recent advancement in infertility management and adoption process.ppt
TRANSCRIPT
![Page 1: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/1.jpg)
![Page 2: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/2.jpg)
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
![Page 3: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/3.jpg)
CAUSES OF INFERTILTY
M ale infertility Female infertility
![Page 4: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/4.jpg)
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
![Page 5: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/5.jpg)
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
![Page 6: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/6.jpg)
Iatrogenic
Radiation , cytotoxic drugs nitro foruantine cimetidine , beta blockers
![Page 7: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/7.jpg)
Immunologic factors
Antiobodies aganist spermatozoa
![Page 8: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/8.jpg)
2.Obsturction of the efferent duct Due to infections like gonococcel or
by surgical trauma ( herniorhaphy) following vasectomy
![Page 9: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/9.jpg)
3. Failure to deposit sperm high in the vagina Erectile dysfunction Ejaculatory defect Hypospasdis
SPERM ABNORMALITY
![Page 10: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/10.jpg)
4.ERRORS IN THE SEMINAL FLUID High or low volume of ejaculate Low fructose content High prostanglandin Undue viscocity
![Page 11: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/11.jpg)
FEMALE INFERTILITY
1. OVARIAN FACTORS The ovulatory dysfunction
encompassesa.anovulation or oligoovulationb. decreased ovarian reserve c.Luteal phase defect( LPD) d. Luteinised unruptured follicle
![Page 12: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/12.jpg)
Anovulation Ovarian activity totally dependent on
the gonadotrophins Related with disturbed hypothalamos
– pituitary ovary axis
![Page 13: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/13.jpg)
Luteal phase defect(LPD)
Inadequate growth and function of the corpus Luteum
Inadequate progesterone secretion
![Page 14: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/14.jpg)
Luteinised unruptured follicular syndrome Ovum is trapped inside the follicle
which gets lutenised
![Page 15: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/15.jpg)
2.TUBAL AND PERITONEAL FACTORS Like pelvic infections , Previous
tubal surgery, tubal endometriosis , polyp
![Page 16: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/16.jpg)
3. Peritoneal factors
Peritubular adhesions, even minimal adhesions and endometriosis
![Page 17: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/17.jpg)
Uterine factors
Uterine hypoplasia , inadequate secretory endometrium
![Page 18: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/18.jpg)
Cervical factors
Anatomical defect Physiological effect
![Page 19: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/19.jpg)
Vaginal factors
Atresia of the vagina , transverse vaginal septum , separate vagina or narrow introtitus
![Page 20: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/20.jpg)
Combined factors
![Page 21: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/21.jpg)
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
![Page 22: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/22.jpg)
Treatment available to the women – who have an immunological reaction to sperm
![Page 23: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/23.jpg)
CHANGES IN NUTRITION AND HABITS – like well balanced diet , exercise , alcohol
![Page 24: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/24.jpg)
HERBAL AND ALTERNATIVE THERAPY
Relaxation , osteopathy , stress management , nutrition and exercise counselling shown increases pregnancy rates
![Page 25: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/25.jpg)
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
![Page 26: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/26.jpg)
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
![Page 27: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/27.jpg)
MENOTROPINS( human menopausal gonadrotropins) – ovarian follicular growth and maturtion
IM INJECTION – variable based on ovarian response
Side effects – ovarian enlargement , ovarian hyperstimulation
![Page 28: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/28.jpg)
FOLLITROPHINS – treatment of polycystic ovarian disease , follicular stimulation for assisted reproduction
Dose – sc or im injection Side effects – ovarian enlargement ‘
ovarian hyperstimulation
![Page 29: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/29.jpg)
HUMAN CHORION GONADOTROPHINS – ovulation induction
Dose 5000- 10,000 iu . IM one day after last dose of menotrophins
Side effects – headache , irritability
![Page 30: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/30.jpg)
ANDROGENS ( danazol) Treatment of endometriosis Dose 200- 800 mg/dl by mouth for 3
to 6 months Mild hirustism, acne , edema , weight
gain
![Page 31: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/31.jpg)
GNRH AGONST Treatment of endometriosis Dose 200 mcg intranasal twice daily
for 6n months Side effects – irritation , nose bleed
![Page 32: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/32.jpg)
PROGESTERONE – treatment of luteal phase inadequacy
Dose – vaginal or rectal suppository 50 to 100 mg daily
Side effects breats temderness, local irritation , headache
![Page 33: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/33.jpg)
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
![Page 34: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/34.jpg)
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
![Page 35: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/35.jpg)
Laprotomy or even microsurgery may be required to do extensive repair of dammaged tubes
![Page 36: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/36.jpg)
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
![Page 37: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/37.jpg)
![Page 38: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/38.jpg)
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
![Page 39: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/39.jpg)
ART OR ASSITED REPRODUCTIVE THERAPIES
![Page 40: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/40.jpg)
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
![Page 41: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/41.jpg)
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
![Page 42: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/42.jpg)
