The document provides an overview of unexplained infertility. It begins by defining unexplained infertility and noting that it accounts for 15-30% of infertility cases. The prognosis is best when the female partner is under 35 years old and the duration of infertility is less than two years. Treatment options discussed include expectant management, ovarian stimulation with medications like clomiphene citrate or letrozole with or without intrauterine insemination (IUI), and in vitro fertilization (IVF). Ovarian stimulation and IUI are generally recommended as first-line treatments before moving to IVF, but success rates decline with female age. The cause of unexplained infertility is likely multiple subtle factors that combine to reduce fertility
presentation on infertility, causes and its management. it gives an idea of the scope of the problem especially in sub Saharan Africa . the challenges in its management.
This presentation outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women’s preferences, cultural and religious beliefs as well as any co-existing medical issues.
This document discusses genetic testing, including its definition, various types, reasons for testing, results, risks and limitations. It provides information on several genetic testing methods like newborn screening, diagnostic testing, carrier testing, prenatal testing, and preimplantation testing. The document outlines the role of nurses in ensuring informed consent, counseling, confidentiality, and addressing psychological impacts of genetic testing. In summary, the document provides a comprehensive overview of genetic testing, its various applications and the ethical considerations involved.
Family planning class for MBBS students based on Park textbook including details on MTP, abortion, Family planning infrastructure and delivery systems in India and National Family Welfare Programme.
pcos other than ART.pptx for mbbs and mdReji Mohan
This document provides an overview of ovulation induction in PCOS other than for ART (assisted reproductive technology). It begins with a brief history of PCOS and discusses its epidemiology. It then covers various treatment options for ovulation induction in PCOS, including aromatase inhibitors like letrozole, clomiphene citrate, insulin-lowering medications like metformin, gonadotropins, and laparoscopic ovarian drilling. Key points are emphasized for each treatment approach and their effectiveness, safety, and side effects are compared. Lifestyle modifications focusing on diet and exercise are also highlighted as an important aspect of PCOS management.
This document provides an overview of basic infertility investigations. It defines primary and secondary infertility and discusses the most common causes of infertility including female factors like ovulation disorders, tubal abnormalities, and uterine issues as well as male factors. It outlines the initial tests that should be performed on both partners to investigate infertility including testing for ovulation, evaluating male factor issues, and assessing tubal patency. Physical exams, histories, and occasionally laparoscopy/hysteroscopy are important initial steps in the evaluation process. The goal of initial investigations is to identify treatable causes of infertility for the couple.
presentation on infertility, causes and its management. it gives an idea of the scope of the problem especially in sub Saharan Africa . the challenges in its management.
This presentation outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women’s preferences, cultural and religious beliefs as well as any co-existing medical issues.
This document discusses genetic testing, including its definition, various types, reasons for testing, results, risks and limitations. It provides information on several genetic testing methods like newborn screening, diagnostic testing, carrier testing, prenatal testing, and preimplantation testing. The document outlines the role of nurses in ensuring informed consent, counseling, confidentiality, and addressing psychological impacts of genetic testing. In summary, the document provides a comprehensive overview of genetic testing, its various applications and the ethical considerations involved.
Family planning class for MBBS students based on Park textbook including details on MTP, abortion, Family planning infrastructure and delivery systems in India and National Family Welfare Programme.
pcos other than ART.pptx for mbbs and mdReji Mohan
This document provides an overview of ovulation induction in PCOS other than for ART (assisted reproductive technology). It begins with a brief history of PCOS and discusses its epidemiology. It then covers various treatment options for ovulation induction in PCOS, including aromatase inhibitors like letrozole, clomiphene citrate, insulin-lowering medications like metformin, gonadotropins, and laparoscopic ovarian drilling. Key points are emphasized for each treatment approach and their effectiveness, safety, and side effects are compared. Lifestyle modifications focusing on diet and exercise are also highlighted as an important aspect of PCOS management.
This document provides an overview of basic infertility investigations. It defines primary and secondary infertility and discusses the most common causes of infertility including female factors like ovulation disorders, tubal abnormalities, and uterine issues as well as male factors. It outlines the initial tests that should be performed on both partners to investigate infertility including testing for ovulation, evaluating male factor issues, and assessing tubal patency. Physical exams, histories, and occasionally laparoscopy/hysteroscopy are important initial steps in the evaluation process. The goal of initial investigations is to identify treatable causes of infertility for the couple.
- Family planning allows individuals to space and limit pregnancies through contraceptive use and infertility treatment. It aims to improve health outcomes for mothers and children.
- Common contraceptive methods include hormonal methods like pills and implants, barrier methods like condoms, and long-acting reversible methods like IUDs. Lactational amenorrhea can also prevent pregnancy during exclusive breastfeeding.
- Widespread access to family planning is important for maternal and child health, but many women still lack contraceptive access or choice due to various barriers. Proper education and counseling are crucial to help individuals select the most effective methods that suit their needs and circumstances.
This document discusses barriers to contraceptive use globally and in Sudan specifically. It begins with an introduction on family planning and contraceptive use trends globally. It then discusses the large unmet need for contraception worldwide, particularly in Africa and the benefits of family planning. Barriers to use discussed globally and in Sudan include socioeconomic factors, lack of education, rural residence, religious influences, lack of access to services, side effects, and cultural practices. The document presents data on very low contraceptive use and high unmet need in Sudan, citing barriers such as shortage of facilities, staff, and commodities, as well as lack of awareness and funding.
This document discusses barriers to contraceptive use globally and in Sudan specifically. It begins with an introduction on family planning and contraceptive use trends globally. It then discusses the large unmet need for contraception worldwide, particularly in Africa and benefits of family planning. Barriers to use discussed globally include socioeconomic factors, limited access, side effects, and cultural/religious opposition. Barriers in Sudan specifically include shortage of facilities, staff turnover, socioeconomic factors, low awareness, and lack of dedicated funding. Figures show contraceptive use in Sudan is only 7.7% with 28.9% unmet need, among the lowest rates in Africa.
This document discusses barriers to contraceptive use globally and in Sudan specifically. It begins with an introduction on family planning and contraceptive use trends globally. It then discusses the large unmet need for contraception worldwide, particularly in Africa and benefits of family planning. Barriers to use discussed globally include socioeconomic factors, limited access, side effects, and cultural/religious opposition. Barriers in Sudan specifically include shortage of facilities, staff turnover, socioeconomic factors, low awareness, and lack of dedicated funding. Figures show contraceptive use in Sudan is only 7.7% with unmet need over 28%, among the lowest rates in the region.
