understanding infertility basic sciences a/prof r gyaneshwar franzcog, mh.ed clinical director of...
TRANSCRIPT
![Page 1: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/1.jpg)
Understanding Understanding InfertilityInfertility
Basic SciencesBasic SciencesA/Prof R GyaneshwarA/Prof R GyaneshwarFRANZCOG, MH.EdFRANZCOG, MH.Ed
Clinical Director of Obstetrics & GynaecologyClinical Director of Obstetrics & GynaecologyLiverpool Health ServiceLiverpool Health Service
Conjoint Associate ProfessorConjoint Associate ProfessorUniversity of New South WalesUniversity of New South Wales
![Page 2: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/2.jpg)
2A/Prof R Gyaneshwar
![Page 3: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/3.jpg)
3A/Prof R Gyaneshwar
AcknowledgementAcknowledgement
Dr Antony Lighten – Dr Antony Lighten – IVF AustraliaIVF Australia
Dr Derek Lok – Dr Derek Lok – Sydney IVFSydney IVF
![Page 4: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/4.jpg)
4A/Prof R Gyaneshwar
Reproductive PhysiologyReproductive Physiology
![Page 5: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/5.jpg)
5A/Prof R Gyaneshwar
Endometriosis
Fibroids
Blocked or damaged Fallopian tubes eg
Ectopic pregnancy
Failure of Ovulation
Polycystic Ovarian
Syndrome
Miscarriage
![Page 6: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/6.jpg)
6A/Prof R Gyaneshwar
Causes of InfertilityCauses of Infertility
![Page 7: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/7.jpg)
7A/Prof R Gyaneshwar
The Causes of Infertility and The Causes of Infertility and their Approximate Frequency their Approximate Frequency (adapted from Hull et al 1985)(adapted from Hull et al 1985)
CausesCauses Frequency %Frequency %
Sperm defects or dysfunctionSperm defects or dysfunction 3030
Ovulation failureOvulation failure (amenorrhoea or oligomenorrhoea)(amenorrhoea or oligomenorrhoea) 2525
Tubal infective damageTubal infective damage 2020
Unexplained infertilityUnexplained infertility 2525
EndometriosisEndometriosis (causing damage)(causing damage) 55
Coital failure or infrequencyCoital failure or infrequency 55
Cervical mucus defects or dysfunctionCervical mucus defects or dysfunction 33
Uterine abnormalitiesUterine abnormalities (eg fibroids or abnormalities of (eg fibroids or abnormalities of shape)shape)
11
15% of couples have more than one sub-fertility factor15% of couples have more than one sub-fertility factor
![Page 8: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/8.jpg)
8A/Prof R Gyaneshwar
InfertilityInfertility
DefinitionDefinition 12 months of attempting to conceive12 months of attempting to conceive
Incidence 1 in 6 couplesIncidence 1 in 6 couples Incidence increases with ageIncidence increases with age
![Page 9: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/9.jpg)
9A/Prof R Gyaneshwar
Natural Cumulative Pregnancy Natural Cumulative Pregnancy RateRate
1
2
34
56
78
910
1112
24
0
10
20
30
40
50
60
70
80
90
1 2 3 4 5 6 7 8 9 10 11 12 24
% pregnant/month
Months of trying
![Page 10: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/10.jpg)
10A/Prof R Gyaneshwar
Natural Pregnancy RateNatural Pregnancy Rate
![Page 11: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/11.jpg)
11A/Prof R Gyaneshwar
Ovarian ReserveOvarian Reserve
![Page 12: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/12.jpg)
12A/Prof R Gyaneshwar
Anovulation Anovulation
LHRH
FSHLH
Hypothalamo-Hypothalamo-pituitarypituitary
WHO Type 1:WHO Type 1: HypogonadotrophicHypogonadotrophicNearly everyone conceivesNearly everyone conceives
AnovulationAnovulation WHO Type 2:WHO Type 2: NormogonadotrophicNormogonadotrophicMost women conceiveMost women conceive
