treatment of anovulation and tubular block....few points about assisted reproductive technology.

1. Management of female
infertility

2. Ovulation disorders Ovulation-inducing drugs
Hyperprolactinemia
Prolactin-suppressing
drugs
Uterine and tubal
abnormalities
Surgical procedures
Cervical mucus problems Intrauterine insemination

3. Clomiphene citrate
Combined CC + hMG
Combined hMG + hCG

4. Gonadotrophin releasing
hormone
Bromocriptin
Micronised progesterone.
prednisolone

5. 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

6. If clomiphene therapy fails
following 6-8 cycles, FSH and hCG
therapy is recommended.
The risk of multiple ovulation and
multiple pregnancy with this
regime is around 10%.
Cervical mucus thickening.

10. 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.

11. It is an alternative to hMG.
Subcutaneous route is
preferred.
It is administered in pulsatile
fashion.

12. Risk of hyperstimulation is
reduced - compared to hMG.
Less monitoring is required.
The drug is very expensive.

13. In case of increased
andrastenedione.
Prednisolone 5.0mg (night) +
2.5mg( every morning)

14. In case of this treatment does
not succeed, this can be
combined with any other
ovulation induction regime.

15. Dose 1.25mg at bedtime daily
for 7 days.
Dose increments of 1.25 mg per
week until this condition gets
corrected.

17. Intramuscular progesterone 100
mg or micronized 300-600mg
vaginal tablet daily
Oral micronized progesterone is
not recommended.

18. 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.

19. Peritoneal disorders include
peritubal adhesions and
endometriosis and on diagnosed
on laparoscopy.
Therapy – operative laparoscopy.

20. Tubal microsurgery
Laparoscopic tubal adhesiolysis,
fimbrioplasy and tubal surgery
In vitro fertlisation

21. Balloon tuboplasty and cannulation
Tubal cannulation
Gamete intrafallopian transfer
Uterine causes, such as a septum
,asherman’s syndrome and a fibroid
need surgical correction.

22. It is advocated in tubal
blockage.
Procedure varies depending on
the site of block.

23. Anaesthetic complications
Postoperative wound infection,
chest infection and embolism
Failure and
An ectopic pregnancy

24. Reversal of tubectomy
conservative ectopic pregnancy
Salpingitis isthmic nodosa

25. 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.

26. Contraindication - Extensive
pelvic adhesions and inaccessible
ovaries due to adhesions .
Laparoscopic adhesiolysis followed
by IVF may be possible.
Normally , three trials are given
and if IVF fails other MAF processes
offered.

28. hysteroscope - transcervical
route - medial end block.
Only breaks flimsy adhesions –
dislodges plugs of mucus and
inspissated material – not dense
adhesion.

29. Infection
Perforation of the tube
Ectopic pregnancy

30. It is the technique of assisted
reproduction which is useful in
cases of immunological
infertility, provided the tubes
are patent.

31. The ova with the sperms are
placed in the distal end of the
fallopian tubes at ovulation
under guidance of the
laparoscope.

33. 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.

34. Abnormal fallopian tubes :
blocked tubes or absent tubes.
Endometriosis - affecting tubo
ovarian pickup function or
distorting the tubes.
Idiopathic infertility.

35. Male sub fertility.
Immunologic infertility
Failure of ovulation - donor
ovum.

36.  In vitro fertilization (IVF)
 Gamete intra fallopian transfer (GIFT)
 Zygote intra fallopian transfer (ZIFT)

37.  Intra cytoplasmic sperm injection (ICSI)
 Ovum donation
 Ovarian transplant – future

38.  Surrogacy and posthumous reproduction
 Stem cell culture agar – future goal
 Adoption.