Infertility Management Made Easy® Sushma Deshmukh
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abortion
habitual 351
incomplete 355
rates 81t
Abscess formation 531
Acanthosis nigricans 10, 13, 226, 227f
Achondroplasia 575
Acid-citrate-dextrose test tube 698
Acne 10
Acromegaly 323
Acrosin activity test 581
Acrosomal defects 565
Acrosome reaction 103, 581
Adenomyoma 38, 39f
Adenomyosis 36, 37f, 40f, 171
infertility 171
treatment 172
Adhesiolysis 139, 372, 493
Adhesion
molecules 520
recurrence 381
spontaneous recurrence of 377
Adnexal masses 12, 124, 184
laparoscopic management of 136
Adnexal surgery 493, 498
Adnexal torsion 137
Adrenal insufficiency 317, 323
Adrenal suppression agents 240
Advanced stage endometriosis, surgical treatment of 494
Air
handling unit system 688
lock 627
proper circulation of 627
quality 687
Air conditioners 627
system 688
Albulin 545
Alcohol 554
Allwin fallopian tube recanalization catheter 465f
Amenorrhea 184, 209, 324, 351
American Association of Gynecologic Laparoscopists 362, 427
American College of Obstetricians and Gynecologists 416
American Institute of Ultrasound in Medicine 28
American Society for Reproductive Medicine 221, 341, 416, 547, 575
classification of 366t
guidelines 628
Amniotic graft 380
Amorphous debris 334
Amphetamine 323
Ampicillin 542
Ampullo-ampullary anastomosis 146
Anabolic steroids 554
Analyzing sperm DNA damage, methods of 578t
Anastomosis, types of 146
Anastrozole 233, 238, 307
pharmacodynamics of 307, 308fc
Androgel 286
Androgen 449, 566, 677
Excess Society 221
insensitivity, partial 585
receptor knockout 313
receptor-blocking agent 240
Anesthesia, general 166
Angiogenesis 698
Aniline blue staining 579
Anorgasmia 559
Anovulation 209, 316, 325, 632
abnormal feedback 211
causes of 209
central causes 209
evaluating and managing 215
management of 216fc
pituitary causes for 211fc
tackling with 207
thyroid in 212fc
Anovulatory cycle 60, 209
ovary in 60
Anterior sessile polyp 159f
Antiadhesive gels, postadhesiolysis use of 378
Antibiotics 541, 542t
Antibodies 519
Antiestrogens 567
Antimicrosomal antibody evaluation, role of 318
Anti-müllerian hormone 13, 228, 521, 673, 701, 720
Antisperm antibody 97, 102, 566, 572
high titer of 643
testing 574
Anti-tumor necrosis factor-alpha 705
Antral follicle
count 74, 284, 521, 604, 667, 701
large number of 276
AO test 578
Apert syndrome 575
Appendicitis, acute 527
Applebaum's uterine scoring 52
Aromatase enzyme catalyzes 233
Aromatase inhibitor 233
aspects of 261
mechanism of action of 260fc
Artificial cycle 648
Artificial insemination 561
Asherman's syndrome 41, 45f, 192, 195, 351, 427
Aspirin 705
therapy, low-dose 286
Assisted hatching 631, 652
method of 653
Assisted reproductive technique 18, 20, 305, 319, 327, 427, 547, 548, 573, 576, 630, 653, 700
center, basic requirement of 633
laboratory 633
stimulation 680
team 637
types of 630
ultrasound-guided 67
Asthenospermia 564
Asthenozoospermia 571
specific forms of 585
Asthenozoospermic samples, severely 105
Atrophy 499
Autism 575
Autoimmune disorders 283
Azoospermia 94, 104, 557, 559, 561, 563fc, 570, 584586, 590, 592, 593, 632
factor 586, 587, 589
nonobstructive 585, 590, 591
severe 585
B
Balloon angiography catheters 463
Balloon angioplasty 454
Barrier contraception 326
Barrier methods 541
Basal body temperature 510, 606
Basal follicle-stimulating hormone 701
Baseline ovulation study 16, 232
Bettocchi hysteroscope 154f, 157
Bicornuate bicollis 33f
Bilateral cornual tubal obstruction 470
Biochemical tests 102
Biopsy 590
endometrial 511, 529, 606
Bipolar disease 338
Bipolar disorders 575
Bipolar resectoscopy 444
Bizarre dirty endometrium 188f
Bizarre pale endometrium 177f, 188
Bladder 148, 487
neck surgery 554, 560
Blastocyst culture 653
Blood
flow 53f
pressure 604
sugar 12, 603
Blunt cervical canal 187
Body mass index 74, 604
Bologna's criterion 282
Bone 183
marrow-derived stem cells 699
Bowel 532
adhesions 198
Bromocriptine 280, 326, 512, 609, 611
Brosen's classification 144
C
Cabergoline 280, 326, 609, 611
Canadian Collaborative Group on Endometriosis 492, 493
Cancer 574, 595
Cannula
bulbous atraumatic head of 469f
types of 112
Cannulation devices 463
Carbon dioxide 635
Carcinoma
bronchogenic 323
in situ, rule out 590
Cardiometabolic diseases 595
Cartridge-based nucleic acid amplification test 605
Caseosalpinx 199
Catheter, types of 647
Cavity 188
abdominopelvic 123
Cefotetan 542
Cefoxitin 541, 542
Ceftizoxime 541
Ceftriaxone 541
Cell, types of 144
Central nervous system 323, 554
Centrifuge 636
Cervical amputation 546
Cervical canal 187
direction 125
distortion of 441
Cervical dilation 372
Cervical factor 440, 520, 544, 601, 632
evaluation of 546
infertility
etiology of 546
evaluation 32
treatment of 548
Cervical mucus 34f, 546
altered 520, 632
compositions of 545
proteins 545
types of 545
Cervical orifice
external 186
internal 187
Cervical stenosis 359, 546
Cervicitis 527
assessment of 32
chronic 546
Cervix 31, 51f, 115, 252t, 527, 544
abnormalities of 601
canal 440
cervical fibroids alter position of 440
congenital defects in 546
duplication of 33f
functions of 544
normal 33f
Cesarean scar, niche in 176
Cesarean section 354
Chemotaxis 108
Chemotherapy 592, 649
short course of 195
Chest wall surgery 323
Chlamydia antibody test 571
Chromopertubation 193, 332
Chromosomal aberrations 585
Chromotubation 332
Ciliated cells 545
Cis-zuclomiphene and trans-enclomiphene, racemic mixture of 306
Clindamycin 542
Clinical pregnancy rates 699
Clomiphene 233, 525, 567
Clomiphene citrate 217, 233, 234, 237, 240, 253, 254, 256, 258, 267, 306308, 495, 511, 523, 606, 613, 713, 719
adjuvant therapies 257
dose of 255, 255t
failure 257
mechanism of action of 254, 254fc
predictors of response to 257
resistant 257
results of 256
Coaxial systems 463
Coelomic metaplasia, Halban's theory of 487
Coenzyme Q10 286
Coital habits, abnormal 553, 565
Coitus
frequency of 553
timing of 553
Collin's knife 174
Color Doppler 73f, 529
sonosalpingography 55f
Colpitis 527
Combined oral contraceptive pills 648
Complete blood count 12, 603
Complete septum 173f, 533f
Complete tubal damage 631
Computer-aided semen analysis 555, 572, 582
Computer-assisted semen analysis 94
Cone biopsy 546
Confocal light absorption scattering spectroscopy technology 704
Contraceptive methods, use of previous 10
Contrast sonohysterography 356
Controlled ovarian
