Saturday 1 October 2016

Fertility issues and low platelet count

Ask the GP...

Nina Byrnes

Published 01/09/2015 | 02:30

Both partners should attend for tests if there are fertility problems
Both partners should attend for tests if there are fertility problems

Advice from our GP on fertility testing and the significance of a low platelet count.

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Question: My husband and I have been trying to conceive for the last year with no luck. I am 34 how do I go about having my fertility checked?

Dr Nina replies: It has been stated that up to 80pc of couples who have regular unprotected intercourse will conceive within two years of trying. Two years can however feel like a very long time for prospective parents and most will want some investigation before two years are up. If you are under 35 and are generally healthy I would advise trying for at least one year. For those over 35 it is advised to have some investigation after six months of no success.

You are at your most fertile in your 20s. Fertility then declines slowly from the age of 30, more rapidly over 35 and dramatically over 40. Up to one in nine couples may experience fertility issues. Increased maternal age is definitely playing a role in this.

Your GP can arrange a lot of the initial tests and this is a good place to start. I would advise that both partners attend as fertility problems are estimated to be 40pc female, 40pc male and 20pc unclear. Firstly ensure you are having regular unprotected intercourse, ideally every two to three days all month.

Sperm can live for up to 72 hours but it can take 24 hours to build up more sperm after intercourse.

Thus daily intercourse isn't advisable. I don't recommend the use of ovulation predictor kits. These can just add undue stress.

Your GP will enquire about any medical issues that may affect your fertility, things like previous abdominal surgery or infection, undescended testes in the male or mumps may be significant.

Your GP will also examine both of you looking for things like abnormalities of the womb or ovaries or changes in the testes. Fibroids and endometriosis can reduce fertility. Chlamydia can reduce fertility and will need to be ruled out. If your smears are not up to date this should also be done.

Lifestyle is important when it comes to fertility. Maintain a healthy weight. Body mass index should ideally be between 20 and 25. Too high or too low can reduce your chance of becoming pregnant. Smoking and alcohol can affect sperm and eggs and you will be advised about these.

The next step is blood tests. These will be timed in your cycle ideally taken on day three of menstruation and then seven days prior to your next menstrual period. Hormone levels can be checked to assess baseline fertility and whether you are ovulating or not.

General tests such as thyroid function are also usually checked. An AMH (Anti Mullerian Hormone) test can check the age of your eggs and can be helpful in assessing fertility.

This is not usually provided for in the public system and you will have to send this to a private lab. Your partner will need to be referred to have a semen analysis done. This assesses the viability of his sperm.

If all these tests are normal it is very reassuring. Those under 35 may then decide whether they would like further assessment or to try for a little longer.

For those over 35 referral to a specialist is advised at this stage. There are a number of excellent fertility clinics in Ireland and your GP can facilitate referral to these.

Question: My daughter was having a lot of nosebleeds lately. Our GP arranged some blood tests which show her platelets are low. Everything else seems normal, we are awaiting a second opinion. Should we worry?

Dr Nina replies: Platelets are one of the factors in blood that help with clotting. These are made inside bone in the bone marrow and they circulate in blood for about seven days before they are destroyed by the spleen. If there are too many platelets in the blood it will clot too easily. If there are too few there is an increased risk of bleeding. In immune thrombocytopenia (ITP) the body produces antibodies against platelets. The platelet count then falls making bleeding more likely.

There are two types of ITP. The first type occurs more commonly in children between the ages of two and six. It comes on suddenly, often a few weeks after a viral illness such as mumps. This resolves spontaneously in the majority of cases and rarely reoccurs.

The second type occurs more slowly. It occurs in adults, most often female. There isn't usually any preceding illness. This type of ITP can last months to years.

ITP may not have any symptoms or there may be easy bruising, nose bleeds, prolonged bleeding after an injury or dental work or heavy menstrual periods.

Bleeding risk increases when these drop very low. In many cases platelets drop slightly and treatment is not required. Regular blood tests can keep an eye on platelet levels. If bleeding risk is higher steroids may be prescribed. If an urgent rise in platelet count is required intravenous imunogobulin or anti-d may be given. Newer medications that work at an immune level or help the bone marrow make more platelets are another option. A surgical option for treatment is removing the spleen although this is rare nowadays.

Thankfully in most cases platelet counts do not drop to critical levels.

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