Infertility Practice Sudhir R Shah, Beena N Trivedi, Dipal D Solanki, Manish R Pandya
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1Step by Step Infertility Practice
2Step by Step Infertility Practice
Sudhir R Shah MD DGO FICOG Head, Department of Obstetrics and Gynecology Dashashrimali Hospital, Rajkot, Gujarat Manish R Pandya MD Associate Professor Department of Obstetrics and Gynecology CU Shah Medical College Surendranagar, Gujarat Beena N Trivedi MD Senior Gynecologist Department of Obstetrics and Gynecology Dashashrimali Hospital, Rajkot, Gujarat Dipal D Solanki MD Gynecologist Department of Obstetrics and Gynecology Dashashrimali Hospital, Rajkot, Gujarat
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Step by Step Infertility Practice
© 2007, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
This book has been published in good faith that the material provided by authors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2007
9788180619861
Typeset at JPBMP typesetting unit
Printed at Paras4
We dedicate this booklet to our patients who kept full faith in us and encouraged us indirectly to write this small booklet.
Our family members and friends without whose constant inspiration and cooperation this attempt would not have been completed.
Shri JP Vij of Jaypee Brothers Medical Publishers, New Delhi for constant cooperation and inspiration.
5Foreword
In my academic career spanning over more than two decades I have penned many reviews, recommendation, analysis and opinions. Never did I find myself however in a position as difficult and as pleasant as writing a foreword for this book. This is because the author Dr Sudhir R Shah is my teacher!
Dr Sudhir R Shah taught me at Medical College, Baroda when I was doing my postgraduation. For me, to write a foreword for this book is one of the most satisfying situations for my life as my teacher is blessing me. On the opposite side it speaks volumes of humility of Dr Sudhir R Shah to ask his student to write a foreword. In all honesty, I feel blessed.
Infertility science advances so fast that we have to run to be at the sample place. This makes clinical practitioners seek aid from books and literature to make their approach scientific and result oriented without making the going very difficult. Precisely this is what this book does. Quickly brushing through the anatomy and physiology of the most complicated system in human body, the reproduction system, the book launches itself to guide the reader systematically right from history taking to adoption. Even the psychological 6aspects have been touched. A readymade set of slides accompanying are an added asset.
Very wisely anovulation is approached quite elaborately and with practical tips. The most important cause of infertility in females is dysovulatory problems. This book keeps it in focus sharply. Different regimes and protocols of ovulation stimulation are very helpful. Other areas of infertility in females including endometriosis and a broad guidance of ART are also very apt. Male infertility is a big challenge for clinicians. The way the book approaches this problem I am sure it will make the approach of the treating doctor more rational.
At the end, I pray to Goddess Aetheas (The Goddess of learning—Maa Saraswati) that may this book guide its readers in such a way that both the reader and the couple are aided by being treated scientifically causing no harm.
Dr Pankaj D Desai
Professor of Obstetrics and Gynaecology
Department of Obs and Gyn
Medical College and SSG Hospital, Baroda
Elected President FOGSI, 2007
7Preface
At any given time, in India, approximately more than 15 to 20 percent of couples are having problems of becoming parents of a nice and healthy child. More than eighty percent of those couples have a problem in conceiving because of some problems concern to either wife, husband or both. This make a large number of patients seek expert medical help to solve their problems and here the word gynecologist enter in their life. Twenty percent of those childless couples consult gynecologist directly and remaining follows a protocol route through their family physicians, which treat them for a certain period and then refer them to gynecologist.
Again at any given time thousands of medicos having postgraduate degree in obstetrics and gynecology enter in the active practice every year. The main work they take up is of obstetricians and treating gynec patients become part of their routine practice. Six out of ten patients in their out door clinics are pregnant patients making them the members of antenatal clinics. Two or three are having some menstrual or other gynec complaints after completing their phase of child bearing.
One or two out of ten routine patients have genuine problems of infertility. That is inability to conceive after all sorts of trial and error. Thus, practically a busy Obstetricians and Gynecologist is facing one such apprehensive couple seeking for a child after managing 8routine nine normal patients in their clinics. Busy and easy practice in other patients give shortest possible time and less enthusiasm to face such a patients. As we all know, the science of infertility practice is fastest advancing and need through counseling and management. Time and mood of treating experts prevents them to give their best to such patients.
Hundreds of excellent specialized infertility clinics have started now in India where doctors are doing only infertility practice. But all patients cannot afford and go to them in the initial phase of their treatment and hence seeks advice from their family gynecologist.
This book has been written for those eighty percent of gynecologist who are actively doing all sorts of practice which comes under the roof of Obstetricians and Gynecologist. Out of our twenty years experience in treating such childless couple at routine gynec clinic we felt that there is a need of simplest book on initial infertility practice for all such eighty percent of gynecologist in most practical aspect of the management. The emphasis is on most basic principles, which are slowly being forgotten due to the invasion of newer methodology in treating infertile couple.
This book aims to help all busy gynecologists doing all sorts of practice and treating infertile couples too, as a part of their practice. They should know the basics of anatomy and physiology of pregnancy science, perfect way of history taking and to the top of everything about couple counseling. They may start the management with minimum investigation and maximum routine 9guidance. Keep all etiological factors of infertility in mind and start managing the patient.
The book includes basics of infertility problems and how the problem should be managed step by step at our own clinics before referring the patients to specialized infertility clinics.
Wishing you happy and absorbing reading.
Sudhir R Shah
Manish R Pandya
Beena N Trivedi
Dipal D Solanki
10Acknowledgements
We are thankful to our Friends.
Dr Pankaj Desai, Dr Pravin Patel, Dr Manish Banker, Dr Tushar Shah, Dr CB Nagori, Dr Himanshu Bavishi who are experts in the field of infertility science.
Mrs Jyoti Shah, Dr Nimish Trivedi, Dr Dharmesh Solanki and Dr Nehal Pandya better halves of the team of authors.
Number of our friends and colleagues who helped us in many ways.
M/s Jaypee Brothers Medical Publishers Pvt. Ltd., New Delhi for excellent moral support and keen interest in the publication of this book.
11References
As a matter of fact this small booklet is the result of knowledge gained after reading number of books on this subjects ranging from Indian authors and International authors, publications of FOGSI, journals and recents advances added with the personal experience gained by attending numbers of conferences, seminars and workshop in the subject of infertility.
For the details of each chapters readers are requested to go through the textbooks and special infertility publications.