DEFINITON OF INFERTILITY

Infertility is a disease of the

reproductive system defined by the
failure to achieve a clinical
pregnancy after 12 months or more
of regular unprotected sexual
intercourse.
by WHO

CAUSES OF INFERTILTY
M ale infertility
Female infertility

Male infertility
1.Defective spermatogensis , the

cause to this
A. Congenital ( undescended testis ,
kartogener syndrome, hypospadias)
B. Thermal factors( raised scrotal
tempertaure, big hydrocale ) other
causes include tight undergarment
C. Infection- mumps orchitis ,
damage spermatogenesis

 D. General factors chronic

debilitating disease , malnutrition or

smoking reduce spermatogenesis
.alcohol
E. Endocrine testicular failure due to
gondatrophic deficiency ( kallmanns
syndrome)
F. Genetic factors chromosomal
abnormality like klienfelters
syndrome

Iatrogenic
Radiation , cytotoxic drugs nitro

foruantine cimetidine , beta blockers

Immunologic factors
Antiobodies aganist spermatozoa

2.Obsturction of the
efferent duct
Due to infections like gonococcel or

by surgical trauma ( herniorhaphy)

following vasectomy

3. Failure to deposit
sperm high in the vagina
Erectile dysfunction
Ejaculatory defect
Hypospasdis

SPERM ABNORMALITY

4.ERRORS IN THE SEMINAL

FLUID
High or low volume of ejaculate
Low fructose content
High prostanglandin
Undue viscocity

FEMALE INFERTILITY
1. OVARIAN FACTORS
The ovulatory dysfunction

encompasses
a.anovulation or oligoovulation
b. decreased ovarian reserve
c. Luteal phase defect( LPD)
d. Luteinised unruptured follicle

 Anovulation
Ovarian activity totally dependent on

the gonadotrophins
Related with disturbed hypothalamos
pituitary ovary axis

Luteal phase defect(LPD)

Inadequate growth and function of

the corpus Luteum

Inadequate progesterone secretion

Luteinised unruptured
follicular syndrome
Ovum is trapped inside the follicle

which gets lutenised

2.TUBAL AND PERITONEAL

FACTORS
Like pelvic infections , Previous tubal

surgery, tubal endometriosis , polyp

3. Peritoneal factors
Peritubular adhesions, even minimal

adhesions and endometriosis

Uterine factors
Uterine hypoplasia , inadequate

secretory endometrium

Cervical factors
Anatomical defect
Physiological effect

Vaginal factors
Atresia of the vagina , transverse

vaginal septum , separate vagina or

narrow introtitus

Combined factors

Management of
infertility
Nonmedical
Simple changes in lifestyles

( wearing loose clothing , long

periods of sitting , avoiding
prolonged hot baths )
Using water soluable lubricants
during intercourse

 Treatment available to the women

who have an immunological reaction

to sperm

 CHANGES IN NUTRITION AND HABITS

like well balanced diet , exercise ,

alcohol

 HERBAL AND ALTERNATIVE THERAPY

Relaxation , osteopathy , stress

management , nutrition and exercise

counselling shown increases
pregnancy rates

 Herbal remedies promote fertility like

red clovers flowers, nettle leaves

Vitamin E and vitamin c ,
gluthathione and co- enzyme
Herbs to avoid while trying to
conceive include licorie, ephedra ,
fennel , goldenseal lavendra

Pharmacological therapy
CLOIPENE CITRATE ovulation

induction , treatment of luteal phase

Dosage starting with 50mg /day by
mouth for 5 days beginning on the 5
th day of menses
Side effects vasomotor flushes ,
abdominal discomfort

 MENOTROPINS( human menopausal

gonadrotropins) ovarian follicular

growth and maturtion
IM INJECTION variable based on
ovarian response
Side effects ovarian enlargement ,
ovarian hyperstimulation

 FOLLITROPHINS treatment of

polycystic ovarian disease , follicular

stimulation for assisted reproduction
Dose sc or im injection
Side effects ovarian enlargement
ovarian hyperstimulation

 HUMAN CHORION

GONADOTROPHINS ovulation
induction
Dose 5000- 10,000 iu . IM one day
after last dose of menotrophins
Side effects headache , irritability

