Managing Subfertility in SAFOG Region Rohana Haththotuwa, Narendra Malhotra, Yousaf Latif Khan
INDEX
Page numbers followed by f refer to figure, fc refer to flowchart
A
Acquired immunodeficiency syndrome 62
Activated partial thromboplastin time 75
Adoption 69
Advice regarding hygiene 33
Alanine aminotransferase 71
Albumin 71
Alcohol 66
Alkaline phosphatase 71
Amenorrhea 18, 19, 35, 77
American Society of Reproductive Medicine 31
Anemia 61
correction of 33
Angiotensin-converting enzyme inhibitors 60
Anovulation 77
Antagonist protocol 45
Anti-Mullerian hormone 34
Antral follicle count 30, 34
Anus 6
Anxiety 63
Apareunia 20, 77
Aromatase inhibitors 34, 35
Aspartate aminotransferase 71
Assisted reproductive technique 32, 36, 38, 39, 43, 44
procedures of 83
stages of 44
Asthenospermia 16
Azoospermia 4, 16, 18, 22, 24, 41, 53, 77, 79
factor region 52
nonobstructive 82
obstructive 44, 51, 82
B
Bacterial vaginosis 19, 62
Bartholin's glands 6, 77
Basal body temperature chart 26
Beta-human chorionic gonadotropin 73
Bicarbonates 72
Bilirubin 71
Blood
complete examination 71
pressure 58, 60
high 60, 63
urea nitrogen 72
Body mass index 30, 39
Borderline high cholesterol 72
Brain 13
C
Cancer 61
irradiation 55
Cervical mucus
hostility 39
self-test of 26
Cervix 7, 13, 26
Chemotherapy 17, 61, 77
Chlamydia 19, 62
Chloride 72
Cholesterol 72
high 72
Chorionic villus sampling 61
Chromosomal defects 16
Chromosome 77
studies of 24
Cilia 14, 77
Clomiphene 35, 36
citrate 3335, 38
Coagulation profile 75
Coital difficulties 22
Coitus 6, 7, 10, 13, 64, 77
infrequent 20
Controlled ovarian stimulation 38, 44
Convulsions 60
Cornual block 29f
Corpus luteum 78
Creatinine 72
Cryopreservation 49, 78
bank 17
Cyclical fashion 78
D
Deep vein thrombosis 59, 63
Delivery, mode of 49
Depression 63, 67
Diabetes mellitus 5860, 63
Diet 59
Donor
egg 55
sperm 55
pregnancy 55
Down's syndrome 58
Ducts 3, 5
Dyspareunia 78
E
Eclampsia 60
Eggs 49
fertilization of 10, 11
freezing 50
retrieval of 44
Ejaculation 4, 78
premature 20, 22, 40
Embryo 14, 43, 49, 54, 55
cryopreservation 49
transfer 32, 43, 44, 47, 48, 78
Endometrial biopsy 27
Endometrial receptivity array test 47
Endometriosis 19, 44
Endometrium 7, 78
Epididymis 5
Epilepsy 63
Epithelial cells 76
Erectile dysfunction 20, 22
Erectile tissue 4, 78
Estimated glomerular filtration rate 72
Estradiol 73
hormonal estimation of 26
Estrogens 8, 9, 12
European Society of Human Reproduction and Embryology) 31
Exercise 63
F
Fallopian tubes 6, 8, 13, 14, 30
Fatigue 35
Female eggs 10, 12
cell 10
defect in production of 18
production of 8, 25
Female front passage 6
Fertilization 8, 10, 11, 13, 43, 44, 78
failure of 54
Fertilized egg, embedding of 10
Fetus 10, 79
Fibroids 19, 30, 64, 78
Fimbrial block 29f
Fine-needle aspiration cytology 24, 79
Fits 60
Flu 63
Follicle-stimulating hormone 11, 24, 3335, 73, 79
Frigidity 13, 80
Frozen embryo transfer 38, 49
Fructose, absence of 24, 51
G
Genital organs 3, 79
female 6, 6f, 7f, 10
male 3, 3f, 5, 6, 10
Genital tract, congenital defects of 39
Germ cells 5, 84
absent of 53
male 10, 11, 16
Globulin 71
Glutamyl transferase 71
Gonadotropin 34, 36, 46, 79
preparations 37
releasing hormone 35
analogs 79
antagonists 79
Gonads
female 6, 8
male 4
Gonorrhea 22, 62
H
Hair, excessive growth of 21
Hard drugs 66
Head piece defects 76
Headache 35
Heart disease 65
Heat flash 36
Heavy periods 61
Hemoglobin 61, 71
Hepatitis 66
screening for 66
Hernia 79
operation for 21
Herpes 62
Hormone 5, 79
female 8
male 10, 11, 81
profile 24, 27
Hot climate 17
Human body, structure of 77
Human cell, normal 11
Human chorionic gonadotropin 35
Human immunodeficiency virus 62
Husband's low count 44
Husband's test 23f
Hydrocele 4, 17, 23, 79
Hydrosalpinx 29
Hymen 7
Hypertension 5860
Hypospadias 8, 40
Hysterosalpingography 28, 34, 39
I
Implantation 10, 14, 44, 54, 80
Impotence 13, 16, 18, 51, 80
In vitro fertilization 17, 27, 32, 43, 52, 70, 79, 80
Infections 1719, 34, 39
Injury 17
Insemination 44
Instinctive desire 80
Intestinal tract 6