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION Dr. Sharda jain Lifecare...Lifecare Centre
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION DR. SHARDA JAIN , DR. JYOTI AGARWAL
DR. JYOTI BHASKAR
DEFINITION
Unexplained infertility means that couple does not conceive after 1year of unprotected vaginal sexual intercourse, with basic infertility evaluation showing no obvious abnormality.
INCIDENCE
15%to 20% of infertile couples
UNEXPLAINED IS PRIMARILY A
DIAGNOSIS OF EXCLUSION
Trouble Getting Pregnant? Get Second Opinion, Hear from an Experienced DoctorDimitri Popov
This document summarizes a webinar on fertility presented by Dr. Gary Levy, Chief Medical Officer of Fertility Cloud. It discusses that approximately 15% of US couples are affected by infertility, with common causes being ovulation disorders, fallopian tube issues, low ovarian reserve, and sperm-related factors. It outlines treatment options including lifestyle changes, oral or injectable medications, surgery, and in-vitro fertilization (IVF). IVF success rates decline with female age but it has higher success rates than other options for certain diagnoses. Less invasive options include medications which have cumulative pregnancy rates around 40-60% depending on the diagnosis. Fertility Cloud offers online consultations and personalized treatment plans using medications
This document discusses different approaches to managing infertility or delayed conception. It advocates for a rapid, active management approach that completes investigations and establishes a diagnosis within 1 month. This accelerated approach aims to help couples facing age-related fertility declines. It outlines investigations that can be completed within a woman's first cycle, including blood tests, imaging and ovulation monitoring. If needed, treatments like timed intercourse, IUI or IVF would be conducted over successive cycles, with the goal of achieving pregnancy within 1 year before more invasive or complex treatments. The document argues this rapid approach is preferable to standard or expectant management methods that can prolong the process and reduce chances of success.
Selection of an embryo from a large number of embryos and then placing it to the uterus is known as selective embryo transfer. This fertility preservation process is usually done after the process of IVF cycle and cancels the risks of spontaneous transfer of multiple embryos. Have a look at the detailed description of elective single embryo transfer in the following ppt.
Explain the wider meaning of family planning.
Give contraceptive counselling.
List the efficiency, contraindications and side effects of the various contraceptive methods.
List the important health benefits of contraception.
Advise a postpartum patient on the most appropriate method of contraception.
Unexplained subfertility is defined as the failure to conceive after 12 months of unprotected intercourse without an identified cause. It accounts for approximately 15% of infertility cases. The likelihood of conception decreases with the female partner's age, with women over 36 having less than a 50% chance of pregnancy within 12 months. Initial evaluations involve counseling, history, examination, and screening tests. If no cause is found, treatments may include expectant management, medical management such as ovulation induction, or assisted reproductive techniques.
Surviving and Thriving with Gynecologic Cancer - 9.7.19Summit Health
Join Gynecologic Oncology and wellness experts for a special "brunch and learn," event for ovarian, cervical and other gynecologic cancer survivors and champions. Speaker-led sessions will cover innovation in treatment and complementary medicine to help manage menopause and other symptoms. Moderated by Darlene Gibbon, MD. FACOG, Medical Director of Gynecologic Oncology.
Other event materials can be found under the Patient Tools tab on this page: https://www.summitmedicalgroup.com/service/gynecological-oncology/
1) Dysmenorrhea is abdominal pain associated with menstruation. It can be primary, caused by increased prostaglandins, or secondary due to underlying conditions like endometriosis.
2) Diagnosis involves a clinical history and exam. Ultrasound or laparoscopy may help diagnose secondary causes. Treatment starts with NSAIDs, but hormonal options like oral contraceptives or the Mirena IUD can also help with pain relief.
3) Myths that menstrual pain is normal and untreatable can delay care. Red flags like worsening pain over time or radiation to the legs suggest further evaluation may be needed to rule out conditions causing secondary dysmenorrhea.
The document discusses subfertility and infertility in couples. It defines key terms like subfertility, infertility, and fecundity. It describes factors that can affect natural conception for both males and females like age, smoking, alcohol, weight, medical conditions, and environmental exposures. The diagnosis and management of subfertility is discussed for both sexes, including history, examinations, lab tests, and treatment options like ovulation induction, surgery, assisted reproduction, and lifestyle changes. The goal is to evaluate and address any underlying medical conditions contributing to the couple's difficulty conceiving.
1) Infertility is defined as the failure to conceive after 12 months of unprotected sex. It affects both men and women and can be caused by various medical conditions, lifestyle factors, and environmental exposures.
2) Male infertility can be caused by problems with sperm production, hormone imbalances, genetic disorders, varicoceles, trauma, illnesses, medications, radiation, chemicals and lifestyle factors like smoking and excessive drinking.
3) Female infertility can be caused by ovulation disorders, uterine abnormalities, fallopian tube damage, endometriosis, early menopause, pelvic adhesions, cancers and their treatments, age, smoking, weight issues, stress and lifestyle factors.
This study aimed to prospectively evaluate the relationship between a history of laparoscopically confirmed endometriosis and subsequent risk of infertility among premenopausal women. The study followed over 58,000 women for 14 years and found that women with a history of endometriosis had a 2-fold increased risk of infertility. However, this increased risk was only observed among women aged 35 years or younger and women with a BMI under 25 kg/m2. The study concluded that a history of endometriosis is associated with an increased risk of infertility, but this risk may be limited to younger, leaner women.
This document discusses topics related to sexual health and prevention, including screening recommendations for STIs, birth control options and effectiveness, emergency contraception, signs of pregnancy, and issues specific to men's and women's sexual health. It emphasizes the importance of understanding sexuality and notes challenges adolescents face in developing healthy attitudes towards sex due to developmental immaturity and lack of comprehensive sex education. The doctor's office, CDC website, and Planned Parenthood are recommended resources for sexual health information.