 ANDROGENS ( danazol)
Treatment of endometriosis
Dose 200- 800 mg/dl by mouth for 3

to 6 months
Mild hirustism, acne , edema , weight
gain

 GNRH AGONST
Treatment of endometriosis
Dose 200 mcg intranasal twice daily

for 6n months
Side effects irritation , nose bleed

 PROGESTERONE treatment of luteal

phase inadequacy
Dose vaginal or rectal suppository
50 to 100 mg daily
Side effects breats temderness, local
irritation , headache

 Gnrh antagonist controlled ovarian

stimulation for infertility treatments

Dose 250 mg daily subcutaneous
usually in the early to mid follicular
phase of the menstrual cycle usally
follwed by hcg administration

SURGICAL MANAGEMENT
HYPERSALPINGOGRAPHY
Useful for the identification for tubal

obstruction and also for the release

of blockage
During laproscopy delicate adhesion
may be divided and removed and
endometrial implants may be
destroyed by electrocoagulation or
LASER

 Laprotomy or even microsurgery

may be required to do extensive

repair of dammaged tubes

 RECONSTRUCTIVE SURGERY
EG: unification operation for bicornate

uterus
Surgical removal of tumours or fibroids
involving endometrium or uterus eg
myomectomy
CHEMOCAUTERY Destruction of tissue
with chemicals
Thermocautery destruction with heat
usually electrical
Cryosurgery destruction of tissue by
application of extreme cold usually liquid
nitrogen

Conization excision of a cone shaped

piece of tissue form the endocervixeffective in elimination chronic
inflammation and infection
Surgeries for male infertility
Surgical repair of the variocele
Microsugery: to reanastomse the
sperm duct after vasectomy can
restore fertility

ART OR ASSITED
REPRODUCTIVE THERAPIES

Treatments include
1. INVITRO FERTILIZATION EMBRYO
TRANSFER( IVF-ET)
Common approach for women with
blocked or absent uterine tubes OR
with unexplained fertility and men
with very low sperm count
99% of all arts use this procedure
Generally only three or fewer
embryos' are transferred to minimize
the risk for multiple pregnancy

 Procedure termed successful when

embryo continues to develop in the

uterus and pregnancy proceeds
Potential for successful pregnancy in
IVF is when maximum 3 to 4
embroyos are placed in the uterus

 For this reason fertility drugs are

used to induce ovulation prior to the

process
Follicular development and oocyte
maturity are monitored frequently
with ultrasound and hormonal assays

Procedure for IVF

Before the procedure the women is

administered an ovulation agent such

as clomiphene citrate or human
menopausal gonadotropin
Beginning from 10thday of the cycle
ovaries are examines by usg for follicle
development
When follicle appears mature , a
women is given an injection of HcGin
38 to 42 hours

 a needle introduced intravaginally ,

guided by usg , and oocyte is

aspirated form the follicle
Because drugs are given to induce
ova maturation many oocytes ripen
at once as many as 3 to 12
3 to 12 oocyte can be removed

 Meanwhile Husband or donor supplies

a fresh semen species

Sperm cells and oocyte are allowed

mixed and allowed to incubate in a

growth medium
Genetic analysis is done to reveal any

abnormalities

 After fertilization of chosen oocyte

occurs , the zygote formed almost

immediately begin to divide and
grow
After 40 hours after fertilization ,
they will undergo their first cell
division
In past multiple eggs were chosen
and implanted to ensure a
pregnancy resulted
This techniques also resulted in
multiple pregnancy

 Once the eggs are fertilized and

progress to the embryo stage , the

embryos are placed in the uterus
After the procedure the women is
advised to engage in only minimal
activity for 12 to 24 hours and
progesterone supplements are
prescribed

 Newborns from multiple births have a

much lower chance of surviving the

neonatal period than others
If couple desires any egg not used be
frozen and used any time

 Proof that zygote had implanted can be

demonstrated by routine serum pregnancy

test
Overall pregnancy rate by ivf is as low as
38 to 42% per treatment cycle
If usg shows multiple pregnancy more than

two zygotes selective termination of

gestational sac until two are remaining

This termination is done by intra-abdominal

injection of potassium chloride into the

gestational sac chosen to be eliminated

 IVF IS A EXPENSIVE PROCEDURE

ABOUT 10,ooo dollars per cycle

Intra-Uterine
Insemination (IUI)
Definition
Intra-uterine Insemination (IUI) is the

placement of sperm directly into the uterus

of the woman, bypassing the cervix.
Indications
This procedure is performed for patients
with a cervical factor (cervicitis, cervical
stenosis, inadequate mucus or hostile
mucus), unexplained infertility, male factor
infertility or immunological infertility

 Procedure
The female's ovaries are stimulated

hormonally to produce follicles

containing the eggs.