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
![Page 43: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/43.jpg)
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
![Page 44: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/44.jpg)
![Page 45: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/45.jpg)
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
![Page 46: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/46.jpg)
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
![Page 47: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/47.jpg)
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
![Page 48: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/48.jpg)
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
![Page 49: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/49.jpg)
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
![Page 50: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/50.jpg)
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
![Page 51: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/51.jpg)
IVF IS A EXPENSIVE PROCEDURE – ABOUT 10,ooo dollars per cycle
![Page 52: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/52.jpg)
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
![Page 53: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/53.jpg)
Procedure The female's ovaries are stimulated
hormonally to produce follicles containing the eggs.
![Page 54: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/54.jpg)
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.
![Page 55: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/55.jpg)
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.
![Page 56: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/56.jpg)
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
![Page 57: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/57.jpg)
![Page 58: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/58.jpg)
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
![Page 59: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/59.jpg)
![Page 60: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/60.jpg)
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
![Page 61: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/61.jpg)
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
![Page 62: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/62.jpg)
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
![Page 63: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/63.jpg)
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
![Page 64: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/64.jpg)
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.
![Page 65: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/65.jpg)
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
![Page 66: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/66.jpg)
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
![Page 67: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/67.jpg)
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
![Page 68: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/68.jpg)
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
![Page 69: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/69.jpg)
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.
![Page 70: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/70.jpg)
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
![Page 71: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/71.jpg)
THERAPEUTIC DONOR INSEMINATIONDefinition TID is the placement of donor sperm
directly into the uterus of the patient
![Page 72: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/72.jpg)
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
![Page 73: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/73.jpg)
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.
![Page 74: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/74.jpg)
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
![Page 75: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/75.jpg)
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
![Page 76: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/76.jpg)
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.
![Page 77: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/77.jpg)
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
![Page 78: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/78.jpg)
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.
![Page 79: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/79.jpg)
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.
![Page 80: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/80.jpg)
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
![Page 81: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/81.jpg)
![Page 82: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/82.jpg)
![Page 83: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/83.jpg)
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
![Page 84: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/84.jpg)
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.
![Page 85: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/85.jpg)
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
![Page 86: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/86.jpg)
. 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).
![Page 87: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/87.jpg)
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.
![Page 88: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/88.jpg)
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.
![Page 89: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/89.jpg)
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).
![Page 90: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/90.jpg)
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).
![Page 91: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/91.jpg)
Sperm Cyropreservation and Thawing Definition The process of preserving sperm by
means of freezing for use at a later time.
![Page 92: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/92.jpg)
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
![Page 93: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/93.jpg)
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.
![Page 94: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/94.jpg)
Embryo Cryopreservation and Thawing Definition The process of storing embryos by
means of freezing in liquid nitrogen for use at a later time.
