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
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Urine routine and microscopic
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Cervical mucus examination
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Abdominal pelvic USS-to look for polycystic ovaries, larger ovarian cysts, fibroids, and, sometimes, to confirm ovulation is taking place.
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HSG (hysterosalpingogram) to check that the fallopian tubes are open and not blocked, as well as to evaluate the shape of the uterus.
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Hysteroscopy- This is done if an HSG examination showed potential abnormalities or was inconclusive.
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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.
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Hormonal profile- FSH, LH,T3 & T4,Testosterone, prolactin, estradioland progesterone
MEN: Perform the following
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Semen analysis
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VDRL tests
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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.
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Educate the couple on the importance of having sexual intercourse during the fertile window
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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)
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Metformin 500mg 8 hourly (sometimes used during PCOS treatment, alone or along with fertility drugs)
Hyperprolactinemia
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Bromocriptine 2.5–5mg once per day until the prolactin level is within the normal range
Surgeries:
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Tubal surgery for Tubal blockage
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Myomectomy for uterine fibroids
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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