treatment of female infertility..... by dr .radhakrishnan
TRANSCRIPT
Ovulation disorders Ovulation-inducing drugs
HyperprolactinemiaProlactin-suppressing
drugs
Uterine and tubal abnormalities
Surgical procedures
Cervical mucus problems Intrauterine insemination
50mg/day from 2-6th day cycle induces ovulation
If not satisfactory dose can be increased upto 150 mg by 50 mg increment.
Ovulation monitored with serial USG
If clomiphene therapy fails following 6-8 cycles, FSH and hCGtherapy is recommended.
The risk of multiple ovulation and multiple pregnancy with this regime is around 10%.
Cervical mucus thickening.
Clomiphene combination with human menopausal gonadotrophin.
CC given from 2-6 days, injection hMG given 75 units on day 3,5,7.
If this fails hMG + hCG is tried.
It is an alternative to hMG.
Subcutaneous route is
preferred.
It is administered in pulsatile
fashion.
Risk of hyperstimulation is
reduced - compared to hMG.
Less monitoring is required.
The drug is very expensive.
In case of this treatment does
not succeed, this can be
combined with any other
ovulation induction regime.
Dose 1.25mg at bedtime daily
for 7 days.
Dose increments of 1.25 mg per
week until this condition gets
corrected.
Intramuscular progesterone 100
mg or micronized 300-600mg
vaginal tablet daily
Oral micronized progesterone is
not recommended.
LUF syndrome is seen in 9%
cases of infertility and is
diagnosed only on ultrasound
scanning.
Micronised progesterone or hCG
is needed in these cases.
Peritoneal disorders include
peritubal adhesions and
endometriosis and on diagnosed
on laparoscopy.
Therapy – operative laparoscopy.
Tubal microsurgery
Laparoscopic tubal adhesiolysis,
fimbrioplasy and tubal surgery
In vitro fertlisation
Balloon tuboplasty and cannulation
Tubal cannulation
Gamete intrafallopian transfer
Uterine causes, such as a septum ,asherman’s syndrome and a fibroid need surgical correction.
Anaesthetic complications
Postoperative wound infection, chest infection and embolism
Failure and
An ectopic pregnancy
Indication – extensive and
irreparable tubal damage and
failed tuboplasty
The overall success rate of 20 to
30 % obtained.
This is very expensive therapy
which a few can afford.
Contraindication - Extensivepelvic adhesions and inaccessibleovaries due to adhesions .
Laparoscopic adhesiolysis followed by IVF may be possible.
Normally , three trials are given and if IVF fails other MAF processes offered.
hysteroscope - transcervical
route - medial end block.
Only breaks flimsy adhesions –
dislodges plugs of mucus and
inspissated material – not dense
adhesion.
It is the technique of assisted
reproduction which is useful in
cases of immunological
infertility, provided the tubes
are patent.
The ova with the sperms are
placed in the distal end of the
fallopian tubes at ovulation
under guidance of the
laparoscope.
Definition : any fertility treatment in which the gametes are manipulated.
It involves surgical removal of eggs known as egg retreival.
IVF is the most common Art procedure.
Abnormal fallopian tubes :
blocked tubes or absent tubes.
Endometriosis - affecting tubo
ovarian pickup function or
distorting the tubes.
Idiopathic infertility.
In vitro fertilization (IVF)
Gamete intra fallopian transfer (GIFT)
Zygote intra fallopian transfer (ZIFT)