infertility

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infertility
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Infertility

• No pregnancy after 1 yr of normal sexual activity
  without conception
• 25 of couples experience infertility at some
  point in their lives
• Male partner contributes to 40from cases

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Tests recommended

• Female tests

• Male

• CBC
• Urinalysis
• Thyroid function tests
• Regular menses
• If so the likelihood of ovulatory cycle is high
• If not measure hormone concentration
• LH
• FSH
• Prolactin
• Physical and genital examination

• CBC
• Urinalysis
• Semen analysis
• Obstain from any sexual activity for 3 days
• Specimen should be tested within 2hr
• Normal Volume1.5-5ml
• Concentration 20 million\ml
• 35are normal forms
• 60 motile
• Physical and genital examination

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Management

• Learn the pts what is the appropriate day for
  coitus
• Home ovulation tests
• Basal body tempreture
• Consistency of the vaginal secretion
• Treat underlying cause if present
• Hypo or hyperthyroidism
• Antibiotics if infection presents
• Antifungal if present
• Endometriosis
• PCOS
• Peritubual adhesions
• Uterine abnormality
• Ovarian tumors
• Varicocele in males
• Reduce exercise if the female exercises
  aggressively
• Achieve ideal body mass index
• Induce ovulation

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Clomiphene

• Clomiphene review the previous slides and look
  at PCOS

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D2 agonist

• Decrease the prolactin levels
• Bromocriptine

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Preparations available
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How to administer gonadotropins
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Male infertility

• 1000-2000 IU hCG 8-12 wks
• 75-2500 IU hCG 3 times a week
• It takes 4-6 months to sperm to appear

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Side effects

• Ovarian hyper stimulation syndrome 0.5-4
• Multiple pregnancy 15-20
• Increase risk of ovarian cancer
• Headache ,depression and edema
• Gynecomasctia in males

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Uses(pulsatile dose)
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Uses(continuous use)
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GnRH antagonists

• Ganirelix
• Citrorelix
• Rarely used why?
• Mechanism of action
• Inhibit FSH and LH secretion in dose dependent
  mannner
• Use
• Control ovarian hyperstimulation syndrome