This document summarizes a study examining the relationship between endometrial BCL6 expression and IVF success or failure. The study found that women with low endometrial BCL6 expression (<1.4) had a 66% success rate for pregnancy through IVF, while women with high BCL6 expression (≥1.4) only had a 10% success rate. This suggests BCL6 expression may be a biomarker for predicting IVF outcomes and identifying women who may benefit more from treating endometriosis directly rather than undergoing IVF. Future studies are needed to validate these findings in other populations and examine how BCL6 expression changes after treating endometriosis.
menstrual manipulation for adolescents with disabilityMini Sood
A presentation of aspects of menstrual care in adolescents including those with disability. Slides for medical students who may encounter young patients who are unable to mange their menses efficiently
EVALUATION OF INFERTILITY AND MEDICAL ASPECTS.pdfBhavyaRaval3
The document provides an overview of infertility, its causes, diagnosis, and treatment options. It discusses infertility in males and females separately. For males, common causes include low sperm count, motility issues, or abnormalities. For females, common causes are ovulation disorders, issues with the fallopian tubes or uterus, poor egg quality, or cervical/uterine problems. Diagnosis involves medical histories, physical exams, and tests like semen analysis, blood tests, and ultrasounds. Treatment may include lifestyle changes, ovulation drugs, surgery, artificial insemination, in vitro fertilization, or donor gametes if needed.
This document provides recommendations from the Canadian Task Force on Preventive Health Care for screening for cervical cancer. It recommends:
- Screening asymptomatic women aged 25-69 with a Pap test every 3 years, as there is evidence this reduces cervical cancer rates.
- Not routinely screening women under 20, as incidence is very low in this age group and there are potential harms.
- A weak recommendation against routinely screening women aged 20-24, and a weak recommendation for screening women aged 25-29 every 3 years, as benefits are uncertain for these groups while risks of false positives are higher.
- It considered evidence on screening effectiveness, harms, and the current epidemiology and understanding of cervical cancer and HPV to
PELVIC FLOOR ANATOMY AND REPAIR.pptx FOR TEACHINGReji Mohan
1) The document discusses the anatomy related to urinary continence and pelvic support. It describes the various muscles, ligaments and fascia that provide support to the pelvic organs.
2) Key anatomical structures that contribute to continence include the urethral sphincters, intact vaginal support, and levator ani muscles. Damage or weakness to these structures can lead to conditions like stress urinary incontinence.
3) Surgical techniques to treat incontinence like retropubic colposuspension and pubovaginal slings are aimed at restoring the hammock-like support of the pelvic organs to improve urethral closure and continence.
sex and sexuality in pregnancy dr reji 2022 .pptxReji Mohan
This document discusses sex and sexuality during pregnancy. It notes that a woman's sexuality is influenced by physical, emotional, and psychological factors. While pregnancy and sexuality are natural, many couples and doctors have knowledge gaps around sexual activity during pregnancy. The document discusses how hormones, physical changes, and psychological factors can impact a woman's sexuality during each trimester. It provides guidance on engaging in safe sexual activity during a normal pregnancy and notes situations where sex should be avoided. The goal is to educate couples and healthcare providers so they are comfortable discussing this topic.
More Related Content
Similar to unexplained infertility BY DR REJI MOHAN.pptx
- Family planning allows individuals to space and limit pregnancies through contraceptive use and infertility treatment. It aims to improve health outcomes for mothers and children.
- Common contraceptive methods include hormonal methods like pills and implants, barrier methods like condoms, and long-acting reversible methods like IUDs. Lactational amenorrhea can also prevent pregnancy during exclusive breastfeeding.
- Widespread access to family planning is important for maternal and child health, but many women still lack contraceptive access or choice due to various barriers. Proper education and counseling are crucial to help individuals select the most effective methods that suit their needs and circumstances.
This document discusses barriers to contraceptive use globally and in Sudan specifically. It begins with an introduction on family planning and contraceptive use trends globally. It then discusses the large unmet need for contraception worldwide, particularly in Africa and the benefits of family planning. Barriers to use discussed globally and in Sudan include socioeconomic factors, lack of education, rural residence, religious influences, lack of access to services, side effects, and cultural practices. The document presents data on very low contraceptive use and high unmet need in Sudan, citing barriers such as shortage of facilities, staff, and commodities, as well as lack of awareness and funding.
This document discusses barriers to contraceptive use globally and in Sudan specifically. It begins with an introduction on family planning and contraceptive use trends globally. It then discusses the large unmet need for contraception worldwide, particularly in Africa and benefits of family planning. Barriers to use discussed globally include socioeconomic factors, limited access, side effects, and cultural/religious opposition. Barriers in Sudan specifically include shortage of facilities, staff turnover, socioeconomic factors, low awareness, and lack of dedicated funding. Figures show contraceptive use in Sudan is only 7.7% with 28.9% unmet need, among the lowest rates in Africa.
This document discusses barriers to contraceptive use globally and in Sudan specifically. It begins with an introduction on family planning and contraceptive use trends globally. It then discusses the large unmet need for contraception worldwide, particularly in Africa and benefits of family planning. Barriers to use discussed globally include socioeconomic factors, limited access, side effects, and cultural/religious opposition. Barriers in Sudan specifically include shortage of facilities, staff turnover, socioeconomic factors, low awareness, and lack of dedicated funding. Figures show contraceptive use in Sudan is only 7.7% with unmet need over 28%, among the lowest rates in the region.
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION Dr. Sharda jain Lifecare...Lifecare Centre
UNEXPLAINED INFERTILITY &INTRAUTERINE INSEMINATION DR. SHARDA JAIN , DR. JYOTI AGARWAL
DR. JYOTI BHASKAR
DEFINITION
Unexplained infertility means that couple does not conceive after 1year of unprotected vaginal sexual intercourse, with basic infertility evaluation showing no obvious abnormality.
INCIDENCE
15%to 20% of infertile couples
UNEXPLAINED IS PRIMARILY A
DIAGNOSIS OF EXCLUSION
Trouble Getting Pregnant? Get Second Opinion, Hear from an Experienced DoctorDimitri Popov
This document summarizes a webinar on fertility presented by Dr. Gary Levy, Chief Medical Officer of Fertility Cloud. It discusses that approximately 15% of US couples are affected by infertility, with common causes being ovulation disorders, fallopian tube issues, low ovarian reserve, and sperm-related factors. It outlines treatment options including lifestyle changes, oral or injectable medications, surgery, and in-vitro fertilization (IVF). IVF success rates decline with female age but it has higher success rates than other options for certain diagnoses. Less invasive options include medications which have cumulative pregnancy rates around 40-60% depending on the diagnosis. Fertility Cloud offers online consultations and personalized treatment plans using medications
This document discusses different approaches to managing infertility or delayed conception. It advocates for a rapid, active management approach that completes investigations and establishes a diagnosis within 1 month. This accelerated approach aims to help couples facing age-related fertility declines. It outlines investigations that can be completed within a woman's first cycle, including blood tests, imaging and ovulation monitoring. If needed, treatments like timed intercourse, IUI or IVF would be conducted over successive cycles, with the goal of achieving pregnancy within 1 year before more invasive or complex treatments. The document argues this rapid approach is preferable to standard or expectant management methods that can prolong the process and reduce chances of success.