hyperstimulation 271, 496, 513, 625, 638, 658
stimulation 625, 657
Conventional sperm preparation methods 105
Cornual polyps 400, 400f
Cornual spasm 457
Coronary heart disease 220
Corpus luteum 32, 70, 507, 509, 513
premature destruction of 324
Couple disease 393
C-reactive protein 529
Cryocans 636
Cryopreservation 592, 651
Cryptorchidism 554, 564
Cryptozoospermia 104
Cul-de-sac 490f
obliteration, posterior 492
Cushing's syndrome 323, 605
Cyclic guanosine monophosphate 699
Cycloserine 203
Cyproterone acetate 239, 240
Cyst 56
endometriotic 493
luteal 276
multiple small 62f
myometrial 36
nabothian 32, 35f
wall 137
Cystic fibrosis 554, 585, 586
Cytomegalovirus 15
Cytotoxic gene therapy 450
D
Danazol 450
D-chiro-inositol 238, 309, 310
Dehydroepiandrosterone 237, 286, 311, 677
sulfate 227, 605
Dermoids 56
Dexamethasone 55, 278, 609
suppression test 605
Diabetes mellitus 554, 560
history of 10
type 1 283
type 2 220, 226
Diethylstilbestrol 546
Diminished ovarian reserve, treatment of 311
Direct swim up 620
Distal tubal
blockage 346
disease 334, 338
Distal tubal obstruction 139, 338
laparoscopic surgery for 340
Distal ureter 487
Dominant follicle 58f, 59f, 63
atresia of 324
oocyte in 250
Domperidone 323
Donor 649
embryo transfer program 631
Dopamine agonists 326
Double insemination 624
Double ovarian stimulation protocol 669, 670f
Down's syndrome 575
Doxycycline 176, 541, 542
Ductal obstruction 562
Dydrogesterone 619
Dye, free flow of 347f, 348f
Dyschezia 488
Dysmenorrhea 178, 351, 488
Dyspareunia 178, 491
deep 488
Dysuria 488, 491
E
Echogenic stroma 229
Ectopic pregnancy 184, 185, 531, 540
chronic 185
Ectopic prolactin production 323
Ejaculate
low-volume 557, 559, 561fc
total sperm in 556
Ejaculation 554
Ejaculatory disorder 643
Ejaculatory duct 29, 643
obstruction 560
transurethral resection of 560, 561
Ejaculatory failure 602
Ejaculatory function 553
Ejaculatory obstruction 562
Electrical injury 147
Electrolytes 545
Embryo 285
cryopreservation 652
culture, basics of 689
development 686
donation 650
factors 700, 702
freezer 636
quality 649
Embryo transfer 441, 630, 644, 691
advice for 676, 677, 679
catheter 645f
day of 676, 677, 689
number of 676
optimal conditions for 67
stylet 466
Embryogenesis, impaired 701
Embryotoxic factors, secretion of 520
Empirical therapy 566
Empty follicular syndrome 705, 707
types of 706
Empty sella syndrome 323
Enclomiphene 306, 307
Endocervical canal 110
Endocervical cells, types of 545
Endocervix, tumors of 546
Endocrine
disorders 317, 323
factors 519
Endocrinopathy 564
Endometrial ablation 356
Endometrial adhesions 632
Endometrial cavity 31, 81, 175f, 359
fluid collection in 185
Endometrial cellular debris 545
Endometrial evaluation, color Doppler for 52
Endometrial factors 520, 701, 702
Endometrial growth, evaluation of 47
Endometrial inflammatory processes 411
Endometrial microbiota 703
Endometrial motion 47
Endometrial myometrial junction 36, 37f, 79, 80
Endometrial polyps 159, 393, 394, 395f, 397, 398t, 402, 403, 404f, 408, 413, 415, 417f, 418f
classic 415f
epidemiology of 394
histology of 397
hysterosalpingography diagnosis of 419
hysteroscopic diagnosis of 420
large 405f, 424f
multiple 399f
office setting of 395f
pathogenesis of 400
sonohysterographic diagnosis of 419
surgical management of 426
three-dimensional ultrasonographic transvaginal scan of 408f
ultrasonographic diagnosis of 416
Endometrial preparation 648, 650
Endometrial proteins 632
abnormal secretion of 520
Endometrial receptivity 702
Endometrial scratching 710, 712
Endometrial synechiae 185
Endometrial thickness 51, 52t, 418f
Endometrioma 56, 129f, 497, 540
blood flow to 65f
Endometriosis 18, 64, 126, 128f, 214, 334, 394, 396, 487, 489, 492, 494497, 500, 510, 603, 631, 701, 719
classification for 491
confirmative diagnosis of 489
diagnosis of 17, 488
diffuse 490f
early stage 493
evaluation of 487
intratubal 452, 457
laparoscopic appearance of 491
management of 487
medical treatment of 499
mild 631
mild-to-moderate 151
moderate 19
predictive diagnosis of 488
severe 19, 458
stages of 127t, 492t
Endometritis 527, 529, 530
chronic 174, 176
Endometrium 31, 42, 48, 49f, 50f, 78, 185, 252t, 509, 697, 699
echogenic 49
function of 83
irregular 171, 185
pale 189f
physiology of 52
preparation of 649
study of 289
Endoscopy 123
Enlarged multicystic globular ovary 535f
Enzymes 545
Epididymal obstruction 562
Epididymis 554, 555, 574
Episodes, severity of 528
Erectile function 553
Erection 554
Erosion 601
Erythrocyte sedimentation rate 529, 531, 603
Estradiol 213, 260
valerate 514
Estrogen 456, 698
therapy 369
Ethambutol 202, 203
Ethinylestradiol 239
Ethionamide 203
European Association of Urology 576
European Society for Gynecological Endoscopy 40, 362
classification 43f
European Society for Human Reproduction 221
and Embryology 570, 628
European Society for Hysteroscopy 168, 363
classification of intrauterine adhesions 365t
Euthyroid 318
antibody 327
Exemestane 233, 307
F
Fallopian tube 38, 54, 55, 110, 112, 118, 123, 336, 454, 469f, 527, 529
blockage of 185
damage 341
diseases 331
recanalization 452, 461
False empty follicular syndrome 706708
Fasting insulin 13, 228
Fasting plasma glucose 13, 226
Fasting serum insulin level 605
Fatigue 488
Female fertility 317
Female infertility 402
Female reproductive
organs 203
tract, assessment of 31
Fertile eunuch syndrome 586
Fertility 493
enhancing surgeries 150
preservation 592
treatment 79
Fertilization
effect of 440
failure 105
Fetal thyroid dysfunction 318
Fibroid 4, 12, 38, 39f, 64, 131, 168, 358, 439, 440
characteristics 171
maternal history of 440
operative techniques 132
size of 441
types of 441
vascularity in 65f
Fibrosis 201
Fimbrial block 139, 631
Fimbrial, agglutination of 139, 199
Fimbrialphimosis 338
Fimbrioplasty 139, 342
Fimbriostomy, procedure of 347f
Finasteride 240
Fitz-Hugh-Curtis syndrome 199, 531
Flexible guide cannula 468f, 469f
Flimsy adhesions 190f, 191f
Fluid collection 529
Fluorescence in situ hybridization 103, 579
Fluoroset 464f
Flutamide 240
Focal glandular hyperplasia 399
Foley balloon catheter, intrauterine placement of 378
Foley's bulb 55
Foley's catheter 55, 112
Folinic acid 567
Follicle 75, 252t
Follicle-stimulating hormone 210212, 218, 222, 235, 247, 254, 260, 266, 279, 307, 308, 556, 557, 563, 659, 719
deficiencies 509
influence of 56
stimulation, anovulation to loss of 213fc
window 249
