sperms while the normal count is at least 15 million. Also the sperms are a little slow in moving.

We will do a few blood tests to try to find out the cause. However it is possible to conceive with treatment.

Question the husband

Is your method of collection correct?

Are you drinking heavily, smoking or taking any off the counter medicines. What is your job ? Are you exposed to heat? Have you had mumps, any major illnesses or operations?

Inquire regarding any sexual difficulties.

Advise

to avoid smoking, alcohol and unprescribed and addictive drugs to avoid warmth and to bathe twice a day

Role player

Doctor is it possible for me to conceive with my husband’s sperms?

Answer (20 marks)

Most probably. First of all he will have to follow our advise to improve the count. We will repeat the count preferably after 3 months because it takes three months for new sperms to form.

In the meantime he can adjust his lifestyle. We can make his sperms stronger by mixing the semen with a nutrient liquid and spinning it so that the stronger sperms will swim upwards. We can insert this prepared sperms to your womb by using a small tube. We do it in the clinic. You will feel a slight discomfort but no serious pain.

We will make sure that you have an egg by giving you some tablets from the second day of menstruation for five days.

We will follow the development of the egg by doing several scans and we will give you a hormone injection when the egg reaches the correct size to ensure its release.

36 hours after the injection we will prepare the sperms and deposit the prepared sperms in your womb. This can be done for 3 of your menstrual cycles.

Role player

What can be done if I don’t conceive with this treatment?

Answer (20 marks)

We can test his hormones and if the levels are low we can give him hormone injections to improve the count.

If the hormones are high we will test his genes. If we have no method to improve his count we might have to inject you with sperms from a bank. These sperms will be carefully tested for viability and diseases and the donor will be matched as much as possible with the requirements you mention. (race, religion, colour etc. )The donor will be anonymous

If the hormones are normal his tubes may be blocked. We can aspirate his sperms and go for a test tube baby.

All these methods are carried out in the private sector and will be expensive.