An ultrasound scan is performed to

determine the number and size of

the follicles and also the thickness of
the endometrium, lining the uterus,
to see whether it is ready for
implantation.

 Also, blood hormone levels will be

measured. Ovulation will be induced

by an injection of human chorionic
gonadotrophin (hCG), and the egg will
be released 36-48hr later.
The male partner's semen is processed
to select the highest quality sperm. The
physician will then inject this sperm via
a catheter through the vagina and
cervix, into the uterus.

 This procedure is contra- indicated if

a womens fallopian tubes are

blocked
Fertilization then occurs in the tube
and the zygote moves to the uterus
for implantation
This procedure is contra- indicated if
a womens fallopian tubes are
blocked

GAMETE INTRA FALLOPIAN

TRANSFER
(GIFT)
In gamete intra fallopian transfer
procedures ova are obtained from ovaries
exactly as IVF . Instead of fertilization to
occur in the laboratory, both ova and
sperm are instilled within matter of hours,
using laparoscopic techniques into the
open end of patent fallopian tube.
Fertilization then occurs in the tube and
the zygote moves to the uterus for
implantation

 Hormones are given for the next 2

weeks to help maintain a pregnancy.

Any extra eggs may be fertilized in
vitro (IVF), cryopreserved, or
donated

ZYGOTE INTRA FALLOPIAN

TRANSFER
This procedure involves oocyte

retrieved by transvaginal, ultra sound

guided aspiration followed by culture
insemination of the oocyte in the
laboratory.
Within 24 hrs the fertilized eggs are
transferred by laparoscopic technique
into the end of a waiting fallopian tube.
ZIFT differs from GIFT

 As in GIFT a women must have one

functioning fallopian tube for the

technique to be successful.
Complication :
Congenital abnormalities occur more
frequently from these embryos
Multiple gestation with increased risk
for both mother and fetus

OOCYTE DONATION
Women who have ovarian failure or

oophorectomy who have a genetic

defect or who fail to achieve pregnancy
with their own oocyte may be eligible
for the use of donor oocytes.
Oocyte donation is done by women who
are younger than 35 years and healthy
and are paid to undergo ovarian
stimulation and oocyte retrieval

 The donor eggs are then fertilized in

the laboratory with male partners

sperm
The recipient women undergoes
hormonal stimulation to allow
development of the uterine lining.
In donor oocyte the eggs are
donated by AVF procedure and the
donated eggs are inseminated.

 The embryos are transferred into the

recipient uterus, which is hormonally

prepared with estrogen/progesterone
therapy.
INDICATIONS:
Early menopause, surgical removal
of ovaries, autosomal sex- linked
disorders, lack of fertilization in
repeated IVF attempts because of
subtle oocyte abnormalities or
defects in oocyte- spermatozoa
interaction

EMBRYO

DONATION

On occasion couple decide that theydo

not want their frozen embryo and their

release for adoption by other infertile
couple
INDICATION:
Infertility not resolved by less
aggressive forms of therapy, absence
of ovaries, male partner's azoospermia
or is severely compromised

SURROGATE MOTHER/EMBRYO
HOSTS/GESTATIONAL CARRIERS
Surrogate mother can be achieved

by two methods:
The first is for surrogate mother to
be inseminated with semen from the
infertile womens partner and to
carry the baby until birth.
The baby is then formally adopted by
infertile couple

 A less common method is to relieve

an ovum from the infertile women

fertilize it with her partners sperm
and place it into the uterus of a
surrogate who becomes an embryo
host or gestation carrier.
These intervention raise
considerable legal and ethical issues
that require extensive counseling of
couple and and the women to
choose to become pregnant

 PROCEDURE TO SURROGATE

MOTHER:
1)A couple undertakes an IVF cycles
and
2)The embryo is transferred to the
uterus of another woman(the
carrier) who has contacted with the
couple to carry the baby to term.
3)The carrier who has no genetic
investment in child.

