Causes of infertility
best time for intercourse is 3 days prior to ovulation and 24 hours after ovulation.
8 cell morula enters the ueterine cavity in the 4th day of fertiization
tbopalsty is an alternative for tubal factors. but ideally ivf.
have to investigate both at the same time..must not think first female and then investigate male. nope. both male and female must be investigated.
the first cause is diagnosed by exclusion..excluding the rest of it.
gonadal can be also due to steriods and atrogenic causes
surgical like inadvertant tying up of the vas deferans.
why not cervical?
- not properly understood even. might not contribute 2. some of the cervical cuases have no treatment so why waste? 3 treatment is anyway OI and iui which bypass the cervix so.
Evlauation of an infertile couple
history of mentration - ask about past surgical interventons
also ask about pain symptoms pelvic and dicharge
if irregular then we know its anovuatory and can diagnose.
These all are only seful in regular cycle = since it means ovulatory
endometrial sample useful if also doing another procedure.
ultrasound is only useful if doing with combining with a treatment protocol...can monitor treatment and see ovulation
around the time of ovulation the endometrium is tri laminar
Tubal patency tests
testing for genital tb usually done before menses becase can combine with tests for fertility as well!
the above is a lap and dye test?
Confirmatory as well as diagnostic
the first two is screening test and the last one is confirmatory test.
sp below answer is laborascopy because have to confirm it with gold standard
in tubal blockage ovulation induction is unwaranted because tube is anyway blocked
so must go for ivf
In this case better to clip both the fallopian tubes to avoid inflammatory mediatros etc coming from them.
the right side distended is abnormalzW
cornual block can be a false block because of spasm ... so lap and dye can solve it but better to do hystercoopy as well because any blockage can be cannulaated as well. In this case its better than lap and dye as both therapeutic and diagnostic!!
HYSTEROSCOPY AND bisopy = GOLD STANDARD
but expsneive so only offered when you're thinking about uterine abnormalaties with high degree of suspicion
can do ovulation indiction and IUI truak and then offer ivf.
serum AMH antimullerian hormone is the best test for ovaria reserve but expensive
but still wroth it because treatment methods are even more expensive
these tests arent definifte..its just an indication for how to tailor the treatment prootocol...like to go for ivf earlier.
with poor reserve can go ivf with ovum donation
clomifense for ovum release for ovf doesnt work...must idrectly use gonadotrphins instead
how to know whether this is gonatarophin problem or isit becase of ovarian pooor reserve.
oestrogen levels fall but day 3 rises paradoxially. its shifted to one side.
not testing for cerivcal factors because anyway for induction and iui we bypass the cervix and then if fails we do ivf. so bypassed.
peak secretary in the endometrium is on day 7 before mentraution as well
Treatment Methods for Infertile Couple
for tubal causes can also try tuboplasty but thats usuaully causes more problems
why wash? becase tochoose the best becasue the cervial mcus chooses normally/
iui is always combined with oi and not used for spontanous cycles has hard to predict then for spontanoeus.
POI = premature ovarian insufcuency
theres no drugs for group 3 because cant induce ovulation here so matter what
ovm donation works tho
for group 1 cant use clomiphene
cabergoline 3 uses for parkisnons for ovlation or inferiity and for stopping milk prduction
these ovlition drugs are used only for 5 days and not always so wont create any abnoral hormonal state
the second drug causes real deficinecy bt then it causes more fsh and more follicular development and produce more oestrgen..so it remains the same and the first once creates more oestrogen state.
can also be given from day 3 ro day 7 as well.
after ovulation trigger go ahead and do normal intercourse.
IUI is usually combined with ovulation triggegr as its conveneinent that way...otherwise mst conitnioulsy scan and see whether ovulition occured or not....and then give it whe theres signs of ovulitiom.
because in pcos is more so it helps to pstop androgen ebing converted to iestroge becase thatsa basis of infertilty here
clomiphenese and the other one is oral bt the other gonatrophins is injevtable
IVF
retirval of oocytes is done under usg and under GA and the embryologist is on site to inspect and see whether there are eggs and put that eggs in a ptry dish with culture medium.
specially designed catheter
day 5 mebryos are better
endometrium lining should be intact..otherwise must use a surrogae mother
why so many eggs are induced? Because things are lost along the way so finally will be left with a few to impant.
Only 1 is implanted nowdays, the rest are frozen and used for the next cycles.
for obstuction can do surgical correction.
like reversal of vasectomy
otherwise sperm retirval and IUI
Infertility
Subfertility case
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