Intracytoplasmic sperm injection 17, 32, 49, 53, 70, 79
Intrauterine growth restriction 65
Intrauterine insemination 40, 80
indications for 40
repeated failure of 44
Intrauterine sperm injection 41, 42
Introitus 80
Irradiation 85
K
Karyotyping 24
Klinefelter syndrome 16
L
Lactation 18, 80
Laparoscopic ovarian diathermy 34, 38
Laparoscopy 28, 30, 80
Letrozole 34, 35
Leukorrhea 81
Leydig cells 12, 81, 84
Libido 5, 22, 81
Lipid profile 72
Lipoprotein
high-density 72
low-density 72
very-low-density 72
Liver function tests 71
Low sperm count 51
Luteal phase support 44, 47, 81
Luteinizing hormone 11, 24, 26, 33, 35, 73, 79
Lymphocytes 71
M
Malformation 81
Maturation 12
Measles 63
Menopause 8, 81
Menstrual cycle 30
Menstruation 8, 19, 81
absence of 18
heavy 21
irregular 21
Metabolic disease 81
Metformin 34
Microsurgical operation 53
Mid-cycle peak 73
Mid-piece defects 76
Miscarriages 48, 81
history of 21
Misconceptions 4
Monocytes 71
Monopolar diathermy 38
Mood swings 35
Motility 82
Multiple births 37
Mumps 17, 22, 55, 82
Muscle aches 35
N
Nausea 35
Nervous system 13
Neurosis 63
Neutrophils 71
Noninvasive prenatal testing 61
O
Oligospermia 4, 16, 41, 44, 51, 82
Oral contraceptive pill 63
Organs 82
external 78
function of 3
internal 80
male 3
structure of 3
Orgasm 82
Ova 10, 12
Ovarian cysts 64
Ovarian hyperstimulation syndrome 37
Ovarian stimulation 40, 41, 45, 82
Ovaries 6, 8, 30, 55
controlled stimulation of 33, 44
hyperstimulation of 36
monitoring of 44
overstimulation of 37
stimulation of 37
Overweight 21
Ovulation 12, 18, 82
absent of 34fc, 44
induction of 32, 33, 80
infrequent 44
phase 73
predictor kit 26
tests of 25
Ovum 8, 10, 12
pick up 44, 46
P
Painful sexual intercourse 20
Passages, obstruction in 16, 18, 19, 53
Pelvic inflammatory disease 83
Pelvic organs 21
Penis 3, 4
malformation of 18
Periods 8, 12
Peristalsis 14, 83
Phallus 3
Piles 61
Pipelle test 27
Pituitary gland 11
Placenta 83
Platelet count 71
Polio drops 63
Polycystic ovarian
disease 38, 63
syndrome 33, 34, 38
Postcoital test 34
Potassium 72
Preeclampsia 60
Pregnancy 1, 3, 5, 10, 48, 58, 73, 65
establishment of 14
loss, early 48
multiple 36, 48, 82
spontaneous 58
Preimplantation genetic testing 83
Premature ovarian insufficiency 55
Progesterone 8, 9, 12, 25, 73, 83
test 27
Prolactin 24, 73
Prolapse 39, 83
Prostate gland 5, 83
Prostatitis 21
Prothrombin 75
Psychiatric disorder 63
Psychological disease 83
Puberty 8, 83
Pus cells 76
presence of 24, 51
Q
Quacks 83
R
Renal function tests 72
Reproduction 3, 83
organs of 4
Royal College of Obstetrics and Gynaecology 31
Rubella 63
S
Saline infused sonography 34
Scrotum 3, 4
local diseases of 17
Secretions 84
production of 5
Semen 18, 51, 78, 84
absent sperm in 51
acidic pH of 24, 51
analysis 23, 39, 52, 76
failure to deposit 16, 18
preparation 44, 46
quantity of 24, 51
Seminal vesicles 5, 85
Serum glutamic oxaloacetic transaminase 71
Serum glutamic pyruvic transaminase 71
Sex 13
Sexual intercourse 10, 13, 20, 64
Sexually transmitted infections 19, 21, 62, 84
Single embryo transfer 84
Sodium 72
Sonohysterography 28
Sperm 10, 11, 49
count 4, 76, 84
defect in production of 16
deletion test 52
DNA fragmentation test 52
freezing 50
motility 4, 84
per millilitre, number of 24, 51
production 5, 10, 17
suppression of 17
survival test 24, 52
Spermatogenesis 16, 84
Spermatozoa 5, 10, 11, 13, 16, 18, 19, 84
absence of 24, 55
morphology of 51
motility of 24, 51
shapes of 24
Stimulation
monitoring of 46
protocols of 38, 83
Subfertility 16, 19, 21, 33, 33fc, 39, 84
causes of 16, 18
investigations of 21
primary 21
treatment of 32, 51, 55
unexplained 16, 32, 40, 44, 54, 84
Surgery 17, 18, 32, 65
Surrogacy 55, 57
Swelling, local 21
Syphilis 17, 62
Systemic lupus erythematosus 61
T
Tail piece defects 76
Test tube baby 43
treatment 27
Testes 3, 4
atrophy of 53
biopsy of 24
hormones 24
tumors of 17
Testosterone 5, 12, 24, 52, 79, 84
hormone 11, 12
Tetanus toxoid 63
Thalassemia 61
Thyroid
disease 63
function tests 24
peroxidase 34
