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Infertility Practical Insights in Management
K Jayakrishnan
1:
Is Human Fertility Declining?
INTRODUCTION
IS THE SPERM COUNT DECLINING?
Environmental Factors and Infertility
POLYCYSTIC OVARY SYNDROME AND ENDOMETRIOSIS–IS IT ON THE INCREASE?
ERECTILE DYSFUNCTION
CONCLUSIONS
2:
Controlled Ovarian Hyperstimulation (COH) for Assisted Reproductive Technology (ART)
INTRODUCTION
DRUGS USED FOR SUPEROVULATION
DRUGS COMMONLY USED FOR SUPEROVULATION
Use of Clomiphene Citrate (CC)
Indication for Cancelling Cycles
Use of hCG in Stimulated Cycles
Advantages of Use of CC
Disadvanatages of CC Stimulated Cycle
Use of Gonadotropin for Induction of Ovulation in IVF
Combined Use of Pure FSH and hMG
Use of Gonadotropin Releasing Hormone Analogs (GnRHa)
GnRH Agonist
Ultrashort Protocol
Short Protocol (Flare-up Protocol)
Long Protocol
Disadvantages of Long-term Down Regulated Protocol with GnRH Agonist
INDUCTION OF OVULATION IN SPECIAL CIRCUMSTANCES
Hypogonadotropic Hypogonadal Women
Women with Borderline Hypergonadotropic Levels
Women with PCO
Women with Endometriosis
USE OF GNRH ANTAGONISTS
Method of Using GnRH Antagonists in Induction of Ovulation
3:
Embryo Transfer (ET): Is There a Perfect Technique?
INTRODUCTION
OPTIMIZING THE ET TECHNIQUE
REVIEW OF LITERATURE
CRITERIA FOR IDEAL ET
SUMMARY
CONCLUSIONS
4:
Fibroids in Infertility Management
INTRODUCTION
ETIOPATHOGENESIS
TYPES OF FIBROIDS
FIBROIDS IN INFERTILITY
DIAGNOSIS
MANAGEMENT
ART Following Myomectomy
Hysteroscopic Myomectomy
Laparotomy or Laparoscopy?
REPRODUCTIVE OUTCOME
RECENT ADVANCES
CONCLUSIONS
5:
GnRH Agonists versus Antagonists
INTRODUCTION
AGONISTS
ANTAGONISTS
IN SUMMARY OF POTENTIAL BENEFITS OF ANTAGONISTS IN COMPARISON TO THE AGONISTS
CONCLUSIONS
6:
Role of IUI in Male Factor Infertility
INTRODUCTION
CAUSES OF MALE INFERTILITY
Temporary and Lifestyle Causes of Low Sperm Count
Emotional Stress
Sexual Issues
Testicular Overheating
Substances Abuses
Smoking
Nutrient Deficiencies
Genetic Factors
Defective Genetic Material
Inherited Disorders
Environmental Factors
Free Radicals (oxidants)
Exposure to Heavy Metals
Low Semen Levels
Varicoceles
Autoantibodies
Physical or Structural Abnormalities
Infections
MALE EVALUATION
Initial Screening Evaluation for Infertility
Semen Analysis
Specialized Clinical Tests on Semen and Sperm
TREATMENT OF MALE INFERTILITY
NATURAL CYCLE VERSUS OVARIAN STIMULATION IN CONJUNCTION WITH IUI
TIMING / INDUCTION OF OVULATION, FREQUENCY OF INSEMINATION
PREDICTION OF PREGNANCY
Factors Related to the Couple
Female Parameters
Male Parameters
SPERM PROCESSING METHODS
CONCLUSIONS
7:
Newer Modalities in Management of PCOS
INTRODUCTION
RECOMMENDATIONS AGAINST SCREENING FOR INSULIN RESISTANCE
INSULIN SENSITIZERS
Metformin
Unresolved Problems with Metformin
Thiazolidinediones
D-chiroinositol
Aromatase Inhibitors
CONCLUSIONS
8:
Male Sexual Dysfunction and Infertility
INTRODUCTION
MSD CAUSING INFERTILITY
Unconsummated Marriage (UCM)
Infrequent Intercourse
Peri-ovulatory Failure
Ejaculatory Disturbances
Premature Ejaculation (PME)
Retrograde Ejaculation
Anejaculation (Shah, 1999a)
DIAGNOSING MALE SEXUAL DYSFUNCTION
MANAGING INFERTILITY DUE TO SEXUAL DYSFUNCTION
Counseling
Oral Erectogenic Drugs
Sildenafil
Vardenafil
Tadalafil
Injectable Erectogenic Drugs
Penile Prosthesis Implantation
Vacuum Therapy
Vibrator and Electro-ejaculation Therapy
