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Surgical:
• Vasoepididymostomy or vasovasostomy
• Hydrocele is corrected by surgery
• Orchidopexy in undecended testes should be done
between 2-3 years of age
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Impotency:
• Psychosexual treatment
• For erectile dysfunction, sildenafil 25-100 mg or
tadalafil 10-20 mg is currently advised. A single
dose orally one hour before sexual activities
should be given
Treatment for female infertility
Ovulatory
Tubal
Associate disorders like
endometriosis, infection
Cervical
Immunological
Unexplained
infertility
Uterovaginal
canal
ART
Ovulatory dysfunction
Anovulation LPD LUF
:
• It may be present in otherwise normal menstrual
cycle or may be associated with oligomenorrhoea or
amenorehoea
:
• General:
▫ Psychotherapy
▫ Reduction of weight in obesity
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• Drugs:
Stimulation of ovulation:
• Clomiphene citrate
• Letrozole
• hMG (humegon, pergonal)
• FSH
▫ Purified urinary FSH
▫ Highly purified urinary FSH
▫ Recombinant FSH
• hCG (Profasi, Pregnyl)
▫ Recombinant hCG
• GnRH
• GnRH analogue
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Correction of biochemical abnormality:
• Hyper insulinaemia- Metformin
• Androgen excess- Dexamethasone
• Prolactin raised- Bromocriptine
Substitution therapy:
• Hypothyroidism- Thyroxin
• Diabetes mellitus- Antidiabetic drug
• BBT recording
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• Natural progesterone at vaginal suppositories 100mg
thrice daily starting from the day of ovulation is effective
• Should continued until mens begins
• In unresponsive cases, clomiphene citrate may be tried.
It increases FSH
• Cervical factors:
• The cervical mucus quality can be improved by
conjugated oestrogen 1.25 mg orally daily starting
on day 8 for 5 days
• In proved cases of Cl. Trachomatis or M. hominis,
doxycycline 100 mg twice daily for 14 days is to be
given to both the partners.
• Cervical factors when cannot be treated, is overcome
by ART procedures like IUI, IVF, GIFT.
Immunological factors
• In the presence of antisperm antibodies in the
cervical mucus, dexamethasone 0.5 mg at bed
time in the follicular phase may be given
• In antisperm antibody positive pateint COH and
IUI or IVF or ICSI is recommended
Uterovaginal surgery
• Myomectomy
• Metroplasty
• Adhesiolysis with insertion of IUCD in uterine
synchiae
• Enlargement of the vaginal introitus or removal of
vaginal septum
• Apart from cauterisation, amputation of the cervix
may have to be done for congenital elongation of the
cervix
• Gilliam’s type of operation to correct third degree
retroversion in unexplained infertility
Unexplained infertility
• It is for the couples who have undergone
complete basic infertility work up and in whom
no abnormality has been detected and still
remain infertile
• The recommended treatment are induction of
ovulation, IUI, superovulation combined with
IUI and ART
• The fault detected in both the partners should be
treated simultaneously and not one after the
other
Assisted Reproductive Technology(ART)
• ART comprise all the procedures that involve manipulation of
gamates and embryos outside the body for the treatment of
infertility
• Different methods of ART
▫ IVF-ET- In vitro fertilization and embryo transfer
▫ GIFT- Gamate intra fallopian transfer
▫ ZIFT- Zygote intra fallopian transfer
▫ POST- Peritoneal oocyte and sperm transfer
▫ SUZI- Subzonal insemination
▫ ICSI- Intracytoplasmic sperm ijection
• Methods of sperm recovery
▫ TESE- Testicular sperm extraction
▫ MESA- Microsurgical epididymal sperm aspiration
▫ PESA- Percutaneous epididymal sperm aspiration
Prognosis
• The pregnancy rate within 2 years after the start
of investigation, ranges between 30-40%
• The rate will increase up to 50-60% if AID cases
are included
• Adoption is the alternative for many couples
References
• Dutta D.C. Textbook of gynaecology. 5th edition.
Kolkata: New central book agency;2008