stimulating hormone 24, 34, 74
Total protein 71
Total testosterone 74
Toxoid vaccinations 63
Transvaginal sonography 26, 46
Triglycerides 72
Trophoblast 84
Tubal insufflation test 28
Tubal ligation, bilateral 39
Tube, X-rays of 24, 79
Tuberculosis 1719, 22
Tumors 17, 19
U
Ultrasonography 26
Ultrasound 26
scan 79
Undescended testes 17
Urea 72
Urethra 4, 6
Urethritis 21
Urinary human menopausal gonadotropins 37
Uterus 6, 7, 30
fallopian tubes of 13
V
Vagina 6, 7, 16, 18, 43
hostility of 32
Vaginal ultrasound 36
Vaginismus 18, 20, 84
Varicocele 4, 17, 23, 84
Vas deferens 5, 16, 18
Vasectomy 85
Viral infections 63
Viscosity 24, 51, 76
Vision, blurring of 35
Vitamin B12 74
Vomiting 35
Vulva 6
W
Weight 39, 59
White vaginal discharge 7
Womb 6, 7
biopsy of lining of 27
World Health Organization 51, 81
X
X-rays 17, 24, 28, 79, 85
Y
Y-chromosome microdeletion test 53
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Chapter Notes

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Why Pregnancy?CHAPTER 1

 
INTRODUCTION
God created the universe and blessed all living things with the ability to procreate. This is God's greatest gift to all living beings. Ever since the evolution of society began, the human beings have been extremely conscious of this fact. To be the master of the world, man had to outnumber so many large and powerful, but less intelligent, animals.
Numerical superiority is the basic necessity for maintaining control over this planet. May be the purpose of life itself is not fulfilled without procreation. The instinctive desire to reproduce has to be satisfied. There could also be a desire for reproduction for inheritance of name and property. It could simply be pressure from senior members of the family or a mother-in-law, who want a couple to have a baby immediately after their marriage, contrary to what the couple desires about starting a family.
It is common to meet couples not having any desire to reproduce. If anything, they are averse to this idea. In such couples, lack of interest in one partner will be frustrating the desire of the other by being noncooperative. This noncooperation may manifest in infrequent coitus or reluctance to have proper guidance and investigations. This negative attitude is usually due to personal reasons but it could also be due to a conviction that any further additions to an already overpopulated world would be detrimental. The couple may feel that they would be unable to look after the child as well as they would wish. This may be due to economic, social, or professional reasons. However, such couples are in a minority. Most of the couples do wish to have at least one baby; in some cases at least one male.
Yet, unfortunately, in every society there is a large percentage of couples who are unable to produce a baby. In spite of their best efforts and application, they fail to procreate. They fail to achieve what comes naturally and in abundance to others. They try desperately every month without any luck. One can imagine their disappointment and desperation.
Unfortunately, 20% of all the married couples suffer from involuntary subfertility which leads to frustration and unhappiness. These subfertile couples welcome, and in fact, seek any kind of help, assistance or treatment which is forthcoming. Therefore, it is quite common to see even educated couples being duped, swindled and mismanaged by quacks. They also frequent shrines to make offerings/sacrifices in the name of Peers/Fakirs.2
Whatever is the motive or driving force for such a desperate desire to have a baby, it is important that the problem should be clearly comprehended and scientifically/professionally treated. Instead of running from pillar to post and knocking at the doors of imposters, charlatans and cheats, such couples must know the causes of subfertility and available remedies. To save such couples from this fruitless yet expensive exercise, I have written the following chapters. I do hope they fulfill the objective.