2. Over 200 ppts are available on slideshare
www.slideshare.net /lifecarecentre
3. India performs approx. 1 Lac cycles of IVF
per year
Around 55% of the IVF
cycles performed across
the top eight metros and
rest 45% across tier 2,3
cities etc.Annual number of IVF cycles
High (>10,000)
Moderate (5,000-10,000)
Low (<5,000)
5. In India
Need for parenthood is greatest
Social status of parenthood is
more influential
Increasing awareness of
infertility is a key imperative
6. This PPT gives checklist
PRE I.V.F. EVALUATION
In male in female
7. For Best Results both Husband & wife
Protein rich diet, Vitamins
micronutrients &
antioxidants to be
liberally started
2 – 3 months
prior to actual IVF
8. A detailed examination, semen analysis,
Semen culture & DNA fragmentation test
(if possible)
should be performed.
MALE
PRE I.V.F. EVALUATION
9. ANTI-OXIDANT IN MALE
Vitamin – C 500 mg O – D daily
Vitamin – E 400 mg B – D daily
Are most important supplementation
******
Lyco – Q 300 mg daily is the 3rd option if they can afford
PRE I.V.F. EVALUATION
10. MALE
•If there is Oligo-spermia (<5 million / ml)
karyotyping & “Y” chromosome micro deletion
should be advised
•ICSI should be done for such case & for that
Counselling properly is required
PRE I.V.F. EVALUATION
11. Testicular biopsy should be done
before IVF & sperms should
be frozen simultaneously.
MALE
PRE I.V.F. EVALUATION
12. If Testicular biopsy done on
the day of OPU , keep donor
sample ready
MALE
PRE I.V.F. EVALUATION
13. Micro TESE is a better than
TESE alone
MALE
PRE I.V.F. EVALUATION
14. If sperm count is good but
H/O repeated IUI failure
..needs ICSI.
MALE
PRE I.V.F. EVALUATION
15. If sperm count is good but
Morphology is poor -- should
be counselled for ICSI
MALE
PRE I.V.F. EVALUATION
17. PRE
FEMALE
The following investigation should be performed.
Hormonal Assessment- Serum TSH Prolactin, AMH
Baseline transvaginal scan (TVS) of Pelvis to assess the uterus
and adnexa & measure antral follicle count
to assess Ovarian Reserve
I.V.F. EVALUATION
19. There is a high incidence of intrauterine pathology
in infertile women. The commonly encountered
intrauterine abnormalities include synechiae,
Polyps, sub mucous myomas, endometrial
hyperplasia, adenomyosis , septum etc. most of
these pathological condition can be appropriately
tackled hysteroscopically.
PRE I.V.F. HYSTEROSCOPY
20. there is a high incidence of intrauterine pathology
in failed IVF cases
*********
in Lifecare IVF study of failed IVF
cases - 100% patients had some pathology.
intrauterine synecia , T- shaped uterus &
small polyps were most commonly found
PRE I.V.F. HYSTEROSCOPY
21. Hysteroscopy is especially relevant or rather
mandatory in women with 2 or more
documented implantation failures in IVF and a
normal diagnostic hysteroscopy study serves as a
positive prognostic factor for IVF.
Dr Osama Shawki / Dr. Sharda Jain
PRE I.V.F. HYSTEROSCOPY
22. There is enough evidence to show
that Hysteroscopy surgery in
these patients, particularly
resection of a sub mucous fibroid
or R/O endometrial polyp,
improves pregnancy rates in IVF.
PRE I.V.F. HYSTEROSCOPY
23. HYDRO-SALPINX
REMOVAL OR CLIPPING
Presence of Hydro salpinx reduces markedly the
Pregnancy rate in IVF.
Therefore it should be treated before starting IVF.
Treatment includes Hydro salpinx removal, disconnection
from uterine end, cuff salpingectomy &
rarely Transvaginal aspiration (not done).
PRE I.V.F.
25. Evaluation and Preparation of
Endometriosis
Endometriosis: Its management includes
both medical and surgical interventions.
Pre IVF GnRH analogue for
minimum 60 days to 6 months
tends to improve outcome of IVF.
PRE I.V.F.
26. Evaluation and Preparation
of Endometriosis
Laparoscopic cystectomy is recommended for
endometrioma more than or equal to 4cm.
Cyst aspiration and fulguration of cyst wall is
useful for recurrent large endometrioma.
PRE I.V.F.
27. Evaluation and Preparation
Polycystic Ovarian Syndrome (PCOS)
The following interventions improve the outcome of
IVF in women suffering from PCOS.
Reduction BMI < 27
Metformin 1500mg / day for 2 months
prior to I.V.F. To decrease OHSS
Ovarian drilling in resistant cases
PRE I.V.F.
29. TOBACCO SMOKING
In MEN smoking affects all
parameters of sperm quality.
In WOMEN smoking leads to
a decrease in live birth rate
comparable to a female
who is 10 yrs older to her.
PRE I.V.F.
30. WEIGHT LOSS IS MAGIC
• Weight loss should be encouraged in
overweight and obese women BMI over 27
• There is 33% reduction in probability of
conception in overweight
women in I.V.F. cycles
• Even 10% weight loss increases the
conception rate in ART cycles & otherwise
31. MICRONUTRIENTS & ANTIOXIDANTS
IN FEMALE ARE EQUALLY IMPORTANT
Protein rich diet, Vitamins
micronutrients &
antioxidants to be
liberally
started 2 – 3 months
prior to actual IVF
32. Role for Life Style Changes
Dietician consultation , yoga &
Acupuncture for stress relief are
good in our practice
34. OUR MOTTO at
Be safe than feel sorry
Readers are reminded that “Pregnancy &
take home baby rates decline with
increasing age of partners especially
the women in ART …… So resort to
IVF early than late”