Follicular development 56
lack of 61
Follicular dominance 250
Follicular function 324
Follicular gonadotropin-releasing hormone agonist protocol 665f
Follicular growth
abnormal 519
hormonal regulations of 250
Follicular monitoring 638
Follicular output rate 283
assisted reproduction 472
Follicular phase stimulation 669
Follicular selection 249
Folliculogenesis 247, 248, 248t, 249
inadequate 509
Free androgen index 227
Free fluid 536f
Frequent vaginal douching 528
Frozen embryo transfer 648, 699
Frozen oocytes 650
Frozen pelvis 194f
Fructose estimation 93, 102
Fulcrum effect 145
G
Galactorrhea 280, 324
Gamete 700
intrafallopian transfer 21, 630
Gene expert 605
Genetic abnormalities, classification of 585b
Genetic disorders 649
Genetic factors, role of 224
Genital examination 555
Genital infections 11
Genital organ 183, 199
internal 114
Genital tract 406
cells 101
ulcer, nonhealing 184
Genital tuberculosis 182, 183, 203, 353
female 184
management of 203
milder stage of 196
Genitourinary infection 184
Genuine empty follicular syndrome 706, 709
Gestational sac 81t
Glands, endometrial 487
Globozoospermia 570, 586
Globulin 545
Glucocorticoid 516
therapy 319
Glutathione 567
Goiter 317
Gonadotropin 233, 235, 236, 262, 277, 289, 512, 524, 525, 562, 564, 566, 609, 613, 615617, 626, 658, 721
action 224
dependent phase 249
doses of 284
generations of 266t
independent phase 249
preparations 265
secretion, physiology of 247
Gonadotropin releasing hormone 19, 57, 210, 211, 222, 247, 254, 270, 273t, 279, 308, 509, 524, 566, 607
agonist 270, 449, 514, 638, 661, 670f, 704
analog 270
use of 442
antagonist 270, 272, 450, 638, 662
conventional 668f
inadequate secretion of 210
therapy 513
effect of 513fc
Gonadotropin therapy 614
indications for 264
principles of 264
Granular lymphocytes, large 185
Granulocyte colony-stimulating factor 698
Granulomas 323
Granulosa cells 263, 706
Grasper dissection 372
Graves’ disease 319
Growth factor 440, 450
Growth hormone 677
secretions 519
use of 285
Gynecologic oncology 150
Gynecology, general 150
Gynecomastia 554
H
Halban's theory 487
Haloperidol 323
Haploid sperms 592
Heat 554
Hematosalpinx 541
Hematuria 488
Hemoglobin 13, 603
Hemorrhages 128
Heparin 705
Hepatitis B surface antigen 603
Herniorrhaphy 554
Herpes simplex 15
Herpes zoster 323
High-efficiency particulate air 627, 634, 689
Highly purified human menopausal gonadotropin 613
Highly selective nonsteroidal aromatase inhibitor 307
Hirsutism 10, 209, 226
severe 239
treatment of 239
Home semen test 583
mobile application 584f
Hormonal therapy, postadhesiolysis use of 378
Hormonal treatment, postsurgical use of 369
Hot air oven 636
Human chorionic gonadotropin 78, 218, 247, 266, 273t, 613, 659, 663, 720
injection 698
Human immunodeficiency virus 603
Human menopausal gonadotropin 218, 235, 524, 658, 713, 719, 721
stimulation 495
Human spermatozoa, cryopreservation of 592
Humidity 687
Huntington disease 575
Hyaluronic acid 368
Hyaluronidase 644
Hydrohysterosonography 119
Hydrosalphinx, right-sided 339f
Hydrosalpingeal fluid 340
leakage of 340
Hydrosalpinx 198, 338, 341, 343, 346, 529, 533f, 540f, 541, 701
around ovary 532f
bilateral 199
effect of 338
large 140f
left side mild 340f
treatment of 705
unilateral 199
Hydroxy progesterone 14
Hyperandrogenemia 227, 609
Hyperandrogenism 275, 510
Hyperemia 189f
Hyperemic endometrium 190f
Hyperglycemia 213
Hyperinsulinemia 130, 213, 222, 223, 223fc, 275, 278, 310
Hypernephroma 323
Hyperplasia, congenital adrenal 605
Hyperprolactinemia 224, 278, 279, 279f, 280, 316, 322324, 325, 325fc, 327, 510, 713, 719
causes of 323
diagnosis 279
effects of 278, 279fc
idiopathic 323
treatment 279
Hypertension, history of 10
Hyperthecosis 223
Hyperthyroid 318
Hyperthyroidism 319, 321
Hypogonadism 325, 554, 586, 595
Hypogonadotropic hypogonadism 210, 281, 561
management 281
types 281
Hypomenorrhea 351
Hypo-osmotic swelling 574, 589
lower limit of 573
test 96, 103, 572, 589
Hypoparathyroidism 317
Hypospadias 555
Hypothalamic lesions 323
Hypothalamic-pituitary-gonadal axis 322, 720
Hypothalamopituitary disease 322
signs of 317
symptoms of 317
Hypothalamus 29, 210, 210fc, 222
Hypothyroid 318
Hypothyroidism 316, 317, 319, 322
Hysterectomy, histological assessment of 439
Hysterolaparoscopy 182
Hysterosalpingo-contrast sonography 121, 332, 605
Hysterosalpingogram 457, 520, 717
abnormal 115
Hysterosalpingography 15, 110, 185, 331, 354, 356, 357, 419, 420, 458, 518, 605, 702
contraindications 111
guided procedure 121
indications 111
interpretation of 114
normal 115, 115f
predictive value of 119
therapeutic effects of 118
Hysteroscope 156f, 371, 470
Hysteroscopic techniques 169
Hysteroscopic treatment 166
Hysteroscopy 16, 124, 125, 152, 158f, 182, 186, 202, 332, 336, 356, 358, 362, 370, 605, 702, 704, 717, 718
diagnostic 358, 468f
instruments 153
organized for 153
surgery by 160
treatment 166
I
Iatrogenic intrauterine adhesions 697
Iliac vessels 57f
Immotile cilia syndrome 102
Immunity, cell-mediated 520
Immunoglobulins 545
Implantation
effect on 440
facilitator of 410
markers 522
window 409
In vitro fertilization 63, 66, 67, 125, 218, 331, 402, 441, 452, 496, 501, 522, 523, 525, 542, 562, 563, 576, 589, 589t, 630, 665f, 670f, 683, 697
basic steps in 638
batch in 647
cycles 70, 75t
pregnancy rates 497
procedure 683
role of 496, 548
short protocols 668f
Incomplete septae 533f
Indian Council of Medical Research 649
Induction 306, 377, 546
Infection 354, 574
evidence of 546
treatment of 548
Infertile ambulatory evaluation 423f
Infertile male, evaluation of 553
Infertility 123, 158, 168, 184, 185, 316, 322, 329, 351, 381, 393, 402, 413, 426, 439, 440, 487, 488, 491, 492, 497, 527, 544, 585
biological basis of 403
doppler in 70
doppler duration of 9
endometriotic 396
factors, multiple 171
idiopathic 557, 559, 566
incidence of 3
laparoscopy in 123
management of 247, 277
rising trend in 5
transvaginal sonography in 27
treatment 10, 86, 159, 305
monitoring 85
unexplained 20, 324, 518, 520, 525, 575, 601, 719
Inflammation 185
Inflammatory disorders, spectrum of 527
Infrahepatic adhesions 538f
Injury 601
Insemination
conventional 691
per cycle, number of 624
timing of 625
Insite vision system 149
Insulin
dependent diabetes mellitus 317
metabolism 224
resistance 213, 222, 223fc
tests for 226
sensitizers 233, 236, 261, 721
Interleukins, release of 185
Intestines 194f
