DEFINITON OF INFERTILITYInfertility 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 ( kallmann’s 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

encompassesa.anovulation or oligoovulationb. 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 endocervix- effective 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 embroyo’s 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 women’s 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 women’s 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 partner’s 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 women’s 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 partner’s 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 INSEMINATIONDefinition 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 AspirationTesticulat 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 -196°C.

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 2-2½ 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 zona-free 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 ofliterature 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 RCT’S

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 intrauterine-insemination 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

ObjectiveDoes 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 meta-analysis

Objective To assess the effectiveness of metformin in improving clinical and biochemical features of polycystic ovary syndrome.

Design Systematic review and meta-analysis.

Data sources Randomised controlled trials that investigated the effect of metformin compared with either placebo or no treatment, or compared with an ovulation  induction agent.

Selection of studies 13 trials were included for analysis, including 543 women with polycystic ovary syndrome that was defined by using biochemical or ultrasound evidence.

Main outcome measure Pregnancy and ovulation rates. Secondary outcomes of clinical and biochemical features of polycystic ovary syndrome.

Results Meta-analysis showed that metformin is effective in achieving ovulation in women with polycystic ovary syndrome

Conclusions Metformin 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