1 / 40

MANAGEMENT OF INFERTILE COUPLE: EVIDENCE BASED VIEW

PubMedCochrane library .Evidence based recommendations RCOGWHOJournal of evidence based obstetrics and gynecology.National Guideline Clearinghouse .. Sources of EB for The Topic. Which Investigations?!. Diagnostic tests for infertility are categorized into 3 categories.. 1-Testes which h

bridie
Download Presentation

MANAGEMENT OF INFERTILE COUPLE: EVIDENCE BASED VIEW

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. MANAGEMENT OF INFERTILE COUPLE: EVIDENCE BASED VIEW

    2. PubMed Cochrane library  . Evidence based recommendations RCOG WHO Journal of evidence based obstetrics and gynecology. National Guideline Clearinghouse . Sources of EB for The Topic

    3. Which Investigations?!

    4. Diagnostic tests for infertility are categorized into 3 categories. 1-Testes which have an established correlation with pregnancy. 2- Testes which are not consistently correlated with pregnancy. 3-Testes which seem not to correlate with pregnancy.

    5. The First Category The Basic Routine Infertility Investigation Tests which have an established correlation with pregnancy are: 1- Semen analysis 2-Tubal patency by HSG or laparoscopy 3-Mid luteal progesterone for the diagnosis of ovulation

    6. The Second Category Testes which are not consistently correlated with pregnancy as. Zona-free hamster egg penetration tests. Post coital test. Antisperm antibodies assays.

    7. The Third Category Includes tests which seem not to correlate with pregnancy as: Endometrial dating. Varicocele assessment. Chlamydial testing. May have a role in special situations

    8. Hysteroscopy U/S ?? Hysteroscopy. U/S scan of the endomerium. Are not recommended in the routine. Investigation of the infertile couple.

    9. There is no value in measuring thyroid function or prolactin in women with a regular menstrual cycle, in the absence of galactorrhoea or symptoms of thyroid disease. T3, T4, TSH & PL??

    10. Day 3 (FSH) And Estradiol D3 (FSH) and (E2)estradiol for patients >35 years. because of their reduced window of fertility potential.

    11. Semen Analysis Serial semen samples (at least two) should be assessed in the same laboratory The lower limit of the normal semen testing is > 20 million/mL. >50% progressive motility >30% normal forms WHO,1999

    12. Semen Analysis In a RCT, the determination of motility characteristics as obtained by computer-assisted sperm analysis (CASA ) systems is of limited value . (Krause ,1995 ).

    13. Azoospermia:Testicular biopsy Testicular biopsy should be performed only in the context of a tertiary service where there are facilities for sperm recovery and cryostorage

    15. Treatment

    16. Male Subfertility Oligo/asthenospermia Gonadotrophin is effective for treatment for male hypogonadotrophic hypogonadism. However, drug treatments are ineffective in the treatment of idiopathic male infertility.

    17. Male Subfertility IUI offers couples with male subfertility benefit over timed intercourse, both in natural cycles and in cycles with COH. Mild ovarian hyperstimulation with gonadotrophins is advised in cases with less severe semen defects (motile sperm concentration > 10 million).

    18. Male Subfertility Intrauterine insemination with or without ovarian stimulation is an effective treatment where the man has abnormalities of semen quality, but it has to be remembered that the pregnancy rates even after treatment remain very low (A)

    19. Varicocele Varicocele treatment should be offered when all of the following are present: A varicocele is palpable. The couple has documented infertility. The female has normal fertility or potentially correctable infertility. The male partner has one or more abnormal semen parameters .

    20. Obstructive Azoospermia Vasectomy reversal and surgical correction of epididymal blockage (microsurgical)can be considered in cases of obstructive azoospermia . It needs Expert hands.

    21. ICSI Intracytoplasmic sperm injection (ICSI) is indicated in Severe deficits in semen quality Obstructive azoospermia . Non-obstructive azoospermia . Previous IVF cycle with failed or very poor fertilisation.

    22. Ovulation Disorders Clomiphene C. is an effective treatment for anovulation in appropriately selected women.(A) (Mild to moderate WHO type 1 T type 2 dysfunction) Up to 12 cycles of treatment should be considered (B).

    23. Ovulation Disorders FSH and hMG are both effective for ovulation induction in women with clomiphene resistant polycystic ovarian syndrome.

    24. Ovulation Disorders There is no advantage in routinely using GRh analogues in conjunction with gonadotrophins for ovulation induction in women with clomiphene-resistant PCOS

    25. Hyperprolactinaemia Dopamine agonists are effective treatment for women with anovulation due to hyperprolactinaemia

    26. Laparoscopic ovarian drilling with either diathermy or laser is an effective treatment for anovulation in women with clomiphene-resistant PCOS PCO:Laparoscopic “Drilling"

    27. PCO:Laparoscopic “Drilling" There is insufficient evidence of a difference in pregnancy rates between : Laparoscopic ovarian drilling after 6-12 m follow up & Gonadotrophins 3-6 cycles . Multiple pregnancy are considerably reduced after laparoscopic drilling. .

    28. Endometriosis :Minimal &Mild Surgical ablation of minimal And mild endometriosis improves fertility in subfertile women

    29. Endometriosis : Mild . Also , ovarian stimulation with IUI is more effective for them than either no treatment or IUI alone.

    30. Endometriosis : Moderate to Severe

    31. Endometriosis :Moderate to Severe Surgical treatment may improve fertility but controlled studies and comparisons with assisted reproduction techniques are required (B).

    32. Endometriosis-associated infertility Hormonal therapy for ovulation suppression cannot be recommended as a standard therapy for endometriosis-associated infertility. So drug treatments don’t improve conception rate.

    33. Microsurgical Tubal Surgery Microsurgical tubal surgery may be appropriate for : Mild distal tubal disease ( Laparoscopy). Proximal tubal obstruction, or Reanastomosis to reverse sterilization . If pregnancy has not occurred within 12 m of surgery, IVF should be discussed.

    34. Microsurgical Tubal Surgery Mild distal tubal disease

    35. Tubal Catheterization Where proximal tubal obstruction is suspected, and there are no other tubal abnormalities, a tubal catheterisation procedure may be attempted

    36. Tubal Catheterization

    37. Moderate to Severe Distal tubal Disease . IVF should be considered as the first line treatment for moderate to severe distal tubal disease

    38. Hydrosalpinges & IVF, Laparoscopic salpingectomy should be considered for all women with hydrosalpinges prior to IVF treatment

    39. Unexplained Infertility Expectant management (no treatment) for up to three years of trying should be considered, taking into consideration the woman's age.

    40. Unexplained Infertility The effective treatment for unexplained infertility is ovarian stimulation in conjunction with IUI . If failed IVF is recommended.

More Related