 Indication: Congenital absence or

surgical removal of uterus a

reproductively impaired uterus,
myomas,uterine adhesions or other
congenital abnormalities, amelical
condition that might be life
threatening during pregnancy such as
diabetes, immunologic problems or
severe heart, kidney or liver diseases

 THERAPEUTIC DONOR INSEMINATION

Definition
TID is the placement of donor sperm
directly into the uterus of the patient

 TDI or therapeutic donor

insemination by donor is when the

male partner has no( previously
referred to as artificial insemination)
or very low sperm count( less than
20 million motile sperm per
milliliter), the couple has a genetic
defect, or the male partner has an
antispermantibody

 Procedure:
1)The procedure is done in the

physicians office or clinic, usually the

day after the woman has LH surge.
2)The sperm are loaded into a
catheter.
3)The sperm are loaded into a
catheter that is then inserted in the
vagina through the cervix and placed
high in the uterine cavity.

 4)The sperms are injected slowly and

the catheter is removed.

5)The woman lies flat for a few
minutes and then can get up and
resume her usual activity

 MICRO MANIPULATION:

Technique to improve fertilization,

embryo growth and genetic testing

are improving at a rapid pace.
Micromanipulation allows the handling
of individual eggs and sperm through
the use of specific instruments and
controls

 INTRA-CYTOPLASMIC SPERM INJECTION:

Definition
The process whereby a single sperm is

injected directly into the cytoplasm of the

egg.
Indications
ICSI is the method of choice for patients with
severe male factor infertility, and for patients
who have had previously failed or poor
fertilization resulting from conventional IVF.

 It is a technique that make it possible

to achieve fertilization or to correct

abnormal fertilization by introducing
sperm beneath the zonapellucida
directly into the egg.ICSI offers the
opportunity to enhance the chances
of fertilization in cases of a severe
male factor

 Procedure
The eggs are retrieved from the woman's

ovaries in the same way as for IVF.

The eggs are then stripped of all
surrounding cells and placed in a droplet
and the male partner's sperm placed in
another droplet.
The sperm can be obtained via
ejaculation or in severe cases, directly
from the testis or epididymis using
microsurgical sperm retrieval techniques.

 The oocyte is held in place by a

specialized holding micropipette.

With a microinjection pipette, one
sperm is picked up (aspirated) and
then carefully injected into the
cytoplasm of the oocyte. This is done
for all the eggs.
The eggs are then placed in the
incubator, and checked the next
morning for fertilization.

 The fertilized eggs are then allowed

to develop for another 24-48hr, after

which they are transferred into the
uterus via a thin catheter.
Hormonal treatment to help
maintain a pregnancy is given for the
next 2 weeks

 PRE-IMPLANTATAION GENETIC

DIAGNOSIS:
It is a form of early genetic testing
designated to eliminate embryos with
serious genetic defects before
implantation through one of the ARTs
and to avoid future termination of
pregnancies for genetic reasons.Micro
manipulation allows removal of a
single cell from a multicellular
embryo for genetic study

 Definition
Assisted hatching is the opening of

the zona pellucida , surrounding the

embryo, to help the
embryo/blastocyst "hatch" or emerge
from the zona and implant in the
uterus.

 Indications
Assisted hatching is usually indicated

in older women, and those with failed

implantation in previous cycles.
Procedure
Prior to embryo transfer, a small
opening is made in the zona
pellucida using microdissection tools.
The embryos are then transferred
normally

 . An infrared laser is used to create a

hole in the zonapellucida so that the

embryo can break through and
implant.
This procedure is considered
experimental and research
continues(Georgia Reproductive
Specialist,2005)(www.ivf.com).

Microsugical Epidiymal Sperm Aspiration

Testiculat Sperm Extraction (TESE)
Round Spermatid Injection (ROSI)
Definition
MESA is the retrieval of sperm from the

epididymis by means of aspiration.

TESE is the retrieval of sperm from the
testis by means of testicular biopsy.
ROSI is the injection of round spermatid
(immature spermatozoa) when no
mature sperm can be found in the testis.

Indications
When sperm are unable to move through
the genital tract due to uncorrectable
damage, sperm can be extracted
directly from the epididymis or testes
via microsurgical techniques.
Congenital absence of the vas
deferens (CAVD) or failed sterilization
reversal are other indications.

