EVIDENCE BASED

INFERTILITY MANAGEMENT

OSAMA M WARDA MD

Professor of Obstetrics & Gynecology

Mansoura University- Egypt

Objective

January 22, 16

2

warda

Defining Infertility

January 22, 16

3

warda

Conception rates for fertile couples

0 10 20 30 40 50 60 70 80 90

100

0 6 12 18 24

Perc

ent o

f Cou

ples

Con

ceiv

ing

Months of intercourse (cycles)

January 22, 16

4

warda

CAUSES OF INFERTILITY

January 22, 16

5

warda

Approach to management

January 22, 16

6

warda

Basic infertility work-up

History taking

&

clinical examination

Semen analysis

Evaluation of ovulation

Tubal patency

evaluation

HSG

DL

January 22, 16

7

warda

Male January 22, 16

8

warda

CASA vs. coventional SA

January 22, 16

9

warda

Male infertility

January 22, 16

10

warda

Post-coital test

January 22, 16

11

warda

Evaluation of ovulation

January 22, 16

12

warda

Mid-luteal progesterone assay

January 22, 16

13

warda

HSG

January 22, 16

14

warda

WHEN TO DO Diagnostic Laparoscopy

January 22, 16

15

warda

Hormonal assay

January 22, 16

16

warda

TSH

January 22, 16

17

warda

PRL

January 22, 16

18

warda

Testing ovarian reserve

January 22, 16

19

warda

Hysteroscopy

January 22, 16

20

warda

IUI

- Its use is questionable (Reindollar et al, 2010)

- If done, offer up to 3 cycles

January 22, 16

21

warda

January 22, 16

22

warda

IVF/ ICSI

• Couples in which IVF is justified should be offered up to three stimulated cycles of in vitro fertilization treatment.

•  ICSI in Moderate or Severe male factor; --Obstructive azoospermia--Non-obstructive azoospermia.

January 22, 16

23

warda

Hypo-gonadotropic hypo-

gonadism

January 22, 16

24

warda

PCOS

January 22, 16

25

warda

METFORMIN

January 22, 16

26

warda

BMI

January 22, 16

27

warda

Tubal Surgery

January 22, 16

28

warda

recFSH vs HMG

January 22, 16

29

warda

GnRHa in IVF/ICSI

January 22, 16

30

warda

Intrauterine adhesions

January 22, 16

31

warda

Endometriosis

January 22, 16

32

warda

Endometriosis Laparoscopic Ablation:

January 22, 16

33

warda

Ovarian Endometriomas

January 22, 16

34

warda

Endometriosis III/IV

January 22, 16

35

warda

HYDROSALPINX

January 22, 16

36

warda

ICSI or IVF?

January 22, 16

37

warda

Embryo Transfer (ET)

January 22, 16

38

warda

Embryo Transfer

January 22, 16

39

warda

Embryo Transfer

January 22, 16

40

warda

LUTEAL PHASE SUPPORT

January 22, 16

41

warda

Karyotype

January 22, 16

warda

42

Children born from ART

January 22, 16

warda

43

January 22, 16

warda

44 THANK YOU FOR YOUR ATTENSION & PATIENCE