Intra-abdominal organ 184
Intracytoplasmic morphologically selected sperm injection 583, 631
Intracytoplasmic sperm injection 327, 429, 525, 542, 559, 573, 576, 589, 589t, 630, 643, 691
Intrafollicular echoes, development of 60
Intramural fibroid 441
large 440, 441
Intramural segment 454
Intrauterine adhesions 41, 163, 164f, 165f, 351, 361f, 362
classification of 364t
diagnosis of 163
extent of 365
Intrauterine device 354, 527, 599
insertion 354
Intrauterine insemination 75f, 159, 218, 441, 495, 496, 513, 522, 525, 576, 589, 589t, 601, 628, 698
cycle 70
number of 624
prerequisites for 603
role of 548
Intrauterine lesion 397
Intrauterine morcellator 447
Intravenous immunoglobulins 705
Ipsilateral internal tubal ostium 467f
Irradiation 323
Irritable bowel syndrome 488
Isoniazid 202
Isthmo-ampullary anastomosis 146
Isthmocele 176, 179f
Isthmo-isthmic anastomosis 146
Isthmus 455
Italian Endometriosis Study Group 494
J
Joints 183
K
Kallikrein 567
Kallmann's syndrome 210, 281, 561, 586
Kanamycin 203
Kidney 148
Klinefelter's syndrome 104, 586
Kremer's capillary tube mucus penetration test 548
Kruger sperm morphology 604
L
Labotect catheter 468f
Lactic acidosis 237
Laminar air flows 627
Laparoscopic instrumentation, advances in 135
Laparoscopic microsurgery 141
Laparoscopic ovarian drilling 130, 216, 217, 239, 258
Laparoscopic procedure 331
Laparoscopic reconstructive surgery 341
Laparoscopic robot-assisted surgery 148
Laparoscopic surgery, complications of 147
Laparoscopic tubal anastomosis 337
advantages of 141
Laparoscopic tubocornual anastomosis 334, 336
Laparoscopy 16, 123125, 126, 182, 186, 196, 202, 332, 443f, 459, 489, 518, 520, 531, 605, 702, 717, 718
diagnostic 492
Laparotomy 141, 478
L-arginine 612
Lasers 447
Leech-Wilkinson
cannula 112
catheter 112
Leptin 224
Letrozole 233, 237, 240, 259, 307, 308, 512, 523, 525, 608, 613, 615617, 628, 719, 721
advantages 259, 608
doses and protocols 261
mechanism of action 259
stimulated cycles 512
Leukemia inhibitory factor 702
Leukocytes 101
Leuprolide 270
Levofloxacin 203
Levothyroxine 609
Live birth rate 697
Live spermatozoa 569
Liver 532
cirrhosis of 323
Low molecular weight heparin 515
Lump, abdominal 184
Luteal phase 46
defect 20, 64, 84, 325, 507, 511
association of 510
deficiency 508
stimulation 669, 675
support 512, 514, 619
Luteinized unruptured follicle 63, 78, 85t, 252, 276, 519
syndrome 712, 713
types of 713
Luteinizing hormone 13, 130, 210212, 214, 218, 223, 237, 247, 254, 266, 279, 290, 307, 308, 508, 556, 557, 563, 719
abnormal 222
suppression of 658
surge 273t
use of 285
Lymph nodes 183
Lymphocytic hypophysitis 323
M
Macroadenoma 280, 326
Macroprolactinemia 323
Macroscopic properties 100, 100t
Magnetic resonance imaging 356, 358, 362, 491
Male factor infertility 28, 29
treatment for 109
Male infertility 551, 568, 587, 593
classification of 556, 559
epigenetics of 587
genetics in 584
idiopathic 566, 585
unexplained 576
Male partner, ultrasound assessment of 28
Male reproductive system 30f
Malformations 601
Malpositions 546
Mantoux test 605
Maturation defects 519
Mature follicle 76f, 713
Mature preovulatory follicle and endometrium 83t
Mechanical instrument 169
Medical therapy 326, 449
Medically assisted reproduction 495
Medications and allergies 10
Medroxyprogesterone acetate 215
Melatonin 611
Menorrhagia 178
Menotropins 658
Menses, irregular 209
Menstrual abnormalities 184, 381
Menstrual blood 178
volume 380
Menstrual cycle 51, 52t, 248, 499
by color Doppler, study of 62
normal luteal phase of 508
phases of 252, 252t
proliferative phase of 418f
Menstrual flow 351
Menstrual history 9, 225
Metabolic abnormalities 220
Metformin 236, 277, 310, 609, 610, 721
doses of 277
Methyldopa 323
Methylene blue and white deposits, instillation of 194f
Metoclopramide 323
Metronidazole 176, 541
Microadenoma 280
Microfluidics 107, 623
sperm-sorting device 623
Microhysteroscopic ostial dilatation 475
Microinsemination
microinjection 631
sperm transfer 21, 630
Micronized progesterone 619
Microprolactinomas 326
Microscopic epididymal sperm extraction 590, 591f
Microsurgical epididymal sperm aspiration 563
Micro-TESE sperm retrieval rate 589
Midtubal occlusion 337
Mifepristone 450
gonadotropin-releasing hormone agonists 449
Mild disease 196
Military disease 184
Minimally invasive technique, development of 453
Miscarriage 354, 368
curettage 354
induced 354
rate 184, 308
Missed abortion 355
Mixed agglutination reaction 98
test 569
Moderate disease 198
Monoamine oxidase inhibitors 323
Monopolar resectoscopy 445
Monounsaturated fats 6
Motile sperm concentration 584
Motile spermatozoa 569
Motility, grading of 95, 95t
Mucin 545
Mucus
abnormal quality of 601
penetration 572
plasma 545
plug 332, 452, 457
Müllerian anomalies 632
Müllerian system 38
Multilayered endometrium 79, 79f
Multiple gestations 235
Multiplier effect 142
Mycobacterium tuberculosis 182, 185, 203
Myoinositol 238, 309, 310, 609, 610
effects of 310
Myolysis, laparoscopic 448
Myoma 440, 441, 446f
shaving of 446f
tissue 135
Myomata 124
Myomectomy 149, 367
abdominal 354, 355, 443
hysteroscopic 444
laparoscopic 442
steps of 134f
N
National Institute for Clinical Excellence 421
Natural cycle, modified 648
Natural hatching 652
Natural killer cell 632
activity 520
Nausea 237
Neck defects 96
Neck irradiation, history of 316
Necrospermia 570
Needle guide 638
Negative progesterone challenge test 218fc
Nelson's syndrome 323
Neodymium-doped yttrium aluminum garnet 166
Neonatal intensive care unit 178
Neosalpingostomy 140, 341
Neural tube defects 575
Nodular salpingitis 199
Nonassisted reproductive technology 247
Nonciliated secretory cells 545
Noncyclical pelvic pain 488
Nongravid endometrium, trauma to 163
Nonseminoma 592
Nonsteroidal anti-inflammatory drugs 713, 719
Noonan's syndrome 586
Normal ovulation 251
Normal ovulatory cycle 251
Novy fallopian tube recanalization catheter 471f
Number antral follicles 276
O
Obesity 10, 130, 215, 225
Obstetrics and gynecological disorders 544
Obstructive azoospermia 590
Occult primary ovarian insufficiency 311
Olfactory system, defects in 210
Oligoasthenospermia 557, 559, 564, 632
Oligoasthenozoospermia, severe 643
Oligomenorrhea 324
Oligo-ovulation 632
Oligospermia 94, 564, 632
moderate 94
severe 29, 94, 584, 590
Oligozoospermia 104, 571, 585, 586
Oligozoospermic samples, severe 105
Omental adhesions 537f
Omental biopsy 198
Omentum 532
