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Infertility

Infertility is defined as not being able to get pregnant despite having frequent, unprotected intercourse for at least a year for most people and six months if you are above 30 years of age. It can be that there is a cause in the female or male or both.

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EVERY BODY ‘S WISH

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INFERTILITY HURTS

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Female infertility

it may be that there is an ovulation defect like PCOS ( polycystic ovarian syndrome) where hormones like testosterone and Prolactin are produced in excess.Block in the fallopian tube /damaged tube like hydrosalpinx which can result from conditions like adhesions,endometriosis and pelvic inflammatorydisease Congenital anomalies in the uterus / cervix like septate uterus, bicornuate uterus( 2 uterus, 2 cervix etc) or tumors in the uterine musculature ( Fibroids) which may distort the uterine cavity .

Endometriosis:

where the endometrium grows outside the uterine cavity in sites like tubes and ovaries.This condition causes infertility, dyspareunia ( pain during coitus)

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COMMON PROBLEMS IN FEMALE INFERTILITY

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COMMON PROBLEMS IN MALE INFERTILITY

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HOW MANY TESTS MORE?

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HOW TO GO ABOUT IT ?

  • 1. CHOOSE THE RIGHT DOCTOR WHO UNDERSTANDS YOU AND YOUR PROBLEM
  • 2. CONCEAL NO FACTS. TELL HIM THE TRUTH
  • 3. HAVE FAITH IN HIS TREATMENT.
  • 4. GET THE TESTS DONE AND VISIT HIM AS AND WHEN CALLED
  • 5. LEAVE NOTHING TO CHANCE.
  • 6. FINALLY BELIEVE IN GOD BECAUSE IT IS MAN WHO PROPOSES BUT IT IS GOD WHO DISPOSES.

BASIC WORKUP

Both partners of an infertile couple should be evaluated

History :

  • ● Duration of infertility and results of previous evaluation and therapy.
  • ● Menstrual history (cycle length and characteristics), which helps in determining ovulatory status.
  • ● Medical, surgical, and gynecological history
  • ● Personal and lifestyle history including age, occupation, exercise, stress, dieting/changes in weight, smoking, and alcohol use
  • ● Sexual history, including sexual dysfunction and frequency of coitus. Infrequent or ineffective coitus can be an explanation for infertility.
  • ● Family history, including family members with infertility, birth defects, genetic mutations, or mental retardation.

Basic blood tests in females: s.tsh, s.prolactin, ESR,day 3 FSH,AMH ( especially in older females), s.oestradiol, s. Progesterone

Role of hystersalpingogram ( HSG)

It is an X ray done witha dye injected to know the status of the fallopian tubes, whether patent or not and it also gives an idea about the uterine cavity(Bicornuate/septate/arcuate)

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The diagnostic accuracy of hysterosalpingography is an area of considerable debate. Opsahl and coauthors evaluated the predictive value of the hysterosalpingogram (HSG) in the diagnosis of tubal and peritoneal factors.2 As expected, a test indicating bilateral distal occlusion was confirmed at laparoscopy with a high degree of accuracy. In contrast, radiographic studies suggesting alternate types of tubal disease were not as accurate, with only 63% of the findings confirmed at laparoscopy. In women with a completely normal HSG, the test accurately predicted the presence of patent Fallopian tubes with a false negative rate of only 3.6%. However, over 40% of women with a normal HSG had associated pelvic disease (adhesions or endometriosis) detected at the time of laparoscopy.

Role of semen analysis :

A sample is collected from the husband after masturbation preferably after 3 days of abstinence.
In WHO 2010, the new normal values are based on data from men with proven fertility, men who were known to help their partners conceive in the previous 12 months. Following a large analysis of semen parameters from over 4000 men in 14 countries, a new set of 5th percentile parameters was recommended. Below are the comparisons of the old and new
reference values:

  • Parameter WHO 1999 WHO 2010
  • Volume 2 ml 1.5 ml
  • Concentration 20 million/ml 15 million/ml
  • Progressive motility 50% 32%
  • Normal forms 14% 4%

Role of laparoscopy

Laparoscopy is a surgical procedure that involves insertion of a narrow telescope-with 3 or 5mm instruments in the abdomen and allows evaluation of the abdominal and pelvic organs including the area of the uterus, fallopian tubes and ovaries.

What is laparoscopy used for in women with infertility?

It helps us to detect whether the tubes are healthy and patent or not .If the tubes are blocked then they can be made patent by hysteroscopic cannulation with the additional help of hysteroscopy.

It also helps us to confirm, diagnose endometriosis and thereby treat it by fulguration and enucleation of chocolate cysts in the ovaries.

It helps us to confirm and remove fibroids( tumours of the uterus).

Because of the cost and invasive nature of laparoscopy it should not be the first test in the couples diagnostic evaluation. In general, semen analysis, hysterosalpingogram, assessment of ovarian reserve and documentation of ovulation should be assessed prior to consideration of laparoscopy.

The risks of complications from laparoscopy are low. As with any surgical procedure, there are risks including injury to the bowel, stomach, urinary bladder, ureters, abdominal and pelvic blood vessels, ovaries, or uterus. Fortunately, the risk of serious complications is less than 1% especially if the laparoscopy is performed by a highly trained fertility surgeon.

DIAGNOSTIC LAPAROSCOPY

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DYE ETST ON LAPAROSCOPY . HERE THE RE IS FREE SPILLAGE OF DYE FROM THE PATENT FALLOPIAN TUBE

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THERE IS PRESENCE OF ADHESIONS IE STICKING UP OF THE STRUCTURES IN THE ABDOMEN SEEN ON LAPAROSCOPY

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CHOCOLATE CYST OF OVARY AS SEEN ON LAPAROSCOPY