Unconsummated Marriages
Sex Education
Erectogenic Drugs
Vaginal Self-dilation
Marital Counseling and Conflict Resolution
Psychotherapy
Homosexuality Resolution
PREVENTING MSD DURING INFERTILITY TREATMENT
Timing of Intercourse
Semen Collection
Unrealistic Sexual Goals
Prophylactic Oral ED Drugs
CONCLUSIONS
9:
Evaluation of Male Infertility
INTRODUCTION
CLINICAL EVALUATION
Childhood and Pubertal Development
Coital Adequacy and Timing
General Health
Stress
Testicular Symptoms
Iatrogenic Infertility
Antispermatogenic Factors
PHYSICAL EXAMINATION
Virilization
Gynecomastia
External Genitalia
Orchoimetry
Testicular Abnormalities
Epididymal Abnormalities
Vasal Abnormalities
Checking for Varicocele
Miscellaneous Abnormalities
LABORATORY EVALUATION
Semen Analysis
Sample Collection and Delivery
Macroscopic Evaluation
Microscopic Evaluation
Sperm Count
Sperm Motility
Round Cells
Sperm Agglutination
Sperm Viability
Sperm Morphology
Hormonal Evaluation
Genetics and Male Infertility
10:
Iatrogenic Factors in ART
INTRODUCTION
PROBLEMS OF CONTROLLED OVARIAN HYPERSTIMULATION
Ovarian Hyperstimulation Syndrome
Predisposing Factors
Grades of OHSS
Prediction of OHSS
Treatment
Prevention of OHSS
PROBLEMS DUE TO TRANSVAGINAL ASPIRATION AND EMBRYO TRANSFER
Bleeding
Vaginal Bleeding
Intraperitoneal or Retroperitoneal Bleeding
Pelvic Infection
Extrauterine Pregnancy
Ectopic and Heterotopic Pregnancies
Multiple Pregnancy
Concerns Regarding IMP
Problems in the Mother
Causes of Maternal Morbidity
Options Available in IMP
Multifetal Pregnancy Reduction
CONCLUSIONS
11:
Myoma in Modern Perspectives
INTRODUCTION
HISTORY
WOMEN AT RISK
ASYMPTOMATIC MYOMA
MYOMA RELATED INFERTILITY AND REPRODUCTIVE FAILURE
PREGNANCY AND MYOMA
Leiomyoma and Leiomyosarcoma
ASSESSMENT OF MYOMA—APPLICATION OF IMAGING SCIENCES
FIBROIDS—MEDICAL THERAPY
LAPAROSCOPIC MYOMECTOMY
UTERINE ARTERY EMBOLIZATION FOR FIBROIDS
FIBROIDS—TRADITIONAL SURGERY
TECHNIQUES TO LIMIT BLOOD LOSS
VAGINAL MYOMECTOMY
HYSTERECTOMY FOR FIBROIDS
CONCLUSION
A PHYSICIAN'S PRAYER
12:
Recurrent Pregnancy Loss: What can ART Offer?
INTRODUCTION
FETAL KARYOTYPING AND PGD
SURROGACY
PARENTAL CHROMOSOMAL REARRANGEMENTS
OLDER AGE GROUPS
AUTOIMMUNITY
CONCLUSIONS
13:
PCOS: Etiology and Diagnosis
INTRODUCTION
ETIOLOGY
The Hypothalamic Connection
The GnRH Pulse Generator
Insulin Resistance and Molecular Defects in Insulin Signaling
Stimulation of Ovarian Cytochrome P45OC17A by Insulin
Hyperinsulinemia Leads to Hyperandrogenemia
The Skin and Adipose Tissue
Hyperprolactinemia in PCOS
Leptin
DIAGNOSIS
Ultrasonographic Appearance
Endocrine Screening
Glucose Tolerance Test
14:
Current Concepts in Treating PCOS
INTRODUCTION
INCIDENCE
MANAGEMENT
Weight Loss and Life-style Modifications
Clomiphene Citrate
Use of Insulin Sensitizers
Other anti-estrogens in Ovulation Induction
Gonadotropins
Standard step-up Protocol
Step-down Protocol
Chronic Low Dose Protocol
Sequential Step-up, Step-down Protocol
Laparoscopic Ovarian Drilling
CONCLUSIONS
15:
Posthumous Reproduction: Ethical Challenges in Reproductive Medicine
ABSTRACT
INTRODUCTION
OUR EXPERIENCE
LEGAL AND SOCIAL STATUS OF THE CHILD
THE FUTURE
CONCLUSIONS
16:
Issues of Fertility for Cancer Patients
CANCER
DEVELOPMENTS IN FERTILITY PRESERVATION
SCIENTIFIC AND CLINICAL BACKGROUND
Fertility
SUMMARY
CONCLUSIONS
INDEX
TOC
Index
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