Oocyte 519, 644
aspiration, suction pump for 636
collection 67
cryopreservation 652
denudation of 644
donation 649
programs 631
harvesting procedures 67
retrieval 643
stimulation 643
Oophorectomy, bilateral 649
Oophoritis 527
Operative endoscopy 126
Operative laparoscopy 492
Operative minihysteroscopy 174
Oral contraceptive 240
pills 268
Oral glucose tolerance test 13, 237
Oral medications 628
Orchidopexy 554
Orifice, internal 193f
Osmolality 686
Ostium adhesions, right 191f
Ovarian affection 185
Ovarian blood flow 74
Ovarian carcinoma, incidence of 259
Ovarian cyst 126, 488
Ovarian disorders 632
Ovarian drilling, mechanism of action of 130
Ovarian evaluation by ultrasound 56
Ovarian factors, evaluation of 701
Ovarian follicles, growth of 259
Ovarian function 139
Ovarian hormones 47
Ovarian hyperstimulation 328
Ovarian hyperstimulation syndrome 67, 74, 235, 256, 268, 291, 309, 613, 664
avoidance of 67
Ovarian malignancy 256
Ovarian preservation, advantages of 138
Ovarian recovery, partial 138f
Ovarian reserve tests 701
Ovarian response improvement 677
Ovarian stimulation 606, 638, 701
monitoring 720
protocol 668f
Ovarian stroma 72, 229
flow 72, 73f
Ovarian study 56
Ovarian suppression agents 240
Ovarian tissue cryopreservation 652
Ovarian transposition 149
Ovarian tumors 541
Ovary 222, 248, 309, 527, 532
changes in 63
lacking any follicles 61f
normal 57f
Ovulation 316, 632
augmentation 606
correction of 714
documentation of 717
prediction of 57
trigger 271, 289
Ovulation induction 247, 305, 309, 523, 606, 697
abnormal cycles 251
agents 609
complications of 291
cycles 251
drugs 253, 511, 713
in stimulated cycles, monitoring of 286
indications for 253
prerequisites before 253
protocols for 612
Ovulatory cycle 217, 247
Ovulatory disorders 305
Ovulatory dysfunction 31, 209
Ovum pick-up 634, 638
catheter 639f
Oxidative stress evaluation 572
Ozone therapy 477
P
Pain
abdominal 178, 351
lower abdominal 127
types of 113
Pale endometrium 191f, 192f
Pancreatic beta function 236
Passive microchips 108
Patency criteria 143
Paternal karyotyping 702
Pathological tubes 146
Peak systolic velocity 74, 83
Pelvic abscess, active 111
Pelvic adhesions 536f, 719
Pelvic anatomy, depiction of 27
Pelvic congestion syndrome 541
Pelvic endometriosis 185
Pelvic examination 28
Pelvic inflammatory disease 64, 176, 331, 334, 488, 527
causative agents of 528f
episodes, number of 528
history of 528
laparoscopy findings of 532t
Pelvic irradiation 356
Pelvic pain, chronic 184, 491, 531
Pelvic peritonitis 527, 531
Pelvic tuberculosis, advanced 192
Pelvis, adhesion band in 535f
Pentoxifylline 567
Percutaneous epididymal sperm aspiration 590, 591f, 631
Perforation 377
Perifollicular flow
index 78
low-resistance 77f
Perifollicular vascularity 77f
Perihepatic adhesions 531
tubercles on 201f
Periovulatory endometrium 50f
Perisalpingitis 185
Peristalsis, abnormal 520
Peritoneal blebs 539f
Peritoneal factors 519
Peritoneal implants, superficial 127
Peritoneal oocyte and sperm transfer 630
Peritoneum 532
Peritonitis, type of 201
Peritubal adhesions 339f, 631
Peroxidase-positive leukocytes 569
pH 93, 101
Phenothiazines 323
Phosphatidylinositol-3 kinase production 310
Physiological intracytoplasmic sperm injection 107
Pigeon eggs 221
Pioglitazone 238
Pituitary lesions 323
Pituitary tumors 561
Placenta
implantation, abnormal 351
manual removal of 355
Plasma progesterone 84
Plastic bag sealer 636
Platelet-rich plasma 370, 698
Polycystic ovarian disease 60, 66, 323, 324
Polycystic ovarian syndrome 6, 7, 129, 210, 213, 216, 219, 220, 235, 240, 241, 252, 257, 277, 309, 310, 325, 510, 632, 701
biochemical tests 226
clinical examination 225
complications 130
confirming the diagnosis 225
effects 130
endometrium in 231
family history of 225
genetics of 224
history 221
and symptoms 225
management 232
medical treatment 233
pathophysiology and etiology 222
treatment 237t
Polycystic ovary 222, 229, 230f
blood flow in 66f
syndrome 227f
Polydioxanone synthetic 135
Polymerase chain reaction 585, 586
Polyp 158
adenomyomatous 398
fibroid 45f
functional 398
hyperplastic 398
types 398
Polypectomy 422f
hysteroscopic 396f, 412f, 424f, 425f
Polyvinylpyrrolidone 644
Poor motility 105
Poor oocyte 649
Poor ovarian reserve 282
risk factors for 283
Poor quality embryo 520
management of 704
Poor sperm quality 701
Poseidon group criterion 282
Positive progesterone challenge test 216fc
Postcoital bleeding 184
Postcoital test 546, 571
abnormal 566, 575, 601
Postmenstrual phase 189
Postovulatory endometrium 51f
Postpartum curettage 354
Postsurgical intrauterine physical barriers 370, 378
Pouch of Douglas 196, 199, 252, 531, 536f, 539f
Powder burns 489
Prader-Willi syndrome 586
Preantral follicles 58f
Prednisone 278
Pregnancy 111
losses 325
rate 308, 602
uterus 354
Preimplantation genetic diagnosis 652
Premature delivery 351
Premature labor 184
Premature ovarian
aging 311
failure 14, 311, 632, 649
Premenstrual phase 111
Preovulatory follicles 249
Preovulatory scan 75
Prepubertal phase 592
Pretubal bulge 455
Previous tubal sterilization 337
Primary ciliary dyskinesia 586
Primary hypothyroidism 317, 323
Primary ovarian
failure 631
insufficiency 311
Progesterone 84, 235, 456, 507, 619, 651
administration, routes of 515t
challenge test 218
effects of 509
inadequate 509
preparations 215
production, inadequate 85
role of 508
supplementation 514
Progestin therapy 449
Progressive motility 569
Prolactin 216, 322, 519, 604
secretion 278, 512
Prolactinoma 278, 280, 323, 327
visual field defects 324
Prolactin-secreting tumor 278
Propylthiouracil 321
Prostaglandins 456
Prostate, lobes of 30f
Protein hormone 224
Proximal fallopian tube obstruction 461
Proximal stump, formation of 335f
Proximal tubal
blockage 333, 346, 456
disease 338
segment 466
Proximal tubal obstruction 452, 453, 475
, laparoscopic surgery for 334
Proximal tubal occlusion 160, 334, 345, 348
classification 164
diagnosis 161, 163
hysteroscopy 163
problems 162
treatment 161
Pseudocyesis 323
Pseudomenopause 499
Pseudo-obstruction 457
Pseudopolyps 398
Pseudopregnancy 499
Puberty 554
Pubic bone 30f
Puckered black lesions 490f
Pulmonary embolism, risk of 138
Pulmonary infection 183
Pulmonary tuberculosis 183
Pulsatility index 81, 83
Pulse Doppler 73f
Pulse repetition frequency 71
Punch biopsy forceps 154f
Pyogenic adnexal mass 185
Pyosalphinges 198
Pyosalpinx 534f, 542