Procedure
the woman has her eggs retrieved,

the husband/male partner will

undergo a surgical procedure that
will either take a very small piece of
testicular tissue (TESE) or aspirate
the fluid from the epididymis (MESA).

 For TESE/MESA the testicular

tissue/epididymal fluid will be

examined for the presence of sperm
cells. These can then be injected into
the oocyte via ICSI. In cases where
no sperm are seen, round spermatids
(immature sperm seen on right) can
be used for ICSI (ROSI).

Sperm Cyropreservation
and Thawing
Definition
The process of preserving sperm by

means of freezing for use at a later

time.

 Indications
Sperm can be cryopreserved if they

are difficulty in producing a specimen

at a given time.
patients planning to undergo
chemotherapy or radiotherapy (for
cancer), sperm may be cryopreserved
as the (therapy may diminish sperm
production). Sperm also frozen for
people if they want to donate

Procedure
Sperm retrieved by , testicular biopsy

or microsurgical epididymal sperm

aspiration are placed together with a
cryoprotectant and stored in
cryostraws in liquid nitrogen at a
temperature of -196C.
Then they are thawed at any time, and
the cryoprotectant can be removed
and the sperm used for ART
procedures.

Embryo Cryopreservation
and Thawing
Definition
The process of storing embryos by

means of freezing in liquid nitrogen

for use at a later time.

 Sperm Donation
Definition
The donation of sperm for the use by

infertile couples with severe male

factor infertility

Indications
Donor sperm used when the male

partner has azoospermia or severe

male factor, has a know
hereditary/genetic disorder that could
be carried over to biologic offspring,
has had previously failed IVF attempts
do not choose to have ICSI.
Donor sperm may also be used in
females without male partners.

Gender Selection
Definition
In this process it increases the

chance of having a female or male

child, by separating sperm that bear
the X chromosome (female) and
those that have the Y chromosome
(male), and inseminating with
whichever sample is desired.

Indications
The procedure can be employed for

couples who want a child of a

specific gender

Procedure
procedure used is the sedimentation

method.
takes approximately 2-2 hours to
process.
On average, it takes about 3-4
cycles to achieve a pregnancy with
this method.

Journal review ......

 TTILE: An alternative medicine study of

herbal effects on the penetration of zonafree hamster oocytes and the integrity of
sperm deoxyribonucleic acid.
OBJECTIVE:
To analyze the effects of certain herbs on
sperm DNA and on the fertilization
process.
DESIGN:
Prospective comparative study.
SETTING:
Clinical and academic research
environment.

 INTERVENTION(S):
Zona-free hamster oocytes were

incubated for 1 hour in saw palmetto

(Serenoa repens), echinacea purpura,
ginkgo biloba, St. John's wort
(Hypericum perforatum), or control
medium before sperm-oocyte
interaction. The DNA of herb-treated
sperm was analyzed with denaturing
gradient gel electrophoresis.

 MAIN OUTCOME MEASURE(S):

Oocyte penetration and integrity of the

sperm BRCAI exon 11 gene

 RESULT(S):
Pretreatment of oocytes with 0.6

mg/mL of St. John's wort resulted in

zero penetration. A lower concentration
(0.06 mg/mL) had no effect. High
concentrations of echinacea and
ginkgo also resulted in reduced oocyte
penetration. Exposure of sperm to
echinacea purpura and St. John's wort
resulted in DNA denaturation

 CONCLUSION(S):
High concentrations of St. John's

wort, echinacea, and ginkgo had

adverse effects on oocytes.
St. John's wort was mutagenic to
sperm cells.

2.Chinese herbal medicine for

infertility with anovulation: a
systematic review
AIM: of this systematic review is to

assess the effectiveness and safety

of Chinese herbal medicine (CHM) in
treatment of anovulation and
infertility in women

 Method : Eight (8) databases were

extensively retrieved. VIP Information,

CMCC, and CNKI. The English electronic
databases included AMED, CINAHL,
Cochrane Library, Embase, and MEDLINE
There were 692 articles retrieved
according to the search strategy, and
1659 participants were involved in the
15 studies that satisfied the selection
criteria

 RESULT:Meta-analysis indicated that

CHM significantly increased the

pregnancy rate and reduced the
miscarriage ratE compared to
clomiphene
CHM also increased the ovulation
rate

 CONCLUSION:CHM is effective in

treating infertility with anovulation.

