INFERTILITTY

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INFERTILITTY

• SALWA NEYAZI
• CONSULTANT OBSTETRICIAN GYNECOLOGIST
• PEDIATRIC ADOLESCENT GYNECOLOGIST

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INFERTILITY

• Failure to conceive after one year of unprotected
  intercourse
• Incidence 15 of couples
• 1ry /2ry infertility
• The normal fecundability rate 20
• What are the causes of infertiliy?
• Anovulation 10-25
• Tubal blockage endometriosis 30-50
• Male factor 30-40
• Cervical factor 5-10
• Unexplained 5

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EVALUATING INFERTILE COUPLES

• History
• Age of both husband wife
• Length of time conception has been attempted
• Previous pregnancies
• Frequency of intercourse/ dysparunea
• Menstrual history/ dysmenorrhea
• Headache visual changes galactorrhea
• Excessive stress or exercise
• Symptoms of thyroid disease
• Pelvic surgery / appendicitis
• PID/ septic aborrtion/ ectopic pregnancy/IUCD
• Cervical conization or cryocautery / trauma
• DC

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HISTORY

• Husband
• Does he have children from another wife
• Testicular injury or surgery
• Mumps
• Medical diseases ? DM , renal disease,
  chemotherapy
• Exposure to heat , drugs ,alcohol, smoking

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PHYSICAL EXAMINATION

• Signs of androgen excess
• Signs of thyroid dysfunction
• Obesity
• Emaciation / anorexia nervosa
• Galactorrhea
• Pelvic examination ? Signs of pelvic infection
• -Uterosacral ligament nodularity
• -Immobility of the uterus
• -Irregular shape of the uterus
• -Pelvic mass

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INVESTIGATIONS

• Semen analysis
• To test for ovulation
• -BBT
• -Endometrial biopsy
• -Serum progestrone
• FSH , LH, prolactin, TFT
• HSG
• Laparoscopy
• Post coital test

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TREATMENT

• Depends on the cause
• 1-Anovulation
• PCO
• -Clomiphene citrate ? Ovulation 70
• ? Pregnancy
  40
• ? Twins 5-10
• -HMG / pure FSH
• -Glucophage
• -Ovarian drilling
• -IVF

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TREATMENT OF ANOVULATION

• Hypothalamic pituitary failure
• Hypogonadotropic hypogonadism
• Kalmans syndrome / Anorexia nervosa / Stress
• -HMG ? pergonal
• -Synthetic pure FSH ? puregon / gonal F
• -Pregnyl (HCG) ? act like LH
• The risk of gonadotropin therapy ?
  Hyperstimulation syndrome
• Multiple pregnancy 10-15

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TREATMENT OF ANOVULATION

• Hyperprolactinemia
• Bromocriptin 2.5 mg bd
• Surgical excision
• Hypothyroidism / hyperthyroidism ? anovulation
• due to altered estrogen metabolism
• Anovulation due to ovarian failure
• Premature menopause

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TREATMENT OF PERITONEAL FACTORS

• Tubal blockage
• -Laparoscopic salpingostomy ? for
  distal
• obstruction
• -Hystroscopic tubal canulation for
  proximal
• obstructuion
• -Microsurgery
• -IVF
• Endometriosis 10-25
• -Surgical treatment ? Laparoscopic
• cauterization of endometriotic
  spots or laser
• ablation ? preg rate mild/mod dis
  60
• severe dis ? 35

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TREATMENT OF PERITONEAL FACTORS

• Medical treatment of endometriosis
• OCP continuously 6M ? preg rate 40-50
• Danazole
• GnRH analogues

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TREATMENT OF CERVICAL FACTORS / MALE FACTOR /
UNEXPLAINED INFERTILITTY

• Superovulation IUI
• Assissted reproductive techniques
• TREATMENT OF UTERINE FACTOR
• Asherman syndrome
• Hystroscopic lysis of adhesions followed by
  estrogen therapy
• Pregnancy rate ? 70

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ASSISSTED REPRODUCTIVE TECHNIQUES

• IVF
• GIFT
• ZIFT
• ICSE