EVIDENCE BASED INFERTILITY MANAGEMENT OSAMA M WARDA MD Professor of Obstetrics & Gynecology Mansoura University- Egypt
EVIDENCE BASED
INFERTILITY MANAGEMENT
OSAMA M WARDA MD
Professor of Obstetrics & Gynecology
Mansoura University- Egypt
Objective
January 22, 16
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Defining Infertility
January 22, 16
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Conception rates for fertile couples
0 10 20 30 40 50 60 70 80 90
100
0 6 12 18 24
Perc
ent o
f Cou
ples
Con
ceiv
ing
Months of intercourse (cycles)
January 22, 16
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CAUSES OF INFERTILITY
January 22, 16
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Approach to management
January 22, 16
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Basic infertility work-up
History taking
&
clinical examination
Semen analysis
Evaluation of ovulation
Tubal patency
evaluation
HSG
DL
January 22, 16
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Male January 22, 16
8
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CASA vs. coventional SA
January 22, 16
9
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Male infertility
January 22, 16
10
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Post-coital test
January 22, 16
11
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Evaluation of ovulation
January 22, 16
12
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Mid-luteal progesterone assay
January 22, 16
13
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HSG
January 22, 16
14
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WHEN TO DO Diagnostic Laparoscopy
January 22, 16
15
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Hormonal assay
January 22, 16
16
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TSH
January 22, 16
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PRL
January 22, 16
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Testing ovarian reserve
January 22, 16
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Hysteroscopy
January 22, 16
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IUI
- Its use is questionable (Reindollar et al, 2010)
- If done, offer up to 3 cycles
January 22, 16
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January 22, 16
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IVF/ ICSI
• Couples in which IVF is justified should be offered up to three stimulated cycles of in vitro fertilization treatment.
• ICSI in Moderate or Severe male factor; --Obstructive azoospermia--Non-obstructive azoospermia.
January 22, 16
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Hypo-gonadotropic hypo-
gonadism
January 22, 16
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PCOS
January 22, 16
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METFORMIN
January 22, 16
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BMI
January 22, 16
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Tubal Surgery
January 22, 16
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recFSH vs HMG
January 22, 16
29
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GnRHa in IVF/ICSI
January 22, 16
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Intrauterine adhesions
January 22, 16
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Endometriosis
January 22, 16
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Endometriosis Laparoscopic Ablation:
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Ovarian Endometriomas
January 22, 16
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Endometriosis III/IV
January 22, 16
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HYDROSALPINX
January 22, 16
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ICSI or IVF?
January 22, 16
37
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Embryo Transfer (ET)
January 22, 16
38
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Embryo Transfer
January 22, 16
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Embryo Transfer
January 22, 16
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LUTEAL PHASE SUPPORT
January 22, 16
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Karyotype
January 22, 16
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Children born from ART
January 22, 16
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January 22, 16
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44 THANK YOU FOR YOUR ATTENSION & PATIENCE