Postcoital intra-uterine aspirate--a unique criterion for selecting patients for natural or assisted conception.

The success of any infertility management programme is reflected in its efficacy to achieve a pregnancy either spontaneously or through assistance. For this purpose some routine investigations are carried out to pinpoint the nature of problem(s) which an infertile couple is troubled with. As the basic requisite for conception to occur is the accumulation of motile spermatozoa around the egg at the site of fertilisation, proper assessment of sperm transit from the vagina to the tubal ampulla becomes a very important criterion to predict the possibility of spontaneous pregnancy. Till date postcoital test was the sole investigative tool available to serve this purpose but unfortunately it fails to furnish any information about the concentration and nature of quality of spermatozoa beyond the cervix. This results in the disparity between postcoital test results and pregnancy outcome. In the present study intra-uterine fluid was examined along with cervical mucus 4-6 hours postcoitus in the pre-ovulatory period. The objective was to gather information about the fate of spermatozoa subjected to the uterine environment after being vaginally deposited during coitus. The result of this combined test has been found to be very much informative and helpful for the fertility physician to set the criteria for timed intercourse and / or intra-uterine insemination. This simple test thus appears to play a leading role in infertility management in near feature.

Medical management of male infertility.

Management of male infertility is always a difficult task. In recent years booming of artificial reproductive technologies (ART) has put infertologists and andrologists in front of a million dollar question whether to treat the person or the gametes. A basic andrology laboratory at present has become part and parcel of an infertility clinic. Hence treatment of male infertility has become institutional and collective for clinicians and basic scientists. The basic approach towards management of male infertility includes confirmation of diagnosis and to find out the cause for which pathological, endocrinological and biochemical tests are essential. In this series specific defects causing seminopathy has been found in 18% cases where treatment is straightforward and towards the cause. The main bulk of idiopathic seminal defects (82%) really poses challenge to the infertologists so far management is concerned. In this study commonest seminal defect has been found to be oligoasthenozoospermia which amounts to 63% cases. For medical management purpose drugs commonly used are clomiphene, gonadotrophins, bromocriptine, L-thyroxine, vitamin E, B12, etc. When they fail the main approach remains to be intra-uterine insemination (IUI) and ART eg, in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI).