ivf infertility treatment india

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    Male and FemaleMale and Female

    InfertilityInfertility

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    GoalsGoals

    Enhance comfort level with workupEnhance comfort level with workup

    Basic Management StrategiesBasic Management Strategies

    TRICARETRICARECoverageCoveragehttp://www.rotundaivf.com/http://www.rotundaivf.com/

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    DefinitionDefinition

    12 months of unprotected intercourse12 months of unprotected intercourse

    Earlier for certain historical factorsEarlier for certain historical factors

    Older than 35Older than 35

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    Infertility EtiologyInfertility Etiology

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    Female FactorsFemale Factors

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    Male FactorsMale Factors

    General CausesGeneral Causes

    Unknown: 40Unknown: 40--50%50%

    11 HypogonadismHypogonadism: 30: 30--

    40%40%

    Altered SpermAltered SpermTransport: 10Transport: 10--20%20%

    22 HypogonadismHypogonadism: 1: 1--2%2%

    MedsMeds

    11 or2or2

    HypogonadismHypogonadism

    Common medicationsCommon medications

    KetoconazoleKetoconazole

    CimetidineCimetidine SpironolactoneSpironolactone

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    The ScenarioThe Scenario

    Tech: Husband and wife cant getTech: Husband and wife cant get

    pregnant.pregnant.

    You: OB rotation was last infertility workupYou: OB rotation was last infertility workup

    What now?What now?

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    WorkupWorkup

    History is KEYHistory is KEY

    Focused Physical ExamFocused Physical Exam

    Labs and Specialized TestsLabs and Specialized Tests

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    Workup: HistoryWorkup: History

    Coital PracticesCoital Practices

    Gestational HistoryGestational History

    PMHx/PSHxPMHx/PSHx

    MedsMeds

    Menstrual HistoryMenstrual History

    SubstancesSubstances

    Recent High FeverRecent High Fever

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    Workup: Physical ExamWorkup: Physical Exam

    MaleMale

    InfectionInfection

    HerniaHernia Vas deferensVas deferens

    Androgen deficiencyAndrogen deficiency

    Testicular massTesticular mass

    VaricoceleVaricocele

    FemaleFemale

    Breast FormationBreast Formation

    GalactorrheaGalactorrhea

    GenitaliaGenitalia

    HyperandrogenismHyperandrogenism??

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    WHO Seminal FluidWHO Seminal Fluid

    Analysis (1999)Analysis (1999) Volume: >2mlVolume: >2ml

    Sperm concentration: >20 million/mlSperm concentration: >20 million/ml

    Total Sperm Number: >40 million/ejaculateTotal Sperm Number: >40 million/ejaculate Sperm Motility:Sperm Motility:

    >50% motile and/or>50% motile and/or

    >25% progressively motile>25% progressively motile Sperm Morphology: >14% normal formsSperm Morphology: >14% normal forms

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    Workup: Special TestsWorkup: Special Tests

    FemaleFemale

    TransvaginalTransvaginal

    UltrasonographyUltrasonography

    (TVUS)(TVUS)

    HysterosalpingographyHysterosalpingography

    (HSG)(HSG)

    HysteroscopyHysteroscopy

    LaparoscopyLaparoscopy

    MaleMale

    ScrotalScrotal

    UltrasonographyUltrasonography

    TransrectalTransrectal

    UltrasonographyUltrasonography(TRUS)(TRUS)

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    Our Couple: Exam,Our Couple: Exam,

    Labs &T

    estsLabs &T

    ests Normal male examNormal male exam

    Normal initial labsNormal initial labs

    Oligospermia on 2 separate semenOligospermia on 2 separate semen

    analysesanalyses

    TRUS and postejaculatoryUA normalTRUS and postejaculatoryUA normal

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    Management: GeneralManagement: General

    ConceptsConcepts 41 different methods41 different methods

    Fertile window intercourseFertile window intercourse

    EE--type vaginal dischargetype vaginal discharge

    Avoid lubricants and douchesAvoid lubricants and douches

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    Management: FemaleManagement: Female

    Treat underlying causeTreat underlying cause

    HyperprolactinemiaHyperprolactinemia

    PCOSPCOS

    GonadotropinGonadotropin therapytherapy

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    Management: FemaleManagement: Female

    OvulatoryOvulatory dysfunction (Unknown etiology)dysfunction (Unknown etiology)

    ClomipheneClomiphene 50mg PO daily x 5 days50mg PO daily x 5 days

    Start on days 3Start on days 3--55 Can increase to 100mg daily next cycleCan increase to 100mg daily next cycle

    ResultsResults

    80% will ovulate80% will ovulate

    HyperstimulationHyperstimulation and Twinningand Twinning

    HigherHigher--order multiples rareorder multiples rare

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    Management: FemaleManagement: Female

    Clomiphene Failure?Clomiphene Failure?

    IVFIVF

    Injectable ovulationInjectable ovulation--inducing agentsinducing agents

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    Management: FemaleManagement: Female

    Tubal/Pelvic/Uterine IssuesTubal/Pelvic/Uterine Issues

    Reparative Surgery (low success)Reparative Surgery (low success)

    IVFIVF

    EndometriosisEndometriosis

    Laparoscopic ablationLaparoscopic ablation

    LaparotomyLaparotomy

    Ovulation induction +/Ovulation induction +/-- IUI and IVFIUI and IVF

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    Management: MaleManagement: Male

    HyperprolactinemiaHyperprolactinemia

    Surgical repairSurgical repair

    Fertility SpecialistFertility Specialist

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    Stress and InfertilityStress and Infertility

    69% Women and 21% Men have69% Women and 21% Men have

    preexisting conditionpreexisting condition

    Greater risk for psychological stressGreater risk for psychological stress

    No significant difference inNo significant difference inpsychopathologypsychopathology

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    Stress and InfertilityStress and Infertility

    Men have increased stress over time,Men have increased stress over time,

    same as womensame as women

    Watch for normal grief vs. psychopathologyWatch for normal grief vs. psychopathology

    Same rates of depression as other chronicSame rates of depression as other chronicdiseasedisease

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    Stress and InfertilityStress and Infertility

    BottomBottom lineline: Not a means to improve: Not a means to improve

    pregnancy rates.pregnancy rates.

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    Management: Our CoupleManagement: Our Couple

    Male:Male: ImipramineImipramine Mar 08Mar 08

    Pregnant inPregnant inhttp://www.rotundaivf.com/http://www.rotundaivf.com/

    June 2008!June 2008!

    Separated from USAF in July2008Separated from USAF in July2008

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    Questions?Questions?