Beruflich Dokumente
Kultur Dokumente
M.D.(OBGYN)
Diploma in Reproductive Medicine
(Germany)
Dr Rupal N Shah
M.D;D.G.O
Diploma In Reproductive Medicine (Germany)
Blossom IVF Centre
&
Rupal Hospital For Women
Surat,India
Objectives:
1. To present the practical concepts in the management of
infertility
1 Year
30-35 Years
6 Months
35-40 Years
Immediately
BACKGROUND INFORMATION
The single most important determinant of a couples
fertility is the age of the female partner
20-25 yrs
2.8% infertile
30-34 yrs
10% infertile
35-39 yrs
33% infertile
40-45yrs
86% infertile
CURRENT GUIDELINES
The current clinical approach to the investigations and the
management of infertility is backed by the evidence-based
guidelines issued by:
Royal College of Obstetricians and Gynecologists (RCOG)
American Society of Reproductive Medicine (ASRM)
European Society of Human Reproduction and Embryology (ESHRE)
INVESTIGATIONS
1st Visit
Trans vaginal USG
TSH and prolactin (apart from CBC, RBS, HIV, HbsAg, Hb
electrophoresis)
Semen analysis
AMH(ML>5 years,patients age >35 years)
1st visit:
>10 to 12 follicles per ovary (PCOS),
Persistent hemorrhagic cysts with low-level echoes
(endometriosis)
Anatomical conditions: fibroids, polyps, and Mllerian
anomalies (uterine septum)
Laproscopy findings
Uterus
Tubes
Patency ,Hydrosalpinx
Ovaries
POD
Endometriosis ,Adhesions
Tubal Block
Hydrosalpinx
Clipping
IVF+ICSI
http://www.rupalhospital.com/
Drainage
Recurrence
AMH
IVF-ICSI
Hysteroscopic
myomectomy
Adhesiolysis
High dose
estrogen
Trial ET
IVF-ET
Septum
polypectomy
Intrauterine adhesions
Polyp/Submucous
fibroids
Minor
septum-DO
NOT CUT
Abnormal Semen??
Count
Motility
(G1+G2)
Morphology
Treatment
Mild
15-20 mill/ml
40-50%
30-40%
IUI
Moderate
10-15mill/ml
20-40%
10-30%
IUI
severe
<10mill/ml
<10%
<10%
IVF-ICSI
Minimum post-process Semen parameters for successful IUI 5 mill/ml motile sperms
MALE INFERTILITY
Medical Management Anti-oestrogens, androgens,
bromocriptine and kinin-enhancing drugs , Antioxidants, mast
cell blockers and alpha blockers, systemic corticosteroids for
treatment of antisperm antibodies have not been shown to be
effective in the treatment of Male infertility
Surgical Management The benefits of the treatment of a
varicocele in oligozoospermic men is less certain
Common algorithms
Based on
Patients age
Duration of INFERTILITY
AMH
IVF-ICSI
AMH
Diagnostic
Laproscopy+
Hysteroscopy
Normal
Abnormal
>2ng/ml
<2ng/ml
CC+/- HMG+IUI
(3-4 Cycles)
IVF
?DHEA
IVF+ICSI
IVF-ICSI
AMH/AFC
Diagnostic
Laproscopy+
Hysteroscopy
AMH>2
AMH<2
AFC >5
AFC<5
CC+/- HMG+IUI
(3-4 Cycles)
IVF
?DHEA
IVF+ICSI
AMH > 2
AMH 1 to 2
AMH < 1
AFC normal
AFC less
AFC less
IVF-Own
eggs/donor
eggs
?DHEA
20%
Donor eggs
80%
Surrogacy-Straight away.
After hysterectomy
Congenital absence of the uterus
Repeated failure of IVF or Recurrent
abortion
PCOS
Weight reduction
Ovulation Induction
Metformin
Ovarian drilling
PCO drilling
WHO BENEFITS FROM PCO Drilling?
CC resistant patients and those who
are not responding to routine doses
of gonadotrophins,
Slim, raised S.LH
Only 4 punctures with monoplor
needle using 4 watts for 4 seconds
PCO drilling
Very damaging procedure
Please,please,please...
Dont over do it.
11/11/2014
www. blossomivfindia.com
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