Ovarian failureOvarian failure WHO Type 3:WHO Type 3: HypergonadotrophicHypergonadotrophicConception remote chance Conception remote chance without donated oocyteswithout donated oocytes
![Page 13: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/13.jpg)
13A/Prof R Gyaneshwar
The CluesThe Clues
Hot flushesHot flushes
Irregular/absent periodsIrregular/absent periods
Short cycleShort cycle
AmenorrhoeaAmenorrhoea
Weight loss/Exercise/StressWeight loss/Exercise/Stress
Drug-inducedDrug-induced
Other diseaseOther disease
LHRH
FSHLHIrregular mensesIrregular menses
Weight gainWeight gain
PCOS signs/symptomsPCOS signs/symptoms
![Page 14: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/14.jpg)
14A/Prof R Gyaneshwar
Ovulation Tests – Ovulation Tests – Luteal Luteal ProgesteroneProgesterone
![Page 15: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/15.jpg)
15A/Prof R Gyaneshwar
Tubal FactorTubal Factor
PeristalsisPeristalsis Ciliary dysfunctionCiliary dysfunction NarrowingNarrowing BlockageBlockage
![Page 16: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/16.jpg)
16A/Prof R Gyaneshwar
Lap / DyeLap / Dye
![Page 17: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/17.jpg)
17A/Prof R Gyaneshwar
EctopicEctopic
![Page 18: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/18.jpg)
18A/Prof R Gyaneshwar
Pelvic Infection and Tubal Pelvic Infection and Tubal DiseaseDisease
![Page 19: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/19.jpg)
19A/Prof R Gyaneshwar
Pelvic Infection and Tubal Pelvic Infection and Tubal DiseaseDisease
![Page 20: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/20.jpg)
20A/Prof R Gyaneshwar
EndometriosisEndometriosis
![Page 21: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/21.jpg)
21A/Prof R Gyaneshwar
Minimal / Mild EndometriosisMinimal / Mild Endometriosis
Monthly fecundity rate 6.1 (laparoscopic surgery) vs 3.2 (diagnostic laparoscopy) per 100 person month
The Canadian Collaborative Group on Endometriosis 1997 NEJM 337:217
![Page 22: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/22.jpg)
22A/Prof R Gyaneshwar
HysteroscopyHysteroscopy
![Page 23: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/23.jpg)
23A/Prof R Gyaneshwar
Septate uterusSeptate uterus
![Page 24: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/24.jpg)
24A/Prof R Gyaneshwar
Congenital AnomaliesCongenital Anomalies
![Page 25: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/25.jpg)
25A/Prof R Gyaneshwar
Failure of sperm production
Blocked/absent vas deferens
Low sperm numbers and/or poor sperm movement
High numbers of abnormal shaped sperm
Antisperm antibodies
Erectile dysfunction
![Page 26: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/26.jpg)
26A/Prof R Gyaneshwar
Male FactorMale Factor
Primary Testicular DiseasePrimary Testicular Disease Most common cause of male factor infertilityMost common cause of male factor infertility AetiologyAetiology
66% unknown66% unknown 20% testicular maldescent20% testicular maldescent 7% trauma and torsion7% trauma and torsion 5% Klinefelter’s Syndrome5% Klinefelter’s Syndrome 1% mumps orchitis1% mumps orchitis 1% chemo1% chemo
![Page 27: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/27.jpg)
27A/Prof R Gyaneshwar
Male FactorMale Factor
Endocrine causesEndocrine causes HyperprolactinaemiaHyperprolactinaemia Hypogonadotrophic hypogonadismHypogonadotrophic hypogonadism HypothrooidismHypothrooidism
RareRare Present with sexual dysfunctionPresent with sexual dysfunction
![Page 28: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/28.jpg)
28A/Prof R Gyaneshwar
Sperm CountSperm Count
VolumeVolume 2 – 5 mls2 – 5 mls