Selection of an embryo from a large number of embryos and then placing it to the uterus is known as selective embryo transfer. This fertility preservation process is usually done after the process of IVF cycle and cancels the risks of spontaneous transfer of multiple embryos. Have a look at the detailed description of elective single embryo transfer in the following ppt.
Explain the wider meaning of family planning.
Give contraceptive counselling.
List the efficiency, contraindications and side effects of the various contraceptive methods.
List the important health benefits of contraception.
Advise a postpartum patient on the most appropriate method of contraception.
Unexplained subfertility is defined as the failure to conceive after 12 months of unprotected intercourse without an identified cause. It accounts for approximately 15% of infertility cases. The likelihood of conception decreases with the female partner's age, with women over 36 having less than a 50% chance of pregnancy within 12 months. Initial evaluations involve counseling, history, examination, and screening tests. If no cause is found, treatments may include expectant management, medical management such as ovulation induction, or assisted reproductive techniques.
Surviving and Thriving with Gynecologic Cancer - 9.7.19Summit Health
Join Gynecologic Oncology and wellness experts for a special "brunch and learn," event for ovarian, cervical and other gynecologic cancer survivors and champions. Speaker-led sessions will cover innovation in treatment and complementary medicine to help manage menopause and other symptoms. Moderated by Darlene Gibbon, MD. FACOG, Medical Director of Gynecologic Oncology.
Other event materials can be found under the Patient Tools tab on this page: https://www.summitmedicalgroup.com/service/gynecological-oncology/
1) Dysmenorrhea is abdominal pain associated with menstruation. It can be primary, caused by increased prostaglandins, or secondary due to underlying conditions like endometriosis.
2) Diagnosis involves a clinical history and exam. Ultrasound or laparoscopy may help diagnose secondary causes. Treatment starts with NSAIDs, but hormonal options like oral contraceptives or the Mirena IUD can also help with pain relief.
3) Myths that menstrual pain is normal and untreatable can delay care. Red flags like worsening pain over time or radiation to the legs suggest further evaluation may be needed to rule out conditions causing secondary dysmenorrhea.
The document discusses subfertility and infertility in couples. It defines key terms like subfertility, infertility, and fecundity. It describes factors that can affect natural conception for both males and females like age, smoking, alcohol, weight, medical conditions, and environmental exposures. The diagnosis and management of subfertility is discussed for both sexes, including history, examinations, lab tests, and treatment options like ovulation induction, surgery, assisted reproduction, and lifestyle changes. The goal is to evaluate and address any underlying medical conditions contributing to the couple's difficulty conceiving.
1) Infertility is defined as the failure to conceive after 12 months of unprotected sex. It affects both men and women and can be caused by various medical conditions, lifestyle factors, and environmental exposures.
2) Male infertility can be caused by problems with sperm production, hormone imbalances, genetic disorders, varicoceles, trauma, illnesses, medications, radiation, chemicals and lifestyle factors like smoking and excessive drinking.
3) Female infertility can be caused by ovulation disorders, uterine abnormalities, fallopian tube damage, endometriosis, early menopause, pelvic adhesions, cancers and their treatments, age, smoking, weight issues, stress and lifestyle factors.
This study aimed to prospectively evaluate the relationship between a history of laparoscopically confirmed endometriosis and subsequent risk of infertility among premenopausal women. The study followed over 58,000 women for 14 years and found that women with a history of endometriosis had a 2-fold increased risk of infertility. However, this increased risk was only observed among women aged 35 years or younger and women with a BMI under 25 kg/m2. The study concluded that a history of endometriosis is associated with an increased risk of infertility, but this risk may be limited to younger, leaner women.
This document discusses topics related to sexual health and prevention, including screening recommendations for STIs, birth control options and effectiveness, emergency contraception, signs of pregnancy, and issues specific to men's and women's sexual health. It emphasizes the importance of understanding sexuality and notes challenges adolescents face in developing healthy attitudes towards sex due to developmental immaturity and lack of comprehensive sex education. The doctor's office, CDC website, and Planned Parenthood are recommended resources for sexual health information.
This document summarizes a study examining the relationship between endometrial BCL6 expression and IVF success or failure. The study found that women with low endometrial BCL6 expression (<1.4) had a 66% success rate for pregnancy through IVF, while women with high BCL6 expression (≥1.4) only had a 10% success rate. This suggests BCL6 expression may be a biomarker for predicting IVF outcomes and identifying women who may benefit more from treating endometriosis directly rather than undergoing IVF. Future studies are needed to validate these findings in other populations and examine how BCL6 expression changes after treating endometriosis.
menstrual manipulation for adolescents with disabilityMini Sood
A presentation of aspects of menstrual care in adolescents including those with disability. Slides for medical students who may encounter young patients who are unable to mange their menses efficiently
EVALUATION OF INFERTILITY AND MEDICAL ASPECTS.pdfBhavyaRaval3
The document provides an overview of infertility, its causes, diagnosis, and treatment options. It discusses infertility in males and females separately. For males, common causes include low sperm count, motility issues, or abnormalities. For females, common causes are ovulation disorders, issues with the fallopian tubes or uterus, poor egg quality, or cervical/uterine problems. Diagnosis involves medical histories, physical exams, and tests like semen analysis, blood tests, and ultrasounds. Treatment may include lifestyle changes, ovulation drugs, surgery, artificial insemination, in vitro fertilization, or donor gametes if needed.
This document provides recommendations from the Canadian Task Force on Preventive Health Care for screening for cervical cancer. It recommends:
- Screening asymptomatic women aged 25-69 with a Pap test every 3 years, as there is evidence this reduces cervical cancer rates.
- Not routinely screening women under 20, as incidence is very low in this age group and there are potential harms.
