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By ULY CLINIC

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Infertility

 

Introduction

 

Infertility is a condition of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.

 

Investigation:

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  • Not every fertility test will be done for every case.

 

WOMEN: For women, fertility testing may include basic gynaecologic examination

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  • VDRL tests

  • Urine routine and microscopic

  • Cervical mucus examination

  • Abdominal pelvic USS-to look for polycystic ovaries, larger ovarian cysts, fibroids, and, sometimes, to confirm ovulation is taking place.

  • HSG (hysterosalpingogram) to check that the fallopian tubes are open and not blocked, as well as to evaluate the shape of the uterus.

  • Hysteroscopy- This is done if an HSG examination showed potential abnormalities or was inconclusive.

  • Diagnostic laparascopy- This test is only done when symptoms point to possible endometriosis, as part of treatment for blocked fallopian tubes, or in some cases of unexplained infertility.

  • Hormonal profile- FSH, LH,T3 & T4,Testosterone, prolactin, estradioland progesterone 

 

MEN: Perform the following

  • Semen analysis

  • VDRL tests

  • Hormonal profile-FSH,Testosterone, but sometimes also LH, estradiol, or prolactin 

 

Treatment will depend on the underlying cause

 

Non-pharmacological treatment

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  • Weight reduction in obese clients.

  • Educate the couple on the importance of having sexual intercourse during the fertile window

  • Try to avoid smoking/excessive drinking 

 

Pharmacological treatment

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Ovulation stimulation;

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  • Clomiphene citrate 50mg (PO) once per day for seven days from the 2nd–5th day of menstruation.(maximum 6 cycles) 

 

Polycystic Ovarian Syndrome (PCOS)

 

  • Metformin 500mg 8 hourly (sometimes used during PCOS treatment, alone or along with fertility drugs) 

 

Hyperprolactinemia

 

  • Bromocriptine 2.5–5mg once per day until the prolactin level is within the normal range 

 

Surgeries:

 

  • Tubal surgery for Tubal blockage

  • Myomectomy for uterine fibroids

  • Ovarian drilling is a possible surgical infertility treatment for PCOS–related infertility 

 

Referral

 

Refer all patients with infertility to a gynecologist

 

 

Updated on, 3.11.2020

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References

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1. STG

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