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Integrated approach to infertility work up
This document outlines an integrated approach to infertility workup. It discusses evaluating the male partner, ovarian function, tubal function, and the uterus. For the male partner, a history, examination, and semen analysis are recommended. Ovarian function is assessed through menstrual history, ultrasound, and hormone levels. Tubal function can be evaluated with HSG, laparoscopy, or hysteroscopy. The uterus is examined with imaging like HSG, ultrasound, or hysteroscopy and potentially endometrial biopsy. A complete workup considers factors from both the male and female partners.
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Integrated approach to infertility work up
- 1. Integrated Approach to InfertilityWork- Up EMAD DARWISH MD PROFESSOR OF OBSTETRICS AND GYNECOLOGY INTEGRATED FERTILITY CENTER ALEXANDRIA
- 2. Etiology of infertility: Malefactor 30% Female factor 40% Combined factors 10-20 % Unexplained 10-20% Infertility Male factor Female factor Combined factors
- 3. Meet the couple History:1- Married for how long? 2- For how long together? L.M.P. 1- Date 2- Regularity Past History: Pelvic Surgery eg myomectomy, ovarian cystectomy ( H.P. ) to exclude endometriosis. Medical disorders thyroid, Diabetes Male partner mumps, orchitis, surgery Husband Job eg drivers Previous investigations: HSG, Endoscopy, IUI, ICSI Details about sexual intercourse.
- 4. Four Points tobe Covered 1- Male Partner 2- Ovarian function 3- Tubal function 4- Utereus
- 5. Male Partener History Examination: General and Local Semen Analysis: Conventional or CASA DNA fragmentation If azospermia Serum FSH : Obstructive or Testicular or Hypo-Hypo TESE Where to do ?
- 6. Volume Normal: 2-6ml > 6 ml may be due to chronic prostatitis or seminal vesiculitis. <2 ml may be due to obstruction or retrograde ejaculation (hypospermia) Sperm count: > 20 million/ml (new WHO strict criteria: < 15 million/ml) Reaction (pH): 7.2-8 (alkaline) Liquefaction: Completed within 30 minutes. Motility: > 50 % motile morphology: > 30 % is considered normal according to the WHO criteria. Agglutination: not exceed 10 %. Cellular elements: < 5 x106/ml rounded cells of which < 1x106/ml are WBCs. Semen Analysis
- 7. Important items inSemen report Count more than 15 million/ml Motility A ( fast forward) 25% B (slow forward) 25% C ( shaking) D ( immotile) Normal Forms more than 4%
- 9. Ovarian Function RegularCycles TVS for follicular scanning Mid luteal phase serum Progesterone PCOS: Trunkal obesity, Hirsutism, Oligomenorrhoea, TVS , family H. of Diabetes Lab: LH:FSH ratio, AMH, Prolactin, Testosteron Insulin resistance FBS and Fasting serum insulin
- 10. Continue Ovarian Reserve 1-Age 2- AFC day 3 of cycle 3- FSH day 3 of cycle 4- History of previous COH
- 11. Continue Choclate Cyst Diagnosis:TVS Laparoscopy limited rule now for diagnosis, treatment mainly for pain, before ICSI ??
- 13. Tubal Function HSG Laparoscopy Hysteroscopy
- 17. Uterine Factor HSG 2D and 3D TVS, SIS Hysteroscopy Endometrial biopsy for diagnosis of chronic endometritis
- 18. HSG: Todiagnose uterine congenital anomalies, intrauterine adhesions, submucous fibromyomata..
- 21. Hysteroscopy: Fordirect visualization of the interior of the uterus, diagnosis and surgical correction of intrauterine adhesions, uterine anomalies & submucous fibromyomata.
- 22. Lab Investigations SerumProgesterone FSH AMH FBS and Fasting serum insulin E2 Prolactine TSH