- A weak recommendation against routinely screening women aged 20-24, and a weak recommendation for screening women aged 25-29 every 3 years, as benefits are uncertain for these groups while risks of false positives are higher.
- It considered evidence on screening effectiveness, harms, and the current epidemiology and understanding of cervical cancer and HPV to
Similar to unexplained infertility BY DR REJI MOHAN.pptx (20)
PELVIC FLOOR ANATOMY AND REPAIR.pptx FOR TEACHINGReji Mohan
1) The document discusses the anatomy related to urinary continence and pelvic support. It describes the various muscles, ligaments and fascia that provide support to the pelvic organs.
2) Key anatomical structures that contribute to continence include the urethral sphincters, intact vaginal support, and levator ani muscles. Damage or weakness to these structures can lead to conditions like stress urinary incontinence.
3) Surgical techniques to treat incontinence like retropubic colposuspension and pubovaginal slings are aimed at restoring the hammock-like support of the pelvic organs to improve urethral closure and continence.
sex and sexuality in pregnancy dr reji 2022 .pptxReji Mohan
This document discusses sex and sexuality during pregnancy. It notes that a woman's sexuality is influenced by physical, emotional, and psychological factors. While pregnancy and sexuality are natural, many couples and doctors have knowledge gaps around sexual activity during pregnancy. The document discusses how hormones, physical changes, and psychological factors can impact a woman's sexuality during each trimester. It provides guidance on engaging in safe sexual activity during a normal pregnancy and notes situations where sex should be avoided. The goal is to educate couples and healthcare providers so they are comfortable discussing this topic.
LIFESTYLE DISEASES.pptx by dr sumitha mk for publicReji Mohan
This document defines and discusses non-communicable diseases (NCDs). It states that NCDs are long-lasting and progress slowly, now cause over 40 million deaths per year globally, and are a major problem worldwide. The four main types of NCDs are cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes. Modifiable risk factors include smoking, physical inactivity, unhealthy diet, and harmful alcohol use. The document provides information on managing modifiable risk factors like smoking cessation, increasing physical activity and healthy eating to reduce risks of NCDs.
Three key imaging modalities for infertility evaluation - hysterosalpingogram (HSG), 3D ultrasound, and their comparison are discussed. HSG uses radiation to image the uterine cavity and fallopian tubes but is painful and exposes the patient to radiation. 3D ultrasound is non-invasive, fast, and can accurately diagnose uterine anomalies in previously unavailable planes like the coronal view. It has advantages over HSG in being non-invasive, having no radiation exposure, and allowing assessment of the endometrium and ovaries in detail. While 3D ultrasound is not as widely available as HSG, it may become the gold standard for evaluating infertility due to its superior accuracy and safety profile compared to HSG.
The document discusses nutritional support for breastfeeding mothers and contraindications for breastfeeding. It provides guidelines on the extra calorie and nutrient needs during lactation. These include an additional 300-450 kcal/day during pregnancy and 600 kcal in the first 6 months of lactation. Certain medical conditions like HIV, active tuberculosis, and illnesses with risk of transmission to the infant are contraindications for breastfeeding. Most medications are secreted in breastmilk, so their use during lactation requires careful consideration and medical supervision. Maintaining good nutrition is important for a mother's health and sufficient milk production.
The document provides information on safe entry techniques for gynecological laparoscopy. It discusses the risks of entry and various techniques such as the Veress needle technique, direct trocar insertion, and open laparoscopic entry. More than half of laparoscopy complications are related to the entry technique, with a risk of 0.3-1.0% for entry-related complications. The document outlines best practices for each entry method and factors to consider such as patient positioning, anatomy, and prior surgeries to safely establish pneumoperitoneum and insert trocars.
TRANSFFERING A CRITICALLY ILL OBSTETRIC PATIENTReji Mohan
1) Transporting a critically ill obstetric patient requires careful planning, stabilization of the patient's condition, and use of qualified personnel and equipment to minimize risks. Key factors include airway management, oxygen support, IV access, medications, and monitoring during transport.
2) Conditions that may require transport of an obstetric patient include pregnancy-related complications as well as medical issues aggravated by pregnancy. Timely transfer to a higher-level facility that can provide specialized care for both mother and baby is important.
3) Careful communication and coordination between referring and receiving physicians is essential before and during transport. The benefits of transport must outweigh the risks, which are reduced by proper preparation, equipment, and personnel
The document discusses the evaluation of male infertility. It outlines the goals of a male infertility evaluation as detecting treatable causes, determining suitability for assisted reproduction, and identifying genetic risks. The components of a complete evaluation are described as history, physical exam, semen analysis, hormonal assays, and imaging tests. The evaluation aims to identify medical conditions, assess treatable factors, and guide treatment and counseling options.
Dr. Reji Mohan provides an overview of adenomyosis. He discusses that adenomyosis is characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Symptoms can include dysmenorrhea, menorrhagia, chronic pelvic pain, and subfertility. Diagnosis involves transvaginal ultrasound or MRI to detect thickening of the junctional zone or intramyometrial cysts and striations. Treatment options include medical management with hormonal therapies or surgical interventions like hysterectomy or conservative surgeries. Adenomyosis can impact fertility by altering uterine function and receptivity.
The document discusses menopause and hormone replacement therapy (HRT). It begins with background on increasing life expectancy and stages of menopause. It then covers symptoms of menopause like hot flashes and vaginal dryness. The document discusses the types, routes of administration, regimens, risks and benefits of HRT. It suggests HRT can help relieve menopausal symptoms and prevent osteoporosis, but some women prefer alternatives due to perceived risks of HRT.
Dr. Reji Mohan discusses ovarian reserve testing, which measures a woman's remaining reproductive potential. Key tests include age, basal FSH, estradiol, AMH, antral follicle count, and ovarian volume. AMH and antral follicle count are the most accurate predictors of ovarian response and reproductive outcomes. Combining tests does not significantly improve predictive power over single tests. Ovarian reserve testing allows for improved patient counseling, individualized treatment protocols, cost effectiveness, and safety in fertility treatments.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
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unexplained infertility BY DR REJI MOHAN.pptx
1. Unexplained infertility-an overview
DR REJI MOHAN, MD DNB , short term FELLOW RM(university of ghent , Belgium)
ASSISTANT PROFESSOR
DEPT. OF REPRODUCTIVE MEDICINE AND SURGERY
SREE AVITTOM THIRUNAAL HOSPITAL
GOVT MEDICAL COLLEGE
THIRUVANANTHAPURAM
12/25/2023 drrrejimohan@gmail.com 1
2. Outline
• Introduction
• Aetiology and pathophysiology
• Diagnosis and Evaluation
• Treatment options
• Conclusion
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So many things are unexplained
3. We were diagnosed with 'unexplained infertility,' which sounds good in one
respect, but on the other hand you almost want something wrong so there
is a problem so you can fix it.
