بسم الله الرحمن الرحیم. به کانفرانس علمی عقامت خوش آمدید ترتیب کننده : پوهنمل دوکتور محمد حسن فرید. In the name of god.
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Definition : if a young couple did not get pregnancy during one year with at least two time intercourse per week ،without using any contraception method ، means infertility
75 - 80 % of couple got pregnancy in 1 year , 20 - 25 % needs more intervention , but around 10 % of these remained infertile.
Any problems interfere in this 5 maintained procedure can change the condition form fertility to infertility . it is effective from 1 - 100 %. absolutely belongs to the intensity ,location , kind of pathology duration and kind of treatment .
1/3 = = = both partner (treatment is verey dificult )
A – Defective spermatogenesis
B - Obstruction in the passage :
C-- Ejaculatory problems
D – immunological problems
E - Medical diseases
F – Other factor
4 Medical illnesses ( D.M , hypertension , thyroid disease , mumps etc ).
a -fallopian tube
Exacerbate angry b –deficiency of g gammete
c – decreased coital f frequency
d – impotence
e - ejaculation p problems
Intercourse abstinence 2 -3 days . after intercourse specimen aspirated form cervical canal and posterior fornix separately . 10 or > motile sperm forward movement PCT is ok .abnormal PCT 3 - 5 % .
Another specimen collected from posterior fornix acts as a control .
3 – sperm cervical mucus contact test (S.C.C.T) : Equal amount of semen and C.M mixed. if > 25 % of sperm show jerky movement after 30 min immunological factor is positive (we need control specimen from the semen) .
When above 3 mintioned test & semen count are normal the problem may be on fertilization process must be do it:
A - In high F.S.H level primary T.T failure is suspected.
B - when TB of the T.T is suspected .
C - To study histopathology in presence of oligospermia & abnormal semen parameter .
D- In azoospermia to distinguish testicular failure from blockage of the vas deferent or unability of the T T.
a – Corticosteroid : 50 mg/d prednisolon.
b – use condom 3 - 6 months .
the above 2 mentioned things eliminate antibodies 30 - 40 % .
c -- Sildenafil ( Viagra ) 25 -100 mg one hour before intercourse, improve erectile function .other method of treatment vacuum pump , local penile implants and local injection . ( have own disadvantage ).
Note : these drugs must be used at least for 3 month because spermatogenesis process take 72 days time and passage from the T.T takes 2 weeks more time .
Testicular and epididymal aspiration of sperm when vas is blocked .
8. Pshycological factor .
Important function of the tube are :
The most important defect of the tube are :
Rule of the uterus in productive process
these following factors are interfere in the process of infertility
Most of medical diseases ( DM , aneamia , vitamins deficiency , hormonal problems .etc ) have own effects on infertility in both partners.
a – Safe ,non invasive & reliable methods .
b – Serial u/s monitoring shows growth ,development & rupture of F.du .Graff
c – Endometrial growth : Normal endometrial growth before ovulation 8- 10 mm thick. normal growth rate 1 -2 mm /d , reaches around 20 mm or more at ovulation time. After ovulation follicle du graff shrink and fluid can be found in Douglas pouch.
d – By u/s we can precise ovulation days .
e – dictate administration of hCG .
f – Retrieval of ova in IVF process.
g – Also recognized PCOD.
FSH,LH & prolactine levels can indicates normal or HPO axise dysfunction & or primary ovarian failure.
A – high LH level in PCOD.
B – High FSH level inhypothyroidism &hyperprolactenemia.
C – Low estrogen level in ovarian failure
D - low progesterone level in L Phase , shows CLP Dificiency.
E - prolactine more than 25 ng /ml is high.
I - HSG
I - HSG
thefirst important diagnostic method for evaluation of tubes. its must be done in 8 – 10 days of cycle .
falls negative : Tubal spasm like block .
falls positive : Hydrosalpinx like spellage .
Tubercular salpingitis : it is cause extravasations of the
dye and show bilateral corneal block .
Laparoscopy is indicated if :
We can help these therapy processes
100 cc serum saline + small amount of air injected transcervical in the cavity of uterus .U/S can screen the movement of the bubble & determined blockage of tube (free fluid in the Douglas pouch indicated patency of the tube in this procedure no risk of x ray & allergic reaction)
Hysteroscopy falloscopy ( HF)
A-Treat an ovulation
Multiple pregnancy (MP)with clomephin & FSH 10 %.
MP with GnRH 1 % .
If failed medical therapy , donor egg or adopts with this condition .
POCD responds to clomephen or gonadotrophin stimulation , but hyperstimulation must be watched , if it occur hCG should be withheld in the cycle. If failed medical therapy calls for laparoscopic drilling of the cyst or cauterized.
I - Tuboplasty : Excising the blocked portion & anastomosis. success depending on the sit of blockage. ( fimb 25 % , cornual end 50 % , isthemic isthmus anastomosis 60 - 70 %).
two weeks after do it this procedure , needs hydrotubation also .
II -Laparoscopy : we can do it : , but hyperstimulation must be watched , if it occur hCG should be withheld in the cycle. If failed medical therapy calls for laparoscopic drilling of the cyst or cauterized.
III_ Balloon tuboplasty & cannulation .
Medical end blocked by flimsy adhesion ( 40 % pregnancy occured )
IV - IVF : we don in :
When all investigation in both male & female are normal we used this term.
a - IUI ( AI ).
b - IVF.
c - ZIFT.
d - GIFT.
e - Cryopreservation technique .
f - ICSI.
Action mechanism :
ovulation induction . intra uterine or fallopian insemination of washed sperms at ovulation time ( 3 - 4 cycle attempted 30 - 40 % success ).
4 - Cryopreservation :
Lately it has been possible to caryopreserve the sperm , ova and embryos .( to avoid of invasive procedure time by time and reduced cost ).
Passage of co2 with Rubin‘s machine in the uterine cavity .
A – complication
B - Contraindication
Note , but hyperstimulation must be watched , if it occur hCG should be withheld in the cycle. If failed medical therapy calls for laparoscopic drilling of the cyst or cauterized. : counseling a couple is essential & prognosis at each treatment should be discussed the last choice of adoption should be left to their decision .
C – Four important following criteria shows open tubes , but hyperstimulation must be watched , if it occur hCG should be withheld in the cycle. If failed medical therapy calls for laparoscopic drilling of the cyst or cauterized.