treatment of female infertility..... by dr .radhakrishnan.....

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Management of female infertility

Transcript of treatment of female infertility..... by dr .radhakrishnan.....

Management of female

infertility

Ovulation disorders Ovulation-inducing drugs

HyperprolactinemiaProlactin-suppressing

drugs

Uterine and tubal abnormalities

Surgical procedures

Cervical mucus problems Intrauterine insemination

Clomiphene citrate

Combined CC + hMG

Combined hMG + hCG

Gonadotrophin releasing

hormone

Bromocriptin

Micronised progesterone.

prednisolone

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 increased

andrastenedione.

Prednisolone 5.0mg (night) +

2.5mg( every morning)

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.

It is advocated in tubal

blockage.

Procedure varies depending on

the site of block.

Anaesthetic complications

Postoperative wound infection, chest infection and embolism

Failure and

An ectopic pregnancy

Reversal of tubectomy

conservative ectopic pregnancy

Salpingitis isthmic nodosa

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.

Infection

Perforation of the tube

Ectopic pregnancy

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.

Male sub fertility.

Immunologic infertility

Failure of ovulation - donor

ovum.

In vitro fertilization (IVF)

Gamete intra fallopian transfer (GIFT)

Zygote intra fallopian transfer (ZIFT)

Intra cytoplasmic sperm injection (ICSI)

Ovum donation

Ovarian transplant – future

Surrogacy and posthumous reproduction

Stem cell culture agar – future goal

Adoption.