around ovary 534f
bilateral 199
Pyrazinamide 202, 203
R
Radiation 554
treatment 649
Radionuclide hysterosalpingography 121
Radiotherapy 592, 697
Randomized controlled trials 311, 368, 548, 699
Reactive oxygen species 572, 573f, 612
Readymade standardized culture media 627
Reassuring stitches 336f
Recent febrile illness 554
Recombinant follicle-stimulating hormone 75f
Reconstructive pelvic surgery 150
Recording system 157
Rectal bleeding 488
Rectosigmoid colon 487
Recurrent abortion 111
Recurrent implantation failure 575, 632, 700
Recurrent miscarriage 577
Recurrent oligo-ovulation 632
Recurrent pregnancy loss 575
Regimes, low-dose 267
Regular menses 219fc
cycle 219
Renal diseases 554
Renal failure, chronic 323, 325
Reproductive age group, couples of 99
Reproductive cell cryopreservation 651
Reproductive failure 182
Reproductive surgery 149
Reproductive system 393
Reproductive tissue cryopreservation 652
Resectoscope 396f
Resectoscopic myomectomy 444
Resectoscopic surgery 174
Resistive index 531
Restoring fertility, role in 152
Retrograde ejaculation 91, 632, 643
Retroverted uterus 546
Revised American Fertility Society Staging System 491
Revised American Society for Reproductive Medicine Classification of Endometriosis 491
Rheotaxis 108
Rifampicin 202
Rosch-Thurmond fallopian tube recanalization catheter 465f
Rosiglitazone 238, 261
Rough dirty looking endometrium 190f
Rough endometrial surface 188
Royal College of Obstetricians and Gynecologist 520
guidelines 717
Rubella 15
Rubin's cannula 112
S
Saline
contrast sonography 44f
infusion sonography 357
infusion sonohysterography 419
Salpingectomy 140, 340, 343, 348
laparoscopic 348
technique of 344
Salpingitis 527
acute 530
chronic 452, 457, 531
isthmica nodosa 334, 452, 457
Salpingography 336
Salpingoscopy 143, 144
and falloposcopy 124
Salpingostomy 340
Salt pepper sign 37f
Saturated fatty acids 6
Scar integrity 135
Schistosoma 356
Schizophrenia 575
Scrotal sonography 29
Scrotal trauma 554
Secretory phase assessment 84
See and treat technology 152
Selective estrogen receptor modulating agent 606
Selective salpingography 121, 454
Semen 589
criteria of normal 97
culture 97, 604
evaluation of 568
examination 92
preparation 643
volume 556, 569
Semen analysis 19, 71, 90, 99, 102, 103, 555, 568, 571, 572, 603
abnormal 577
important concerns 90
normal 518
predictive value of 570
Semen collection 90, 620, 643
room 634, 636
Semenology 620
Seminal fructose 569
Seminal neutral glucosidase 569
Seminal vesicle bow-tie picture 31f
Seminal zinc 569
Seminoma 592
Semisolid adhesion barriers 367
Sensitivity 531
Sepsis 531
Septate uterus 42f, 414f
Serine phosphorylation 222
Sertoli cell-only syndrome 562, 589
Serum
anti-mullerian hormone 604
follicle-stimulating hormone 604
luteinizing hormone 604
progesterone 15, 510, 606
prolactin 219, 279
Severe disease 198
Sex hormone 210
binding globulin 212, 311, 610
Sexually transmitted diseases 554
history of 10
Shoulder pain 488
Shrunken small cavity 193f
Sims-Hühner postcoital test 546
Single infectious agent 182
Single insemination 624
Single-layer density gradient 99
Single-line endometrium 47
Sinus 184
Sion procedure 120
Small endometrial polyp 12, 406f, 414f, 419f, 421f, 423f
Smith's grading 49
Sodium bicarbonate 92
Sonohysterography 40, 357, 702
Sonosalpingography 120
Spasm 452
Specific genetic mutations 585
Sperm
abnormalities of 103
agglutination 566, 575
antibodies 604
banking 592
cervical mucus contact test 547
concentration 93, 94t, 103, 569
cryopreservation 651
dysfunction 572
evaluation of 701
flagella, multiple morphological abnormalities of 586
function tests 102, 572, 583
functional assessment 572
macrocephaly 586
morphology 95, 569
movement 564
normal 96
preparation 99, 106, 620
processing 98
subzonal insemination of 21, 630
viability testing 102
zona-binding tests 582
Sperm chromatin
dispersion 103
test 580
structure assay 103, 578
Sperm DNA fragmentation 576t, 581
index 701
origin of 577f
test 572, 575, 604
Sperm extraction
procedure of 591
techniques, types of 590, 591f
Sperm motility 94, 104
impaired 566
Sperm penetration
assay 582
test 547
Spermatic cords 574
Spermatids 592
Spermatogenesis 554
abnormal 581
disorders of 562
qualitative defects in 586t
quantitative defects in 585t
Spermatozoa 95, 96, 105
fertilization profiles of 519
normal 99
Spinal cord injury 554, 559
Spironolactone 240
Spleen, tubercles on 200f
Spontaneous abortion 235, 355
Spontaneous miscarriage 168, 354
SRY gene defect 104
Starry sky appearance 193
Stem cells 370, 380
Stenosis 32, 601
evidence of 546
Stereozoom microscope 636
Sterile saline, instillation of 40
Sterilization, reversal of 140
Steroid hormone 224
production 512
Steroidogenesis 224
Stimulation 306, 658, 678
complications of 236
planning 703
protocol 70, 664
Stress 93
Stroma 487
Stromal echogenicity 229
Subclinical hyperthyroidism 317
Subclinical hypothyroidism 317
Submucous
fibroid 441
myoma 150
Suction apparatus 640, 640f
Sulbactam 542
Suppressing ovarian function 499
Supraisthmic endometrial polyp 403f
Supravital staining technique 96
Surgery, endoscopic 123
Surgical complications 147
Surrogacy 631
Swim-down technique 99
Swim-up technique 99
Synechia 351
and tiny tubercles in cervical canal 187f
Synechialysis, hysteroscopic 195
Systemic infections 564
T
T cell 632
abnormal 520
Tachycardia 321
Tail defects 96
Tamoxifen 238, 258
citrate 258
Telepresence surgery 150
Tension 93
Teratomas 323
Teratozoospermia 632, 643
index 572, 582, 589
specific forms of 585
Terumo glidewire 464f
lostium with 162f
Test tube warmer 636
Testicular biopsy 574, 590
Testicular cancers 592
Testicular sperm 106
aspiration 589, 591f, 631
extraction 563, 589, 591, 591f, 725
in vitro maturation of 631
Testicular torsion 554
Testis 30f, 555, 574
undescended 11
Testosterone 286, 556, 604
rebound therapy 566
Theca cells 263
Therapeutic hysteroscopy, role of 195
Thermal injury 147
Thermotaxis 108
Thick fibrous adhesion 352f
Thin endometrium
management of 697
treatment of 704
Third-generation immunoradiometric assay, development of 319
Three-dimensional ultrasonography 358
transvaginal scan 408f, 418f
Thrombophilia, treatment of 705
Thyroid 211, 316, 317, 719
disorder 510
function 328
gland 316
illness, family history of 316
status 327
surgery 316
Thyroid disease 316
classification of 317t
management of 320fc
screening for 317
Thyroid hormone 211