Density/ConcentrationDensity/Concentration > 20 mill/ml> 20 mill/ml
MotilityMotility > 50%> 50%
MorphologyMorphology > 14% > 14% normalnormal
![Page 29: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/29.jpg)
29A/Prof R Gyaneshwar
Male InfertilityMale Infertility
Semen Analysis Semen Analysis (WHO 1999)(WHO 1999) 3 days of abstinence, collection technique, 72 3 days of abstinence, collection technique, 72
days for sperm to be ejaculateddays for sperm to be ejaculated Vol > 1 mlVol > 1 ml Concentration > 20 x 10Concentration > 20 x 106 6 / mL/ mL Motility > 50%Motility > 50% Morphology Morphology (WHO Strict Criteria 99)(WHO Strict Criteria 99) > > 15% 15%
normalnormal Note:Note: SA best performed in andrology lab; If SA best performed in andrology lab; If
abnormalabnormal always repeatalways repeat
![Page 30: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/30.jpg)
30A/Prof R Gyaneshwar
Sperm Count Variation in a Sperm Count Variation in a Healthy ManHealthy Man
![Page 31: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/31.jpg)
31A/Prof R Gyaneshwar
![Page 32: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/32.jpg)
32A/Prof R Gyaneshwar
Important ConceptsImportant Concepts
AgeAge Duration of infertilityDuration of infertility Primary versus secondary infertilityPrimary versus secondary infertility Multiple causes of infertilityMultiple causes of infertility Sub-fertility versus sterilitySub-fertility versus sterility
![Page 33: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/33.jpg)
33A/Prof R Gyaneshwar
HistoryHistory DurationDuration Previous pregnanciesPrevious pregnancies Wt / Ht / BMIWt / Ht / BMI Full menstrual historyFull menstrual history Androgenising signsAndrogenising signs Pelvic painPelvic pain Previous investigationsPrevious investigations Past medical historyPast medical history Past surgical historyPast surgical history Medications / cigarettes / alcoholMedications / cigarettes / alcohol
![Page 34: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/34.jpg)
34A/Prof R Gyaneshwar
HistoryHistory Previous paternitiesPrevious paternities Sexual dysfunctionSexual dysfunction Mumps / STDMumps / STD TraumaTrauma Undescended testesUndescended testes Previous investigationsPrevious investigations Past medical historyPast medical history Past surgical historyPast surgical history Medications / cigarettes/ alcoholMedications / cigarettes/ alcohol
![Page 35: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/35.jpg)
35A/Prof R Gyaneshwar
RANZCOG Statement RANZCOG Statement C-Obs 3 March 2004C-Obs 3 March 2004
Tests recommended at the first antenatal visit of Tests recommended at the first antenatal visit of each pregnancy:each pregnancy:
Blood group and antibody screenBlood group and antibody screen Full blood examinationFull blood examination Rubella Antibody statusRubella Antibody status Syphilis serologySyphilis serology Hepatitis B serologyHepatitis B serology Midstream urine examination by culture: Midstream urine examination by culture: eg dipslideeg dipslide HIV serologyHIV serology Hepatitis C serologyHepatitis C serology Cervical cytologyCervical cytology
![Page 36: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/36.jpg)
36A/Prof R Gyaneshwar
Prognostic FactorsPrognostic Factors
AgeAge Duration of infertilityDuration of infertility Primary versus secondary infertilityPrimary versus secondary infertility Multiple causes of infertilityMultiple causes of infertility Sub-fertility versus sterilitySub-fertility versus sterility
![Page 37: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/37.jpg)
37A/Prof R Gyaneshwar
Duration of InfertilityDuration of Infertility
