treatment of infertility using follistim and intrauterine insemination powerpoint
TRANSCRIPT
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Treatment of Infertility using Follistim and
Intrauterine Insemination to
Achieve Pregnancy
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Polycystic Ovarian Syndrome• Traits
•Irregular or absent menstrual periods.•Menorrhagia (heavy menstruation).•Hirsutism (facial hair).•Obesity.•Depression.•Anovulation (absent ovulation).•Hyperandrogenism.
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Hirsutism• A condition of unwanted, male-pattern hair growth in
women.• This may arise from excess male hormones called
androgens, primarily testosterone.
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Diagnosing AnovulationBloodwork
• Follicle stimulating hormone (FSH) (normal or low).
• Lutenizing hormone (elevated).
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Diagnosing AnovulationBloodwork
• Estradiol is the primary female sex hormone (normal or elevated).• Estradiol level in blood rises during time before ovulation.
• Testosterone (elevated).• Elevated testosterone causes hirsutism.
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Semen (Sperm) Analysis• For the male, a semen analysis is performed to measure the
number and shape of sperm, and sperm morphology (sperm size and shape) is evaluated as part of a semen analysis to evaluate male infertility.• Normal sperm have an oval head with a long tail. • Abnormal sperm have head or tail defect (misshapen head or
tail) which can affect the ability of the sperm to reach and penetrate an egg.
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Diagnosing AnovulationEndometrial Biopsy
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Diagnosing AnovulationEndometrial Biopsy
• Sound the uterus by measuring the depth from the external os of the cervix to the fundus. A pipelle curette is marked in centimeters so you can measure sounding depth.• An endometrium showing little
or no progesterone on pathology indicates anovulation.
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Menstruation Before Beginning Treatment
• If a patient is not menstruating, a prescription for (synthetic) Provera is provided to induce a period.
• Progesterone is one of the hormones that controls the menstrual cycle and ovulation, the monthly release of an egg from the ovaries.
• Progesterone also helps to prepare the womb lining for pregnancy and shed the lining each month when pregnancy does not occur (a process you know as your monthly period).
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• A transvaginal ultrasound study that measures a woman’s ovarian reserve (remaining egg supply) which reflects her fertility potential. • An antral (resting) follicle is a small, fluid-
filled sac that contains an immature egg.• Follicles can be seen, measured and
counted on Cycle Days 2, 3, and 5 by using ultrasound.
Basal Antral Follicle Count
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Transvaginal Probe
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Basal Antral Follicle CountUltrasound Image
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Oral Meds: Femara or Clomid• Both Clomid and Femara are
medications used to treat infertile women who have an ovulation problem.
• These medications work by helping the pituitary gland (located at the base of the brain) improve the stimulation of developing follicles (eggs) in the ovaries.
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IVF Drugs: Follistim
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Follistim and Monitoring
•Follistim is started at 150 mg by subcutaneous injection for 7-14 days with the physician adjusting the dose in order to get 1 or more follicles to grow. •Blood sample is drawn for serum estradiol every other day along with transvaginal ultrasound evaluate follicles until they reach a mature size.
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Follistim and Monitoring•When mature size follicles are seen on ultrasound, an injection of HCG (human chorionic gonadotropin) is given which induces ovulation to occur in about 36 to 40 hours. • Intrauterine insemination is performed to release the processed sperm sample inside the uterus near the egg for fertilization.
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Results•A pregnancy test can be taken in 2 weeks.
•A yolk sac can be seen and heartbeat heard in 6 weeks.
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Maturing Follicles
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Sperm Washing
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Intrauterine Insemination
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Successful Results