Integrated approach to infertility work up
-
Upload
nermine-amin -
Category
Health & Medicine
-
view
26 -
download
1
Transcript of Integrated approach to infertility work up
![Page 1: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/1.jpg)
Integrated Approach to
Infertility Work-Up
EMAD DARWISH MDPROFESSOR OF OBSTETRICS AND GYNECOLOGY
INTEGRATED FERTILITY CENTERALEXANDRIA
![Page 2: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/2.jpg)
Etiology of infertility:
Male factor 30%Female factor 40%
Combined factors
10-20 %
Unexplained 10-20%Infertility
Male factor Female factor Combined fac-tors Unexplained
![Page 3: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/3.jpg)
Meet the coupleHistory: 1- Married for how long? 2- For how long together?L.M.P. 1- Date 2- RegularityPast History: Pelvic Surgery eg myomectomy, ovarian cystectomy ( H.P. ) to exclude endometriosis. Medical disorders thyroid, Diabetes Male partner mumps, orchitis, surgeryHusband Job eg driversPrevious investigations: HSG, Endoscopy, IUI, ICSI Details about sexual intercourse.
![Page 4: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/4.jpg)
Four Points to be Covered
1- Male Partner2- Ovarian function3- Tubal function4- Utereus
![Page 5: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/5.jpg)
Male Partener
History Examination: General and Local Semen Analysis: Conventional or CASA DNA fragmentation If azospermia Serum FSH : Obstructive or
Testicular or Hypo-Hypo TESE Where to do ?
![Page 6: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/6.jpg)
Volume Normal: 2-6 ml
> 6 ml may be due to chronic prostatitis or seminal vesiculitis.
<2 ml may be due to obstruction or retrograde ejaculation (hypospermia)
Sperm count: > 20 million/ml (new WHO strict criteria: < 15 million/ml)
Reaction (pH): 7.2-8 (alkaline)
Liquefaction: Completed within 30 minutes.
Motility: > 50 % motile
morphology: > 30 % is considered normal according to the WHO criteria.
Agglutination: not exceed 10 %.
Cellular elements:
< 5 x106/ml rounded cells of which < 1x106/ml are WBCs.
Semen Analysis
![Page 7: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/7.jpg)
Important items in Semen report Count more than 15 million/ml Motility A ( fast forward) 25% B (slow forward) 25% C ( shaking) D ( immotile) Normal Forms more than 4%
![Page 8: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/8.jpg)
![Page 9: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/9.jpg)
Ovarian Function
Regular Cycles TVS for follicular scanning Mid luteal phase serum Progesterone PCOS: Trunkal obesity, Hirsutism,
Oligomenorrhoea, TVS , family H. of Diabetes Lab: LH:FSH ratio, AMH, Prolactin, Testosteron Insulin resistance FBS and Fasting serum insulin
![Page 10: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/10.jpg)
Continue
Ovarian Reserve1- Age2- AFC day 3 of cycle3- FSH day 3 of cycle4- History of previous COH
![Page 11: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/11.jpg)
Continue
Choclate CystDiagnosis: TVS Laparoscopy limited rule now for diagnosis, treatment mainly for pain, before ICSI ??
![Page 12: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/12.jpg)
![Page 13: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/13.jpg)
Tubal Function
HSG Laparoscopy Hysteroscopy
![Page 14: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/14.jpg)
![Page 15: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/15.jpg)
![Page 16: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/16.jpg)
![Page 17: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/17.jpg)
Uterine Factor
HSG 2D and 3D TVS, SIS Hysteroscopy Endometrial biopsy for diagnosis of chronic endometritis
![Page 18: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/18.jpg)
HSG: To diagnose uterine congenital anomalies, intrauterine adhesions,
submucous fibromyomata..
![Page 19: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/19.jpg)
![Page 20: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/20.jpg)
![Page 21: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/21.jpg)
Hysteroscopy:For direct visualization of the interior of the
uterus, diagnosis and surgical correction of intrauterine adhesions, uterine anomalies & submucous fibromyomata.
![Page 22: Integrated approach to infertility work up](https://reader035.fdocuments.in/reader035/viewer/2022062901/58f0d26a1a28aba51d8b4595/html5/thumbnails/22.jpg)
Lab Investigations Serum Progesterone FSH AMH FBS and Fasting serum insulin E2 Prolactine TSH