- CINDY MARGOLIS
• Doubts
• Frustration
• Hopelessness
• For us this is one of the most fascinating challenges in Reproductive
medicine
• Couples with unexplained infertility range from 15% to 30% and will increase with increasing age
• Definition
• Couples with unexplained infertility, according to the International Committee for
Monitoring Assisted Reproductive Technologies definition, have ‘‘apparently normal
ovarian function, normal fallopian tubes, uterus, cervix and pelvis, adequate coital
frequency, apparently normal testicular function, genitourinary anatomy and a
normal ejaculate’’
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4. Prognosis
• Maternal age is the most important prognostic factor
• Duration of infertility -The success rate of interventions decreases with
increase in the duration of infertility despite regular sexual intercourse
• In the general population, of couples attempting conception, 84% will
conceive after 1 year and 92% will conceive after 2 years
• Couples with UI might be reassured that even after one year of unsuccessful
attempts 50% will conceive in the following 12 months and another 12% in
the year after.
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5. Fecundity and prognosis
• Average monthly fecundity is <35 years have 20%
• After 35years the fecundity reduces and reaches almost zero by 40 years
• For each year of females age the conception rate is decreased by about 9%
after 30 years
• Good prognosis –
Less than two years
Partners age is less than 35
Patient has conceived earlier.
• (Bhattacharya et al., 2008; Collins et al., 1995)
• Worst prognosis - duration of infertility exceeds 3 years and the female partner is >35 years of age
• (Collins et al., 1995)
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6. Aetiology
• Most diagnostic tests in the assessment of infertility do not
detect abnormalities that may be rare or subtle.
• Advanced tests may detect these etiologies and narrow
down the cause of infertility
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7. Aetiology
• Male
• Can be idiopathic or unexplained
• Defective spermatogenesis
• Genetic abnormalities
• Functional integrity problems
• Defective sperm fertilisation potential
• Immunological
• ROS &DNA fragmentation were
significantly higher in men with UE
• FEMALE
• Ovarian: defective folliculogenesis,
genetic problems, ovulatory
dysfunction
• Tubal: defective OPU, disturbed
transportation
• Toxic fluids, peritubular adhesions.
• Uterine: Altered ER, Altered uterine
peristalsis
• Vaginal: raised pH, Altered flora…
• Cervical : cervical mucous
abnormalities, immunological,
functional efficiency
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10. Observation
• Couples with unexplained infertility who are treated with in vitro fertilization (IVF)
• -demonstrate reduced oocyte fertilization and embryo cleavage rates (52%)compared with
couples in whom tubal factor is the cause of the infertility(60%)
• -a higher rate of complete fertilization failure when treated with IVF than couples with tubal
factor infertility (6 versus 3 percent).
• This suggest that couples with unexplained infertility probably have subtle functional
abnormalities in oocyte and/or sperm function.
• Defective endometrial receptivity may account for some cases of unexplained infertility and
recurrent pregnancy loss
• IVF can be considered as a diagnostic procedure
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11. • Many cases of unexplained infertility are probably caused by the
presence of multiple factors each of which on their own do not
significantly reduce fertility, but can reduce the pregnancy rate when
combined
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Better understanding of mechanisms underlying UI could lead to less invasive
and less expensive treatment strategies
12. Evaluation of a Couple with Unexplained
Infertility
• History and examination of both the partners
• Standard evaluation
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13. The standard evaluation Tests of ovulatory function:
Husband’s semen analysis :twice
Tests to assess tubal patency
(HSG/laparoscopy/saline infusion
sonography)
Ultrasound of the pelvis
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Investigations should include a basic
workup to assess the following
ASRM recommends laparoscopy in women with UI,those with signs and symptoms of
endometriosis or suspected tubal adhesions but still can miss tubal dysfunction spasm or
proximal tubal occlusion
14. UI is a diagnosis of exclusion and does not have a definite
pathophysiologic basis.
Multifactorial
Impossible to find out all the etiologies
Gleicher and Barad suggested substitution of term UI to undiagnosed
One should not offer experimental tests or unnecessary additional
tests
Remember subfertility may not be a permanent disability
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15. APPROACH-Basic principles
• The management of couples with unexplained infertility should
balance the efficacy, cost, safety, and risks of various treatment
alternatives.
• Treatment is empirical as it is not meant for any particular defect
• The approach to treatment should be individualized for each couple
• In general, if a specific fertility treatment does not result in pregnancy
after three cycles, alternative treatments should be considered
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16. Management Options for Unexplained
Infertility
• Clinical guidelines for the management of unexplained infertility
recommend starting with the least invasive intervention before
moving on to those that are more invasive
• (ASRM 2006; NICE 2013; NVOG 2010)
• Effective fertility treatment for unexplained infertility must
demonstrate an increase in the pregnancy rate above the baseline
fecundability
• No single algorithm
• Extensive counselling of the couples
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17. Patient controlled approaches-Lifestyle changes
• Cigarette smoking, abnormal body mass index, and excessive caffeine consumption
reduce fertility in the female partner and possibly the male partner.
• Stop smoking
• Try to achieve a body mass index between 20 and 27 kg/m2
• Reduce caffeine intake to no more than approximately 250 mg daily (two cups of coffee)
• Reduce alcohol intake to no more than four standardized drinks per week .
• These changes may be useful for enhancing both natural and assisted conception .
• Couple centered approach
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18. Management Options for Unexplained
Infertility
The options are as follows:
Expectant management(TIC)
Ovarian stimulation(CC,Letz,Gonadotropins)
Intrauterine insemination (IUI) with or without OS
In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)
Most successful and most expensive
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19. Expectant Management
Plays an important role in limited resource settings, especially if the woman is
relatively young (around 25 years) and the period of infertility is short
It is often the first line of treatment
The average cycle fecundity of 1.3% to 4.1% has been reported with expectant
management
The couple is advised to follow up regular intercourse during the fertile period
Couples have a good chance of achieving pregnancy without treatment.