With no side effects

The role of antioxidant

therapy in the treatment
of male infertility
The aim of this study was to

review the current literature on the

effects of various antioxidants to
improve fertilisation and pregnancy
rates
The sources of
literature were Pubmed and the
Cochrane data base

 Result
Reviewing the current literature

revealed that Carnitines and vitamin

Cand E have been clearly shown to
be effective
Conclusion there is however a need
for further invetigation with RCTS

 4.Weight loss results in significant

improvement in pregnancy and

ovulation rates in anovulatory
obese women
a weight loss programme was assessed
to determine whether it could help
infertile overweight anovulatory
women to establish ovulation and
assist in achieving pregnancy, ideally
without further medical intervention

 METHOLODOLOGY:They underwent a

weekly programme of behavioural

change in relation to exercise and
diet over 6 months; those who did
not complete the 6 months were
treated as the comparison group
RESULT:Women in the study group
lost an average of 6.3 kg, with 12 of
the 13 subjects resuming ovulation
and 11 becoming pregnant, five of
these spontaneously.

 CONCLUSION
weight loss with a resultant

improvement in ovulation, pregnancy

outcome, self-esteem and endocrine
parameters is the first therapeutic
option for women who are infertile
and overweight

Acupuncture on the day of

embryo transfer significantly
improves the reproductive
outcome in infertile women: a
prospective, randomized trial
Objective
To evaluate the effect of acupuncture

on reproductive outcome in patients

treated with IVF/intracytoplasmic
sperm injection (ICSI).

 Design
Prospective, randomized trial.
Setting
Private fertility center.
. On the day of oocyte retrieval, patients

were randomly allocated (with sealed

envelopes) to receive acupuncture on
the day of ET on that day and again 2
days later or no acupuncture (control
group, n = 87).

 Intervention(s)
Acupuncture was performed

immediately before and after ET (ACU 1

and 2 groups), with each session lasting
25 minutes; and one 25-minute session
was performed 2 days later in the ACU 2
group.
Main Outcome Measure(s)
Clinical pregnancy and ongoing
pregnancy rates in the three groups.

 Result(s)
Clinical and ongoing pregnancy rates were

significantly higher in the ACU 1 group as

compared with controls (37 of 95 [39%
Conclusion(s)
Acupuncture on the day of ET significantly
improves the reproductive outcome of
IVF/ICSI, compared with no acupuncture.
Repeating acupuncture on ET day +2 provided
no additional beneficial effect

. Title : female infertility and

chiropractic wellness care : a case
study on the autonomic sytem
response while under
subluxationbased on chiropratic care
and subse quent fertility
Objective: This case study
describes a woman, previously
diagnosed with a lazy (reproductive)
system, who became pregnant after
commencing subluxation-based
chiropractic care

 Clinical Features: A 31 year old

woman underwent medical treatment

for infertility as they had been
attempting to become pregnant for
over 12 months, and the woman had
been taking Clomiphine Citrate
(clomid) for 3 months.

 conceived naturally.

Conclusion: After vertebral

subluxations, the practice member
showed marked improvement in
autonomic and motor system function
as demonstrated on her sEMG and
thermography scans. In
Additonal, she became pregnant nine
months after commencing chiropractic
care

 Title :Study of Combined Use of

Clomiphene Citrate and

Gonadotropins on the Infertile
Patients with PCOS
Objective
To investigate the efficacy and safety
of combined use of clomiphene citrate
(CC) and gonadotropins (Gn) on the
infertile patients with PCOS.

 Methods
A total of 367 infertile patients with

PCOS were included in this

retrospective study. Patients received
CC from menstrual cycle day 3 until
the day of triggering and human
menopausal gonadotrophins (hMG)
from menstrual cycle day 5 until the
ovulation day

 GN duration and doses , serum LH

and estradiol levels , frozen thawed

embroyo implantation and clinical
pregnancy rates were compared with
patients with cc and Gnrh

 Results
Gn duration and doses, blood estrogen

level, transferable embryos and incidence

of OHSS in the group of CC plus hMG were
decreased significantly than those of long
and short protocols. No differences were
observed in the frozen-thawed embryo
implantation and clinical pregnancy rates
among three groups.

