Tubo-uterine Factors in Infertility Surveen Ghumman
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1Step by Step Tubo-uterine Factors in Infertility
2Step by Step Tubo-uterine Factors in Infertility
Surveen Ghumman MD Specialist Department of Obstetrics and Gynecology Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Step by Step Tubo-uterine Factors in Infertility
© 2007, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication and DVD-ROM 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 author and the publisher.
First Edition: 2007
9788184480191
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd, Sector 60, Noida4
5
6Contributors 8Foreword
Infertility, though not a public health priority in many countries, is a central issue in the lives of the people who suffer from it. A multinational study by WHO that included India, placed the incidence of infertility between 10 and 15%. In a country like ours, where the very existence of mankind centers around procreation, womanhood is defined through motherhood and the essence of the very religion, with all its cultures and traditions, is about the celebration of fertility, an estimated 25% of the population (about 250 million individuals) may be conservatively estimated to be attempting parenthood at any given time. By extrapolating the WHO estimates, approxi-mately 13 to 19 million couples are likely to be infertile in the country at any given time.
In the past decade, developments in the field of ART have intensified the hopes and wishes of infertile people to resolve their infertility and have resulted in an increasing demand for such services in both developed and developing countries. The increasing effort and determination on the part of researchers, clinicians and surgeons alike to overpower and eliminate the crippling stigma of infertility and the promise to help every infertile couple experience the reality of parenthood has led to aggressive research and a plethora of information in the fields of reproductive endocrinology and infertility. The growing challenge of providing a therapy for every cause of infertility is obviously accompanied with efforts to obviate the complications that beset these therapies.9
This remarkably concise and clear book deals with the many issues relating to uterotubal factor in infertility, including evaluation of the uterine cavity and the laparoscopic and hysteroscopic management of the condition. Not all problems are alike, and this book will satisfy different needs of different people by touching upon a diverse range of problems, from fibroids to intrauterine adhesions to endometriosis. It holds a treasure of information for all interested in helping infertile patients. I am sure that any practicing physician who treats infertile patients will greatly benefit from reading this well written book.
I would like to congratulate the contributors and the editor Dr. Surveen Ghumman of the book for their valuable effort and time in creating an interesting and scientifically stimulating book that would be hard to put down.
Gautam N Allahbadia md dnb fnams
Consultant Fertility Physician
Dr LH Hiranandani Center for Human Reproduction
Dr LH Hiranandani Hospital, Powai, Mumbai
Scientific Director
Prince Aly Khan Hospital IVF Center and the Aesculap
Academy – Asia Pacific Center for Minimally Invasive
Surgery, Training and Research, Mazagaon, Mumbai
Medical Director
Rotunda – The Center for Human Reproduction
Bandra, Mumbai
10Preface
Fertility therapy continues to expand most rapidly into superspecialized areas of assisted reproductive techniques. While the scientists have been busy making successful advances in these areas the clinical approach and therapy has also taken a great step forward to minimize the time taken to reach a diagnosis and direct a couple to appropriate therapy.
Tubo-uterine causes of infertility have been gradually increasing in importance in the field of infertility management. Their incidence is between 25 to 40% in the infertile patient. Keeping these factors in mind this book has been written to enable a practicing clinician to have a concise road map in dealing with such patients.
Evaluation of the uterine cavity, tubal structure and function along with their imaging forms the basis on which the diagnosis depends are dealt in detail. The various conditions like fibroids, ectopic pregnancy and other intrauterine, tubal and peritubal pathologies have been discussed in the various chapters with special reference to their diagnosis and management. Medical and surgical management have been explained with flow charts, diagrams and photographs. Keeping in view the theme of the book the chapter on endometriosis deals extensively with the postsurgical management of the infertile woman. With the advent of endoscopes, early diagnosis and minimal tissue handling during surgical procedures has led to successful treatment of a vast number of cases. Separate chapters on the minimal invasive surgical management have been incorporated. This includes photographs of instrumentation and of the actual procedure. Postoperative adhesions 11in the abdominal cavity are an important cause of infertility and a separate chapter deals with its prevention.
This book has been written as a practical guide with the aim of placing the modern approach to the management of infertility in the context of sound theory, evidence based therapy and recent advances. A comprehensive classification, investigation and management of all tubouterine factors causing infertility have been presented in the book.
In this day of information overload this book is an attempt to integrate information into a practice management protocol that is rational, logical and rewarding for the reader.
I hope this book is stimulating enough to help every practising infertility specialist to solve dilemmas in dealing with tubouterine pathologies in their patients enabling them to achieve the desired goal—A successful pregnancy in all patients.
Surveen Ghumman
12Acknowledgements
I am indebted to Dr R.N. Salhan, Medical Superintendent of Safdarjung Hospital and Vardhman Mahavir Medical College for his encouragement and support. I sincerely thank Dr Sudha Salhan, Professor and Head of Department of Obstetrics and Gynecology at Safdarjung Hospital for encouraging me in this academic pursuit.
I thank all the contributors for their well researched chapters and for sparing their invaluable time and intellectual skills. I have thoroughly enjoyed interacting with all the authors during this academic venture.
I would also like to acknowledge the invaluable contribution of the team and artists at my publishers, M/s Jaypee Brothers Medical Publishers (P) Ltd. for making this volume in its present form.
I would like to extend my gratitude to my family for bearing with me for the time I have invested in this project rather than spend with them. The constant support, help and encouragement I received from my husband went a long way in bringing this book together. A special thanks to my daughters who helped in many ways. I would also like to thank my parents for guiding me to reach this day.
Although this book has my name on it but it is a combined effort of all above without which it would not have its present form.