The age of the female partner , duration of infertility and proven prior fertility
influences the pregnancy rate associated with expectant management
Women with unexplained infertility older than 37 years of age have a pregnancy
rate of less than 1 percent per cycle with expectant management
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20. TEM –Hunault model
Identify couples that are eligible for TEM (Tailored expectant management)
A prognostic model of Hunault-age, duration,type, and quality of semen
TEM advises on fertile period, optimal coital frequency, and healthy lifestyle
Expectant management may be an option for a couple with unexplained
infertility in whom the female partner is less than 32 years of age and there
is no immediate concern about oocyte depletion.
In women over 37 years of age, inevitably causes ovarian aging and
depletion to become a major component of the fertility problem and
expectant management should not be an option.
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21. Ovarian stimulation
• Subtle defects in ovulation can be overcome
• Increases the number of oocytes available and change in endometrial
receptivity
• Anti-oestrogens (e.g. clomiphene), gonadotropins (e.g. urinary or
recombinant follicle-stimulating hormone), and aromatase inhibitors
(e.g. letrozole) are the most commonly used medications for OS.
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22. Clomiphene Citrate
• Very commonly used drug for ovulation induction
• Its role in unexplained infertility is debatable.
• CC use is best paired with IUI in patients with unexplained infertility.
• The main complication of clomiphene is an increase in the incidence of multiple gestation.
• The combination of CC plus IUI may simultaneously treat mild abnormalities of ovulation,
oocyte function, and sperm function.
• CC/IUI is generally the first line treatment for unexplained infertility because of its good
clinical pregnancy rate, relatively low rate of multiple gestations, oral route of intake, lack of
need for monitoring, and low cost
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23. Evidence
• In trial of 900 women with unexplained infertility randomly assigned to treatment with CC, letrozole, or
gonadotropin (all combined with IUI), the clinical pregnancy rates were 28 (CC), 22 (letrozole), and 36
(gonadotropin) percent . However, the rates of multiple gestation were lowest for the women treated
with CC/IUI (9 percent) compared with letrozole (13 percent) or gonadotropin (32 percent)
• Diamond MP, Legro RS, Coutifaris C, et al. Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility. N Engl J Med 2015; 373:1230.
• According to ASRM cc is associated with a small but significant treatment effect,one additional
pregnancy with 40 cycles of clomiphene compared to no treatment.
• A Cochrane review including 1159 patients and 7 trials has shown that there is no evidence of
clomiphene citrate being more effective than no treatment or placebo.
• Recommendation is not to use clomiphene in unexplained infertility
• In limited resources, empirical treatment with clomiphene citrate starting with 50 mg up to a
maximum of 250 mg can be used for 3–6 cycles, especially in younger women.
• The aim should be mono follicular growth to avoid complications such as ovarian hyperstimulation and
multiple gestations.
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24. • In comparative treatment trials, clomiphene was not as effective as gonadotropin injections.
• Typically three to four treatment cycles before moving on to another modality.
• Age should be taken into account; multiple treatment cycles are not beneficial in older women.
• One study showed that on a per patient treated basis, cumulative pregnancy rates by age were
24.2 percent under age 35, 18.5 percent ages 35 to 37, 15.1 percent ages 38 to 40, 7.4 percent
ages 41 to 42, and 1.8 percent age above 42 (one pregnancy in 55 patients) .
• In this study, there were no pregnancies beyond the fourth cycle in women age 41 and older.
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25. Aromatase inhibitors plus IUI
• Ovarian stimulation with aromatase inhibitors (AIs) plus IUI may result in pregnancy for women
with unexplained infertility who do not respond to CC plus IUI and who cannot or choose not to
use IVF or gonadotropin therapy.
• AIs have similar clinical pregnancy, multiple gestation, and live birth rates compared with CC and
they are easier to use (oral dosing, no monitoring required) and less expensive compared with
injectable gonadotropin therapy.
• AIs are associated with a lower clinical pregnancy rate compared with gonadotropin treatment,
AIs are also associated with a lower rate of multiple gestations, including a much lower rate of
triplet pregnancy.
• When other treatment options do not result in pregnancy, AI treatment is a reasonable option
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26. • A trial of 900 women, 18 to 40 years of age with unexplained infertility, who were randomly
assigned to receive the AI letrozole, CC, or gonadotropin for ovulation induction in addition to
timed IUI .
• The overall LBR were 19 % for the letrozole group, 23 % for the CC group, and 32 percent for the
gonadotropin group.
• Multiple gestations occurred in 13 percent of the gonadotropin group, 1 percent of the CC group,
and 3 percent of the letrozole group.
• For women receiving gonadotropin treatment, approximately 30 percent of the multiple
pregnancies were triplet pregnancies. In contrast, the women receiving letrozole and CC who
conceived multiple gestations had only twin pregnancies; no triplet pregnancies occurred.
• Diamond MP, Legro RS, Coutifaris C, et al. Letrozole, Gonadotropin, or Clomiphene for
Unexplained Infertility. N Engl J Med 2015; 373:1230.
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27. Gonadotropins
• Along with IUI and oral agents
• Gn and IUI may double the pregnancy rate at the cost of multiple pregnancy rates
• Disadvantage is cost, OHSS, overresponse, and multiple pregnancies
• Gn therapy is more effective than CC or Letrozole and when both are combined
with IUI,their cumulative effect increases.
• A recent SR by Gunn and Bates (2016)concluded CC is more effective than LETZ
but Gns have a better response than both CC and LETZ
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28. Intrauterine Insemination
• The rationale behind doing IUI in unexplained infertility is that it increases the gamete density and brings
together the gametes into close proximity
• Superovulation IUI is advised in which ovarian stimulation is done with clomiphene, gonadotropin, or in
combination to achieve more than one follicle development.
• A recent Cochrane review published in 2012 suggests that IUI in stimulated cycles
is better than IUI in natural cycles
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29. • In a meta-analysis of eight trials comparing gonadotropins versus oral agents with IUI for patients
with unexplained infertility, gonadotropin use did not result in improved live birth rates
• To gain additional live births, high doses of gonadotropins with more relaxed cancellation
protocols were required, which resulted in a higher risk of multiple gestation.
• While the lower gonadotropin dose was no better than the oral agents, with higher doses, 13
cycles were needed to treat to exceed the oral medications, but only 7 were needed to harm
patients with multiple gestations.