 Conclusion
Mild stimulation of CC combined with

hMG on infertile patients with high

risk for OHSS is safe and efficient.

 title: Human menopausal gonadotropins:

a justifiable therapy in ovulatory women

with long-standing idiopathic infertility.
Methodology: A group of 97 couples, with
long-standing idiopathic infertility received up
to four cycles of empiric human menopausal
gonadotropin therapy before in vitro
fertilization.
This group was compared with a control group
of 48 couples who did not receive human
menopausal gonadotropin before in vitro
fertilization

 Result:The 12 (12.4%) conceptions

and eight (8.2%) term births resulted

from human menopausal
gonadotropin therapy in the study
group was significantly higher than
the number of spontaneous
conceptions and births (1%) in the
study group

 Title: Timed intercourse after

intrauterine insemination for

treatment of infertility.
OBJECTIVE:
To compare the pregnancy rates,
between intrauterine insemination
(IUI) followed by timed intercourse
and IUI only for treatment of the
infertile couples.

 STUDY DESIGN:
A prospective study of two different

protocols of intrauterine insemination

in two hundred and one infertile
couples with a normal spermiogram
was carried out
101 couples were treated with IUI
alone and 100 couples had both IUI
and timed intercourse within a 12-18
h period. The pregnancy rates were
compared between groups.

 RESULT:The pregnancy rate per cycle

increased with increasing numbers of

total motile sperm per insemination
in the IUI alone group (. Timed
intercourse increased pregnancy rate
in patients with lower motile sperm
number, but not in patients with
higher sperm number

 CONCLUSIONS:
In IUI with low number of motile

sperm inseminated, timed

intercourse significantly increases
the pregnancy rates over IUI alone in
infertile couples with a normal
sperminogram

 title: Efficacy of Superovulation and

Intrauterine Insemination in the

Treatment of Infertility
Objective : to assess the efficacy of
superovulation and interuterine
insemination over intracervical
insemination alone

 METHODS

studied on 932 couples in which the

woman had no identifiable infertility
factor and the man had motile
sperm.The couple was randomly
assigned to receive intracervical
insemination , iui insemination,
superovlution and intracervical
insemination or superovulation and iui

 RESULTS
The 231 couples in the group treated

with superovulation and intrauterine

insemination had a higher rate of
pregnancy (33 percent) than the 234
couples in the intrauterineinsemination group

 CONCLUSION among the infertile

couple treatment with the induction

of superovlution and iui in three
times are likely to result in
pregnancy as treated with either
superovulation and intracervical
insemination or iui

 Title: Follicular flushing and in

vitro fertilization outcomes in

the poorest responders: a
randomized controlled trial
Objective
Does follicular flushing during oocyte
retrieval improve the number of
oocytes retrieved in the poorest
responders?

 STUDY DESIGN, SIZE, DURATION:

This randomized controlled trial

compared the effects of follicular

flushing and direct aspiration on IVF
outcomes in the poorest responders.
Fifty patients were randomized
during the 12-month enrollment
period.

 MAIN RESULTS
Patients who underwent follicular

flushing had significantly fewer

embryos transferred { a lower
implantation rate and a lower
clinical pregnancy rate . The
difference in pregnancy rates
remained significant after adjusting
for embryos transferred.

 Title : role of laproscopic ovarian

drilling as a first line mangement in

infertility with poly cystic ovarian
disease
Aim: main objective of the study was
to evaluate the effectiveness of
laproscopic ovarian drilling in pcos in
terms of prenancy rate

 Study design: retrospective study with

50 patients
RESULT : majority of the women had a

sucess full cumaltative ovulation rate of

72%was observed and a pregnancy
rate of 48% a mean duration of 3 to 9
months
CONCLUSION: laproscopic ovarian

drilling is effective in induction of

ovulation and increasing the pregnancy
in case of PCOD

 Title: Nonsurgical fallopian tube

recanalization for treatment of

infertility.