therapy 320f
Thyroid peroxidase 320f
antibody 327
Thyroid stimulating hormone 217, 216, 219, 317, 320, 325
Thyroiditis 316, 321
Thyrotoxicosis 316, 317, 319, 321
Thyroxine 611
Timed endometrial biopsy method 511
Tissue trauma 141
Toluidine blue staining 580
Torsion 562, 574
right adnexa 137f
Total antioxidant capacity 572
Total motile sperm count 570, 571, 571f, 589, 602, 625
Total motility 569
Total sperm number 569
Toxoplasmosis 15
Traditional hysteroscopic polypectomy 413f
Transabdominal sonography 41f
Transcervical balloon tuboplasty 454
Transcervical catheterization 454, 459
Transcervical fallopian tube cannulation 454
Transferred embryos, number of 676, 678
Transient hyperprolactinemia 323, 324
Transmembrane conductance regulator 585
Transrectal ultrasonography 29, 31f, 560
Transvaginal color Doppler
in infertility, role of 62
role of 63
Transvaginal fluoroscopic recanalization 461
Transvaginal hydrolaparoscopy 124
Transvaginal probe 639f
Transvaginal sonography 12, 14, 41, 218, 219, 229, 251, 511, 702
evaluation 651
Transvaginal ultrasonography 136, 164f
Transvaginal ultrasound 255, 529
application of 27
Trauma 323
Tremors 321
Trigger oocytes ovulation 663
Tripterygium wilfordii 449
Triptorelin 270
Troglitazone 238
Trophoblastic disease evacuation 354
Tubal anatomy 454
Tubal block 18, 118
Tubal cannulation 334, 336
Tubal causes 64
Tubal damage 528
Tubal disease 452
diagnosis of 331
Tubal embryo stage transfer 21, 630
Tubal evaluation 54
Tubal factor 331, 520, 631
infertility, management of 331
Tubal functions, loss of 185
Tubal hyperemia 529
Tubal intrafallopian transfer 21, 630
Tubal ligation 541
Tubal ostial fibrosis 189
Tubal ostium 342
internal 469f
Tubal patency 332, 717
diagnosis of 161
Tubal physiology, normal 456
Tubal polyps 399
Tubal reanastomosis 149
Tubal recanalization 460
indications for 457
techniques 459
Tubal reconstructive surgery 331, 348
Tubal spasm 332
phenomenon of 457
Tubal surgery 139, 346
effects of 111
port position for 336
role of 141
Tubercles 194f
Tubercular endometritis 185
Tubercular pelvis, diagnosis of 184
Tubercular peritonitis 201
Tuberculosis 118, 176, 182, 186, 196, 354, 546
diagnosis of 186
endometrial 356
hysteroscopy in 186
worldwide, impact of 182
Tubocornual anastomosis 146, 336, 452
Tubocornual polyps 399
Tubo-ovarian
abscess 527, 530, 540f
masses 198, 534f
relation criteria 143
relationship 128
Tuboplasty 337
failure of 631
Tumors 56, 323
necrosis factor 410, 488
Tunel assay 578
Two-cell–two-gonadotropin theory 263
Two-dimensional transvaginal ultrasonography 416
Tyrode's solution 653
U
Ulipristal acetate 449
Ultrasonography 185, 356, 357
Ultrasound 489, 604, 717
guidance 460
guided hysteroscopic cannulated hydrotubation 332
guided tubal recanalization 475
machine 638, 644
and probes 27f
technique of 71
Unicornuate uterus 117f
Unilateral cornual tubal obstruction 470
Upper female genital tract 527
Ureteral catheters 463
Ureteral stents 463
Ureters 148
Urinary infections 554
Urinary luteinizing hormone 511
Urinary tract 183
congenital abnormalities of 554
Urine 12
alkalization of 92
Uterine abnormalities 124
Uterine adhesions 182
Uterine and ovarian flow in infertility, Doppler assessment of 63
Uterine anomalies, treatment of 704
Uterine artery 51, 66
embolization 448
flow waveform, high-resistance 82f
Uterine bleeding, abnormal 4, 158
Uterine cavity 113, 116, 125, 185, 193f, 395f, 404f, 405f, 415f, 417f, 418f, 425f, 487
evaluation of 152
filling 114
irregularity of 186
middle 408f
Uterine congenital anomalies 40
Uterine factor 32, 66, 702
Uterine perfusions, abnormalities in 520
Uterine polyps 397, 410
macroscopically 398
Uterine prolapsed, second-degree 546
Uterine scar 136
Uterine septum 42, 172
classification 173
treatment 174
Uterine synechia 116
Uterine wall
anterior 399
lateral 399
posterior 399
Uterosacral ligaments 487
Uterotubal implantation 452
Uterotubal junction 399, 414f, 456, 519
Uterotubal ostium, transient spasm of 333
Uterotubal polyp 405f
Uterus 31, 32, 34, 123, 329, 527, 532
anterior wall of 194f
arcuate 116f
bicornuate 41f, 117f
congenital anomalies of 116
hyperemic 538f
normal 36f
perforation of 362
transvaginal ultrasonographic scan of 395f, 417f
V
Vagina 31, 527
Vaginal discharge 184
Vaginal factor infertility evaluation 32
Vaginal septae 32
Vaginismus 32
Varicocele 30f, 564, 574
large 562
repair 565
Vas deferens 586
congenital absence of 562, 643
Vasal aplasia 585
Vasal obstruction 562
Vascular endothelial growth factor inhibitors 369, 679
Vascularity flow index 82
Vasectomy 574
Vasoepididymal anastomosis 563
Vasovasostomy, failure of 643
Venereal disease research laboratory 12, 603
Venous intravasation 114
Versapoint system 445
Violin string bands 196
Viral orchitis 554, 562
Viscosity 92
glycoprotein responsible for 545
Vision and metallic test, blurring of 237
Visual diagnosis 202
Vitamin
D 228, 286
addition 311
deficiency 311
E 567
Volatile organic carbon compounds 688
Volume ejaculate 29
W
Wallace embryo transfer 463f, 467f
Weakness 237
Weight reduction exercise 232
Wet peritonitis 201
White blood cell 147, 529, 531
World Endometriosis Society Consensus 491
World Health Organization 97, 98t, 393
Y
Y chromosome 588f
microdeletion 104, 585
Z
Zinc 567
Zona
pellucida 519
penetration 519
Zuclomiphene 306, 307, 607
Zygote intrafallopian transfer 21, 630
×
Chapter Notes

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1Introduction
  1. Doctor We Want a Child
    Sushma Deshmukh
  2. Initial Workup and Diagnosis
    Sushma Deshmukh
zoom view
  • The infertile couple
  • Many times unmanageable
  • As treatment is sometimes unbearable
  • It starts with examination of couple
  • With ultrasonography of female
  • Including blood tests, urine as a routine
  • Do semen analysis of male partner
  • If it is OK then proceed further
  • Then test the tube with SSG, HSG
  • If hormonal abnormality, March on hormonal therapy
zoom view
  • Go for endoscopy, i.e., laparoscopy and hysteroscopy
  • To find out the cause of infertility
  • If all efforts are in vain
  • Some ray of hope still remain, i.e., assisted reproduction
  • IVF-ET, ICSI, GIFT, MIST
  • There are still donor embryos-eggs
  • So you have involved your leg
  • Deeper and deeper
  • Try for frozen embryos or co-cultures
  • Advice for a surrogate mother
  • If again no conception
  • Give a wise decision of adoption!