• The data do not support the use of gonadotropins with IUI in patients with unexplained
infertility.
• Zolton JR, Lindner PG, Terry N, et al. Gonadotropins versus oral
ovarian stimulation agents for unexplained infertility: a systematic
review and meta-analysis. Fertil Steril 2020; 113:417.
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30. Intrauterine Insemination
• Success rate In a meta-analysis by van Rumste et al the pregnancy rate was 8.4% for
monofollicular growth and 15% for multi follicular growth
• A study published by Kamath et al has shown pregnancy rates of 11.3% with stimulated IUI
cycles in patients with unexplained infertility.
• Live birth rates of approximately 6% to 10% per cycle have been reported for infertile couples
with unexplained infertility undergoing IUI with or without ovarian stimulation (Huang 2018)
• Pregnancy rates with IUI are higher with a higher follicular number but this carries a risk of
higher-order pregnancy (more than 2). 10 times more
• A disadvantage of superovulation IUI is that it is often difficult to control the number of
follicles.
• It will be advisable to aim for 1–2 follicles and keep a low threshold for cancellation when
superovulation IUI is being offered in low-resource setting.
• Strict cancellation policy
• Ideally after 3 to 4 attempts of IUI and OI one must move to IVF
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31. In Vitro Fertilization/Intracytoplasmic Sperm
Injection
• IVF is an effective and expensive method of treatment for unexplained infertility
• IVF is the intervention that results in the highest per cycle pregnancy rate in the
shortest time interval.
• It is also the most costly intervention and has a high rate of high order multiple
pregnancy, unless single embryo transfer is performed
•
• Success rate The ASRM reports a pregnancy rate of 30.4% with IVF.
• A recent Cochrane review has shown that IVF is associated with higher live birth rates
than expectant management (45.8% vs. 3.7%) and unstimulated IUI.
• Multiple pregnancy rates are lower with IVF because of greater control over the number
of follicles being fertilized when compared to IUI.
• IVF must be considered in a woman if age >35 years or with prolonged duration of
infertility or if the cycles have undergone 3–4 cycles of IUI without conception
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32. • IVF other than treatment purpose we can learn about the fertilisation process
• Decreased fert,cleavage rate and fert failure seen in couples with UI
• ICSI can be offered after one failed cycle
• Two landmark trials in UI
• 2010 FASTT trial :less than 40 years CC/IUI,Gn/IUI and IVF was compared.
• Fast track approach to IVF lead to lesser time to conception,lesser no of cycles
and cost benefit
• Best protocol suggested was directly proceeding to IVF after trial with CC/IUI.
• FSH/IUI no advantage.
• FORT-T trial between 38 and 40
• They inferred that in older women 2 cycles of IVF will lead to greater conception
and LBR as compared to with two attempts of CC/IUI or Gn /IUI
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33. • Another review proposed that 2 cycles of Gn /IUI can be tried before
going for IVF in some patients as IVF has its own complications like
OHSS,Multiple pregnancies and perinatal morbidity.
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34. ALTERNATIVE TO IN VITRO FERTILIZATION
• For women with unexplained infertility who do not pursue in vitro fertilization
due to cost or other reasons, laparoscopy can be offered as the next step after
ovulation induction.
• Laparoscopy provides visualization of the pelvis, can identify causes for infertility
and failed therapy, and allows for surgical intervention.
• Surgical treatment of conditions such as endometriosis or pelvic adhesions can
improve fertility.
• Other options are donor-egg pregnancy, gestational surrogacy, adoption, and
cessation of treatment.
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35. Recent publications
• Effect of endometrial scratching on unassisted conception for unexplained infertility: a
randomized controlled trial Fertil Steril. 2022 Mar;117(3):612-619
• 220 women
• Conclusion(s): This trial did not find evidence that endometrial scratching improves the
live birth rate in women with unexplained infertility trying to conceive without assistance.
The effect of endometrial scratching on pregnancy rate after failed
intrauterine insemination: A Randomised Controlled Trail
168 women
• M S Madhuri 1, Chitra Thyagaraju 2, Archana Naidu 1, Papa Dasari Eur J Obstet Gynecol
Reprod Biol. 2022 Jan;268:37-42
• Endometrial Scratching improves clinical pregnancy rate in patients with Unexplained
infertility and mild male factor infertility with previous failed IUI cycles. ES will be an
inexpensive alternative to IVF for couples after IUI failures especially in developing
countries, with an acceptable pregnancy rate and does not demand any special
qualification or equipment and can be trained easily in primary settings. Larger and
adequately powered studies are needed to elucidate the beneficial effects of endometrial
scratching on implantation.
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36. • IVF and IUI in couples with unexplained
infertility (FIIX study): study protocol of a
non-inferiority randomized controlled trial
• Lucy Prentice 1 2, Lynn Sadler 2 3, Sarah Lensen 4, Melissa
Vercoe 2, Jack Wilkinson 5, Richard Edlin 6, Georgina M
Chambers 7 8, Cynthia M Farquhar 1 2
• 580 couples with unexplained infertility comparing four cycles of
IUI-OS with clomiphene citrate and one completed cycle of IVF.
• Study Not over
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37. • Comprehensive genetic studies are needed to better understand the etiologies of unexplained
infertility.
• A comprehensive, 10-year evaluation is underway by the National Institutes of Health entitled "The
All Of Us Research Program," which is inviting one million people to help build one of the most
diverse health databases in history; the database will combine genetic histories, lifestyle, medical
conditions, and whole genome application .
• From this information, multiple breakthroughs are expected, such as recurrent pregnancy wastage
and unexplained infertility. Study still going on
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38. Conclusion
• Unexplained infertility poses a great challenge to both patients and treating
physicians. Infertility is not only a medical condition but also has a significant
negative psychological and social impact.
• In addition to the medical treatment, some couples may require additional
psychological support and counseling.
• The pros and cons have to be discussed before going ahead with treatment.
• Any intervention or invasive diagnostic tests on the female partner to be
withheld till semen analysis is available.
• Expectant management is associated with satisfactory pregnancy rates in selected
group of patients.
• Clomiphene citrate has a limited role in unexplained infertility, probably in a low-
resource setting. Superovulation with IUI is an effective second-line treatment,
and IVF/ICSI is the final treatment option for unexplained infertility generally
offered in a tertiary level center.
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