The longer the duration of infertility, the The longer the duration of infertility, the greater the likelihood of a cause of greater the likelihood of a cause of infertility; infertility; ie the less likely that the situation ie the less likely that the situation is due to bad luckis due to bad luck
Treatment is more successful in patients Treatment is more successful in patients where a specific treatable cause is foundwhere a specific treatable cause is found
![Page 38: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/38.jpg)
38A/Prof R Gyaneshwar
PrognosisPrognosis
![Page 39: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/39.jpg)
39A/Prof R Gyaneshwar
Effect of Multiple Minor Effect of Multiple Minor AbnormalitiesAbnormalities
Number of Number of FactorsFactors
Monthly Monthly ChanceChance
% Pregnancy % Pregnancy in 2 yearsin 2 years
Mean Years Mean Years to Pregnancyto Pregnancy
00 20%20% 93.693.6 0.3 (4m)0.3 (4m)
11 5%5% 63.863.8 1.5 - 21.5 - 2
22 1%1% 20.720.7 77
33 0.2%0.2% 4.74.7 4040
![Page 40: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/40.jpg)
40A/Prof R Gyaneshwar
InvestigationsInvestigations
Tubal PatencyTubal PatencyHSGHSGLap & DyeLap & DyeOvulationOvulationMidluteal P4Midluteal P4Testosterone, TSH,Testosterone, TSH,Prolactin, LH, FSH asProlactin, LH, FSH asindicatedindicatedRubella, VaricellaRubella, VaricellaHep B, C, HIV, VDRLHep B, C, HIV, VDRL
Semen AnalysisSemen Analysis
LH, FSH, Prolactin as LH, FSH, Prolactin as indicatedindicated
KaryotypeKaryotype
Hep B, C, HIV, VDRLHep B, C, HIV, VDRL
![Page 41: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/41.jpg)
41A/Prof R Gyaneshwar
Hormone / Ovulatory TestsHormone / Ovulatory Tests Day 2-3 hormonesDay 2-3 hormones
FSH, LH, OestradiolFSH, LH, Oestradiol Testosterone, SHBGTestosterone, SHBG Others:Others:
17-OH P, DHEAS, Androstenedione, cortisol17-OH P, DHEAS, Androstenedione, cortisol TSH, prolactinTSH, prolactin 75g GTT & fasting insulin75g GTT & fasting insulin
Luteal ProgesteroneLuteal Progesterone 7 days prior to estimated date of period if regular7 days prior to estimated date of period if regular If irregular, start 7 days prior to shortest cycle date If irregular, start 7 days prior to shortest cycle date
and repeat every 5-7 days till next period arrivesand repeat every 5-7 days till next period arrives
![Page 42: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/42.jpg)
42A/Prof R Gyaneshwar
Treatment OptionsTreatment Options
AdviceAdvice AssessmentAssessment
OIOI Ovulation InductionOvulation Induction
IUIIUI Intrauterine InseminationIntrauterine Insemination
IVFIVF In Vitro FertilisationIn Vitro Fertilisation
ICSIICSI Intra Cytoplasmic Sperm InjectionIntra Cytoplasmic Sperm Injection
SSCSSC Surgical Sperm CollectionSurgical Sperm Collection
DonorDonor Sperm, Eggs or EmbryosSperm, Eggs or Embryos
![Page 43: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/43.jpg)
43A/Prof R Gyaneshwar
Ovulation InductionOvulation Induction
PCOSPCOS
11stst line lineClomiphene – 60% pregnant after 6 monthsClomiphene – 60% pregnant after 6 months
22ndnd line lineMetforminMetformin
FSHFSH
Surgical Ovarian DrillingSurgical Ovarian Drilling
![Page 44: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/44.jpg)
44A/Prof R Gyaneshwar
Ovarian DrillingOvarian Drilling
![Page 45: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/45.jpg)
45A/Prof R Gyaneshwar
Ovarian InductionOvarian Induction
Hypothalamic amenorrhoeaHypothalamic amenorrhoeaFSHFSH
Pulsatile GnRHPulsatile GnRH
HyperprolactinaemiaHyperprolactinaemiaCarbergolideCarbergolide
![Page 46: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/46.jpg)
