2

3

1

Causes of sub fertility

• Ovulation problem

• Tubal abnormality

– Endometriosis

Male factor

• Unexplained subfertility

Investigation of the subfertile couple

• Semen analysis & timing

• Ovulation assessment – Luteal progesterone

– Hormonal normality: • Thyroid function

• Prolactin

• Tubal assessment – Laparoscopy/ hydrotubation/ D & C

– Ultrasound

– HSG

Male subfertility

• Very few cases are treatable

• Artificial insemination has low success rate unless there is a mechanical factor

• IVF and /or ICSI fall back position

Hypothalamus

Pituitary

FSH

E2

LH

P4

Ovaries

0 5 10 14 20 25 28

Follicle developing

Ovulation

FSH

LH

T°

Oestrogen

Progesterone

Ovulation Induction

• Clomiphene citrate

• Gonadotrophins

– rFSH

• GnRH

• Bromocryptine

Tubal factors

An IVF treatment cycle

1. Controlled ovarian hyperstimulation Various protocols- Primarily FSH + inhibit spontaneous ovulation GnRH agonist or antagonist

2. Monitoring

Ultrasound/ Oestrogen Assay 3. Oocyte collection

Transvaginal, Ultrasound guided, IV sedation 4. IVF 5. Embryo transfer-

Similar to smear test

6. Freezing

Intervention to Enhance IVF

• Steroids

• Asprin/ Heparin • Growth Hormone (GH)

• Transdermal testosterone

• DHEA

• Different stimulation protocol

• Intralipid

• Endometrial scratch

• Viagra

• Melatonin

Published in May 2015