previous pregnancies and their outcomes
frequency of intercourse, use of lubricants (eg, K-Y gel) that could be
spermicidal, use of vaginal douches after intercourse, and the presence of
any sexual dysfunction such as anorgasmia or dyspareunia.
menstrual history, frequency, and patterns since menarche. A history of
weight changes, hirsutism, frontal balding, and acne should also be
Ask male patients about previous semen analysis results, history of
impotence, premature ejaculation, change in libido, history of testicular
trauma, previous relationships, history of any previous pregnancy, and the
existence of offspring from previous partners.
history of sexually transmitted diseases (STDs); surgical contraception
lifestyle; consumption of alcohol, tobacco, and recreational occupation;
and physical activities.
Ask the couple whether they are currently under medical treatment, the
reason, and whether they have a history of allergies.
A complete review of systems may be helpful to identify any
endocrinological or immunological problem that may be associated with
height and weight to calculate the body mass
Perform an eye examination
The presence of epicanthus, lower implantation
of the ears and hairline, and webbed neck
gland enlargement or thyroid nodules
Perform a breast examination galactorrhea.
A thorough gynecologic examination should include an
evaluation of hair distribution, clitoris size, Bartholin
glands, labia majora and minora, and any condylomata
acuminatum or other lesions that could indicate the
existence of venereal disease.
Bimanual examination should be performed to establish
the direction of the cervix and the size and position of the
uterus to exclude the presence of uterine fibroids, adnexal
masses, tenderness, or pelvic nodules indicative of infection
The examination of the extremities is important to rule out
malformation, such as shortness of the fourth finger or
cubitus valgus, which can be associated with chromosomal
abnormalities and other congenital defects. Examine the
skin to establish the presence of acne, hypertrichosis, and
Postcoital test (PCT), Sims-Huhner test
Saline infusion sonography
Progesterone greater than 4 ng/mL
Sonographic confirmation of follicle rupture with
serial ultrasonography can also be performed.
Basal body temperature charts prefer to use
urinary ovulation predictor kits as they are more
accurate and easier to administer
Late menstrual endometrium
The uterine lining changes throughout the normal menstrual cycle
Volume - 2-5 mL
pH level - 7.2-7.8
Sperm concentration - 20 million or greater
Motility - 50%, forward progression
Morphology - Normal sperm (>4%)
White blood cells - Fewer than 1 million cells/µL
Sperm function test
the acrosome reaction test
computer assessment of the sperm head,
computer motility assessment
hamster penetration test
human sperm-zona penetration assay
Collection condoms are sterile and made
from silicone or polyurethane, as latex is
somewhat harmful to sperm. Semen can also
be collected by masturbation into a sterile
container, such as a specimen cup.
In vitro fertilisation (IVF)
1. Retrieval of pre-ovulatory oocytes from the woman.
2. In vitro fertilization by sperm.
3. Culture to 8 or 16 cell stage.
4. Transfer to the uterus.
1. Ovarian follicles stimulated
2. Mature oocytes aspirated at laproscopy
3. Oocytes placed in a petri dish to culture with
4. Cleavage monitored in fertilized egg till 6-8 cell
5. Embryo transferred into vagina and cervical canal
•In vivo fertilization occur within 12 hours
•In vitro fertilization is not possible after
•Most human sperms do not survive for
more than 48 hours in the female genital
•Increased risk of multiple gestations,
•High incidence of chromosomal and cellular
Long periods of preservation of blastocysts and
Prior to any GIFT, IVF, or ICSI procedure, the woman
receives hormones to stimulate development of the
The fluid containing the ova is placed in a laboratory
dish and observed under a microscope.
The ovum is located and its stage of maturity noted.
It is then carefully cultured in a special nutrient.
Approximately three hours before the procedure, a semen sample from the
husband is obtained.
The sperm is washed and prepared for loading into the same catheter into which
several of the wife's ova will be placed.
The ova are obtained by transvaginal needle aspiration (no surgical incision) via
an ultrasound guide.
Sperm and ova are sequentially loaded into the catheter, which is then introduced
into the patient's fallopian tube through a tiny incision in her abdomen.
Just prior to beginning the hatching process on an 8-cell embryo
Hatching a high quality 8-cell embryo
A small opening is being made in the embryo's shell (zona pellucida)
The needle has been further advanced through the embryo's shell
A gap in the shell is developing
A gap in the zona has been created
The oolemma (egg membrane) is bulging and about to "pop"
A blastocyst starting to hatch from its shell - lower right of photo
After hatching, the embryo can implant in the uterine lining
Photo taken a few minutes prior to EmbryoTransfer
Intracytoplasmic sperm injection (ICSI)
The injection of the sperm into the oocyte
Process of supplementation of sperm fertilization potential by
the direct transport of the sperm into the oocyte is termed
Non satisfactory sperm motility
Loss of acrosome
Presence of antisperm antibodies in the woman.
The sperm will be injected into the oocyte cytoplasm using
apparatus called micromanipulator
Under microscope control the oocyte will be moderately
vacuum held and using an injection pipette of the diameter
of 5 micrometers, the direct transport of the sperm into the
oocyte is performed.
1. Oocyte holder
2. Spermatozoon expulsed
from the capillary
3. Mature oocyte with the
4. Injection capilary
About to inject the egg with a sperm
Holding pipette on left
ICSI needle on right
Sperm head visible in needle at far right, just below X
Polar body of egg at 7 o'clock
Needle is advanced to the left
Shell of embryo has already been penetrated by needle
Membrane of egg (oolemma) is stretching and is about to break
Sperm head is visible at tip of needle
ICSI needle has penetrated the egg membrane
A single sperm is being injected into the cytoplasm of the egg