If the tests have shown that the woman does not have regular ovulation and if the man’s sperm is viable, she may be given treatment at this point. Unless the complex cycle ofwhich governs a woman’s menstrual cycle is working effectively, she cannot ovulate and therefore have the chance of becoming pregnant. Hormones are produced by the pituitary gland, located at the base of the brain, as well as by the ovaries. Clomiphene (a ‘ drug’) may be given to induce her pituitary to release the hormones which trigger ovulation, or human gonadotropin* may be used directly to stimulate the ovaries. It is important therefore, that these drugs are taken exactly as prescribed, because of the high risk of multiple pregnancy involved. An ultrasound scan midway through the menstrual cycle would reveal whether ovulation is taking place, because a maturing egg (Graffian follicle) shows up as a dark patch on the ovary. A scan is also necessary to check whether the stimulating hormones are causing too many eggs to mature. Most triplets and quadruplets are simply the result of overstimulation of the ovaries.
If no hormonal disorder seems to be present or if hormonal intervention is unsuccessful, various surgical examinations may be tried on the woman. An ultrasound scan may reveal whether any mass, such as a, is interfering with ovulation, or whether scar tissue or ‘adhesions’ are affecting the Fallopian tubes. Surgery may then be recommended. A laparoscopy would allow the surgeon to examine the uterus, ovaries and Fallopian tubes in detail. One or two abdominal incisions are made to allow a laparoscope* into the pelvic cavity. It may then be possible to remove the scar tissue. Another method of testing the menstrual cycle is by taking an endometrial biopsy. A small sample of the uterine lining is removed through the vagina. Examination of the sample could show if the lining is properly developed and ready to accept a fertilized egg, or whether small growths such as or polyps – or a hormone deficiency – prevent it functioning. If the condition of the endometrium is abnormal, a dilatation and curettage may be advised in order to study it in greater detail. In this, the neck of the womb, the cervix, is dilated or stretched and a curette* is used to scrape out the endometrium. In rare cases this diagnostic method even seems to have a therapeutic effect, as sometimes pregnancy follows when intercourse resumes after this operation. Some doctors believe that, where the cervix offers too narrow a passage, dilatation encourages the cervical mucus to provide more hospitable channels for the sperm to pass through.
If there is any suspicion about blockage of the Fallopian tubes, the doctor may advise a hystero-salpingography. In this procedure a radio-opaque dye is injected into the uterus and its journey through the uterine cavity and Fallopian tubes to the pelvic cavity is followed on an X-ray screen. Any blockage will be represented on the screen, and in some cases the test procedure itself is successful in removing a small obstruction.
Depending on the results of these tests, further operations may be necessary to removeor other obstructions or to free the Fallopian tubes from scar tissue. Hormone treatment may be offered in an attempt to cure endometriosis or to help restore the normal hormonal balance.