Aim whether non surgical fallopian tube

recanalization was help full in treatment ,

caused by proximal tubal obstruction
Methodology ; fluroscopic fallopian tube
recanlization was performed in 100
consecutive patients with infetility and
proximal tubal obsturction

 RESULT Recanalization of one or

both tubes was successful in 19 of

these women (95%). Nine patients
conceived (47%) without receiving
any other therapy, and the average
time from procedure to conception
was 4 months. All pregnancies were
intrauterine. Eight of the 10 patients
who did not conceive underwent
follow-up hysterosalpingography an
average of 6 months following the
procedure; four (50%) demonstrated
reocclusion of both tubes

 CONCLUSION
The authors conclude that

nonsurgical fallopian tube

recanalization is an effective
treatment for infertility caused by
proximal tubal obstruction.

 Title : Metformin in polycystic ovary

syndrome: systematic review and metaanalysis

ObjectiveTo assess the effectiveness of
metformin in improving clinical and
biochemical features of polycystic ovary
syndrome.
DesignSystematic review and metaanalysis.
Data sourcesRandomised controlled
trials that investigated the effect of
metformin compared with either placebo
or no treatment, or compared with an
ovulation induction agent.

 Selection of studies13 trials were

included for analysis, including 543

women with polycystic ovary
syndrome that was defined by using
biochemical or ultrasound evidence.

Main outcome measurePregnancy

and ovulation rates. Secondary

outcomes of clinical and biochemical
features of polycystic ovary syndrome.

 ResultsMeta-analysis showed that

metformin is effective in achieving

ovulation in women with polycystic
ovary syndrome
ConclusionsMetformin is an
effective treatment for anovulation in
women with polycystic ovary
syndrome.

 TITLE :Safety and efficacy of

clomiphene citrate and L-carnitine

in idiopathic male infertility: a
comparative study.
PURPOSE:
To compare the effects of L-carnitine
with clomiphene citrate in idiopathic
infertile men.

 MATERIALS AND METHODS:

Fifty-two men with idiopathic infertility

were recruited in this randomized

controlled trial. They were randomly
assigned into 2 treatment groups,
group 1 (n = 20) and group 2 (n = 32),
who received L-carnitine 25 mg/day
and clomiphene citrate 2 gr/day,
respectively, for a period of 3 months

 RESULTS, both medications had

influence on sperm count and

motility (P = .01). L-carnitine
significantly increased the semen
volume (P = .001), while clomiphene
citrate was significantly associated
with the motility percentage and
normal morphology (P = .008).

 CONCLUSION:
It seems that the use of clomiphene

citrate and L-carnitine, either

individually or in combination, as the
first step of idiopathic male infertility
treatment is reasonable, safe, and
effective

 Title : day three versus day two

embryo transfer following in vitro

fertilisation or intracytoplasmic sperm

Objective: to detremine if there is any

difference in the live births and

pregnancy rate when et is performed
on day 3 compared to day two

 SELECTION CRITERIA RCT that

compared day 3 versus day 2

Conclusion : although an increase in
clinical pregnancy rate with day three
embryo transfer was demonstrated

 TITLE : LOW OXYGEN

CONCENTRATION FOR EMBRYO

CULTUE IN ASSISTED REPRODUCTIVE
TECHNOLOGY
Objective to detremine whether
embroyos culture at low 02 conc ,
improves treatment out come
Population- seven study with 2422
participant were included in this
systematic review

 Main results- evidence of a benefical

effect of culturing in low oxygen

concentration was found
Clincally improve live birth by 30%
using atmospheric conc than 32%
and 43%using low o2 conc

 TITLE the morphological normaly of the

sperm nucleus and pregnancy rate of

intracytoplasmic injection with
morphological selected sperm
AIM to detremine whether increased

pregancy outcome attributed to the

nuclear morphology of the sperm

Result implantation and pregancy was

significant higher and abortion rate

significantly lower

 TITLE use of carnitine therapy in

selected cases of male factor infertility

a double blind cross over study
Objective to determine the efficacy

of l-carnitine therapy in selected cases

of male infertility

 Population 1oo infertile males

RESULT A statically significant

improvement in semen quality ,was

seen after the use of l- carnitine

 TITLE : Smaller fetal size in

singletons after infertility therapies :

the influence of technoolgy and
underlying infertility
AIM to determine whether fetal size
differnce exist between matched
fertile and infertile women
Result compared to the matched

fertile women had smaller neonate

at birth and mor e lbw infants

NEW PAPER ARTICLE IN THE

TIMES TRENDS DATED
JUNE28,2O13