![Page 95: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/95.jpg)
Sperm Donation Definition The donation of sperm for the use by
infertile couples with severe male factor infertility
![Page 96: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/96.jpg)
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.
![Page 97: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/97.jpg)
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.
![Page 98: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/98.jpg)
Indications
The procedure can be employed for
couples who want a child of a specific gender
![Page 99: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/99.jpg)
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.
![Page 100: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/100.jpg)
Journal review ......
![Page 101: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/101.jpg)
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.
![Page 102: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/102.jpg)
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.
![Page 103: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/103.jpg)
MAIN OUTCOME MEASURE(S):Oocyte penetration and integrity of the
sperm BRCAI exon 11 gene
![Page 104: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/104.jpg)
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
![Page 105: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/105.jpg)
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.
![Page 106: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/106.jpg)
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
![Page 107: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/107.jpg)
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
![Page 108: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/108.jpg)
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
![Page 109: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/109.jpg)
CONCLUSION:CHM is effective in treating infertility with anovulation. With no side effects
![Page 110: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/110.jpg)
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
![Page 111: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/111.jpg)
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
![Page 112: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/112.jpg)
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
![Page 113: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/113.jpg)
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.
![Page 114: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/114.jpg)
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
![Page 115: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/115.jpg)
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).
![Page 116: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/116.jpg)
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).
![Page 117: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/117.jpg)
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.
![Page 118: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/118.jpg)
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
![Page 119: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/119.jpg)
. 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
![Page 120: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/120.jpg)
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.
![Page 121: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/121.jpg)
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
![Page 122: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/122.jpg)
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.
![Page 123: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/123.jpg)
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
![Page 124: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/124.jpg)
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
![Page 125: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/125.jpg)
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.
![Page 126: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/126.jpg)
Conclusion Mild stimulation of CC combined with
hMG on infertile patients with high risk for OHSS is safe and efficient.
![Page 127: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/127.jpg)
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
![Page 128: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/128.jpg)
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
![Page 129: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/129.jpg)
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.
![Page 130: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/130.jpg)
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.
![Page 131: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/131.jpg)
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
![Page 132: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/132.jpg)
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
![Page 133: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/133.jpg)
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
![Page 134: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/134.jpg)
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
![Page 135: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/135.jpg)
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
![Page 136: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/136.jpg)
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
![Page 137: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/137.jpg)
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?
![Page 138: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/138.jpg)
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.
![Page 139: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/139.jpg)
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.
![Page 140: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/140.jpg)
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
![Page 141: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/141.jpg)
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
![Page 142: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/142.jpg)
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
![Page 143: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/143.jpg)
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
![Page 144: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/144.jpg)
CONCLUSION The authors conclude that
nonsurgical fallopian tube recanalization is an effective treatment for infertility caused by proximal tubal obstruction.
![Page 145: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/145.jpg)
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.
![Page 146: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/146.jpg)
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.
![Page 147: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/147.jpg)
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.
![Page 148: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/148.jpg)
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.
![Page 149: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/149.jpg)
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
![Page 150: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/150.jpg)
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).
![Page 151: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/151.jpg)
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
![Page 152: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/152.jpg)
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
![Page 153: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/153.jpg)
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
![Page 154: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/154.jpg)
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
![Page 155: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/155.jpg)
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
![Page 156: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/156.jpg)
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
![Page 157: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/157.jpg)
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
![Page 158: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/158.jpg)
Population – 1oo infertile males RESULT – A statically significant
improvement in semen quality ,was seen after the use of l- carnitine
![Page 159: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/159.jpg)
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
![Page 160: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/160.jpg)
NEW PAPER ARTICLE IN THE TIMES TRENDS DATED JUNE28,2O13
![Page 161: RECENT ADVANCEMENT IN INFERTILITY MANAGEMENT AND ADOPTION PROCESS.ppt](https://reader034.vdocument.in/reader034/viewer/2022042608/55cf9179550346f57b8dac0d/html5/thumbnails/161.jpg)