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Management of infertility
Introduction
Classification
Initial work up and diagnosis
Medical history
Etiology
Examination
Investigations
Treatment
3
Introduction
Definition:
Infertility defined as a failure to conceive within one or more
years of regular unprotected intercourse.
Category 3 Category 4
• Any age group but less than • Old age couples
35 years • Young female with premature
• Previously diagnosed ovarian failure
condition like tubal block, • Severe uterine problems
endometriosis, severe male
factor
Common causes for male infertility 7
Common causes for female infertility 8
Initial work up and diagnosis 9
Options
Clomiphene citrate (CC)
Gonadotropins (hMG/FSH followed hCG)
GnRH analogue
Clomiphene citrate(CC): 18
hCG
Common procedures: COS 28
Day 6 of
FSH hCG
Day 2 or 3 Embryo Transfer
of menses GnRH
antagonist
Cycle day
rFSH/hMG IVF
21-24 Luteal
GnRH agonist or phase
support
rFSH/hMG ICSI
Male infertility treatment
29
30
Procedure
Initially used in women with fallopian tube blockage or
damage
Now employed for many causes of infertility (eg.
Endometriosis, male factor)
Involves
COS
Egg retrieval
Insemination, fertilization, embryo culture
Embryo transfer
Cryopreservation of extra embryos
33
Risks
Ovarian hyperstimulation stimulation syndrome
Usually not serious and resolves with outpatient management
1%-2% severe requiring hospitalization
Dose-dependent, avoided by careful titration
Anesthesia
Multiple births
Ectopic pregnancy
Cost
Psychologic distress
Intracytoplasmic Sperm Injection 34
Indications
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