46A/Prof R Gyaneshwar
Intrauterine InseminationIntrauterine Insemination
IndicationsIndicationsUnexplainedUnexplained
Mild male factorMild male factor
Success/CycleSuccess/CycleNatural 10-15%Natural 10-15%
Stimulated 15-20%Stimulated 15-20%
![Page 47: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/47.jpg)
47A/Prof R Gyaneshwar
In Vitro FertilisationIn Vitro Fertilisation
IndicationsIndicationsProlonged unexplainedProlonged unexplained
Tubal factorTubal factor
Severe male factorSevere male factor
Unsuccessful OI / IUI / fertility surgeryUnsuccessful OI / IUI / fertility surgery
![Page 48: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/48.jpg)
48A/Prof R Gyaneshwar
In Vitro FertilisationIn Vitro Fertilisation
Success / CycleSuccess / Cycle40 – 5-%40 – 5-%
Single embryo transferSingle embryo transferNow gold standardNow gold standard
Twin rate 1%Twin rate 1%
![Page 49: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/49.jpg)
49A/Prof R Gyaneshwar49
Sperm Preparation
![Page 50: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/50.jpg)
50A/Prof R Gyaneshwar50
![Page 51: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/51.jpg)
51A/Prof R Gyaneshwar51
![Page 52: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/52.jpg)
52A/Prof R Gyaneshwar52
![Page 53: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/53.jpg)
53A/Prof R Gyaneshwar53
Day surgery for egg collection
![Page 54: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/54.jpg)
54A/Prof R Gyaneshwar54
IVF (In Vitro Fertilisation) ICSI (Intra Cytoplasmic
Sperm Injection)
![Page 55: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/55.jpg)
55A/Prof R Gyaneshwar55
IVF (In Vitro Fertilisation
![Page 56: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/56.jpg)
56A/Prof R Gyaneshwar56
ICSI (Intra Cytoplasmic Sperm Injection)
![Page 57: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/57.jpg)
57A/Prof R Gyaneshwar
Fertilisation Day 2 Day 3
Day 4Day 5
BlastocystDay 5
Blastocyst
![Page 58: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/58.jpg)
58A/Prof R Gyaneshwar58
Fate of recovered eggs (averages)
![Page 59: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/59.jpg)
59A/Prof R Gyaneshwar59
Embryo transfer
![Page 60: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/60.jpg)
60A/Prof R Gyaneshwar60
Pregnancy blood test
2 weeks after embryo transfer
![Page 61: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/61.jpg)
61A/Prof R Gyaneshwar61
Embryo freezing
![Page 62: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/62.jpg)
62A/Prof R Gyaneshwar62
Oocyte Oocyte CryopreservationCryopreservation
AuthorAuthor MethodMethod Survival Survival rate, n (%)rate, n (%)
Fertilisation Fertilisation rate, n (%)rate, n (%)
No. of No. of oocytes per oocytes per pregnancypregnancy
Fabbri (2001)Fabbri (2001) Slow-FreezeSlow-Freeze 796/1,502 (53)796/1,502 (53) 632/796 (79)632/796 (79) 9494
Chen (2005)Chen (2005) Slow-FreezeSlow-Freeze 119/159 (75)119/159 (75) 80/119 (67)80/119 (67) 2323
Boldt (2006)Boldt (2006) Slow-FreezeSlow-Freeze 218/361 (60)218/361 (60) 124/218 (61)124/218 (61) 2626
Yoon (2003)Yoon (2003) VitrificationVitrification 325/474 (69)325/474 (69) 142/198 (72)142/198 (72) 7979
Kuwayama Kuwayama (2005)(2005)
VitrificationVitrification 58/64 (91)58/64 (91) 52/58 (90)52/58 (90) 55
Jain. Fertil Steril 2006
![Page 63: Understanding Infertility Basic Sciences A/Prof R Gyaneshwar FRANZCOG, MH.Ed Clinical Director of Obstetrics & Gynaecology Liverpool Health Service Conjoint](https://reader031.vdocument.in/reader031/viewer/2022032702/56649cd75503460f9499e8a8/html5/thumbnails/63.jpg)
63A/Prof R Gyaneshwar63
Any Questions?