Sushma Deshmukh2

Doctor We Want a ChildCHAPTER 1

Sushma Deshmukh
 
INTRODUCTION
Infertility is a global issue. Couples from all levels of society come to clinician. The only statement from them is “Doctor, do anything but we want a child!”
Human reproduction is a complex system. If we look at the system carefully, then we also give credits to Almighty God or nature that though it is complex, every system is hormoneously organized. All hormones are in tune and rhythm. Endocrinal, reproductive and body's defensive systems are all working synergistically.
Incidence of infertility is about 15% in the population and increasing. We call a couple infertile when there is no pregnancy after 1 year of marriage without using contraceptive with regular sexual practice. So, it is very important that the couple should be aware of it. In infertility, mind and psyche both are involved along with body. And, in many communities, it is a social taboo. The couple always keeps on telling you that “Doctor, do whatever but we want affirmative results, i.e., child.”
Infertile couple is always in stress and strain. Many of the couples are wandering from one doctor to another. Some of them are lucky enough to get a proper treatment. But infertility is such a problem that many faculties with little knowledge treat it. And when all efforts are in vain then the couple comes to an infertility specialist.4
Most of the patients, when they come to us, have pile of files with them. It is very difficult to go through all files when clinician is busy in the outpatient department (OPD) where a large crowd is in the waiting room. But, one should make a habit to have a look at the files and try to go through it in a short span. Note down the important points in your own file. While going through the files, if for a moment you look at them, then you will notice that most of the couples have very high hopes on their faces, i.e., for a child. Some are desperate. Some will say that we have no hopes but someone has recommended your name, so as a last try, we have approached to you. And, your tension and responsibility goes on increasing.
In other branches of our obstetric and gynecology, we have very bright options in treating patients, e.g., antenatal care (ANC) patients, gynecological problems like prolapse uterus, abnormal uterine bleeding (AUB), and fibroid. But, treating infertility is many a times frustrating for the clinicians as well as patients. Because, they demand a new live creation either naturally or artificially, i.e., a child.
So, when an infertile couple comes to your center since beginning, i.e., from reception, they have to be treated nicely. It is a usual complaint of the patient that they have been sitting in the waiting hall since hours. In a busy infertility clinic, it is not possible for the clinician to do a perfect time management. But, at least use kind words, give them adequate time and always explain the plan of treatment.
Many newly married couples rush to infertility center for treatment within 3–6 months. Counsel them that only 15% conceive in 1st month, 50% in 6 months, 75% in 1 year and 90% at the end of 2 years.
Always insist the couple to come together and examine husband and wife by andrologist and gynecologist, 5respectively. After that counsel them together and explain regarding the female reproductive system; particularly ovulation, and importance of tubal, uterine factors.
Divide the couple in various categories like newly married young couples, couple with secondary infertility, couple with age between 30–35 years and above 35 years, female having major problems like tubal blockage/endometriosis/diminished ovarian reserve and male with abnormal semen parameters. Broadly, we can divide but the couple can present in any combinations.
Day-by-day, the science and technology are advancing. But along with that, infertility is also on rising trend.
 
WHY RISING TREND IN INFERTILITY?
While couple is demanding child, we cannot forget certain important things before starting major investigations.
  • Changing lifestyle
  • Stress-induced infertility
  • Environmental and occupational hazards and modern gadgets
    Changing lifestyle and stress-induced infertility go hand-in-hand.
 
Changing Lifestyle
Modern lifestyle, advanced age of couple, smoking, alcohol, obesity, lack of exercise, poor diet and stress are important factors which affects fertility.
  • Age of the couple to enter into the parenthood is increasing. As the age of female increases above 30, the number of oocytes starts declining. In men, semen parameters also begin to get a steady decline as early as 35 years and after 640 years, even more DNA damage is seen in their sperms. Marital conflicts and remarriages are increasing.
  • Consumption of saturated fatty acids, trans fats instead of monounsaturated fats in the diet has been demonstrated to increase the risk of anovulatory infertility.
  • Obesity and sedentary lifestyle cause increase in body mass index (BMI) leading to polycystic ovarian syndrome (PCOS). It will lead to anovulatory cycles, inadequate endometrial response and implantation failure.
  • Moderate exercise is always necessary. But strenuous exercise more than 5–6 hours per week is associated with low sperm count in men and higher rate of cycle cancellation, implantation failure in IVF.
  • Smoking, tobacco and alcohol also affect male as well as female fertility. Cigarette smoke affects sperm activity and leads to decreased fertilization capacity. In females, it causes decreased ovarian function and reduction in ovarian reserve.
 
Stress Gives Rise to Infertility and Vice Versa
  • Prolonged stress will activate hypothalamopituitary adrenal axis and inhibits hypothalamic–pituitary–gonadal axis.
  • In female, it will cause functional hypothalamic amenorrhea and functional hypothalamic anovulation. This persistent suppression will lead to ovarian quiescence, amenorrhea and infertility.
  • In male, it will decrease testosterone levels affecting ejaculation and sperm parameters.
  • Stress can be professional, emotional, psychological, environmental, medical disease, familial, financial, and infertility related. All are related to each other in some aspect.7
 
Environmental and Occupational Hazards and Modern Gadgets
Day-by-day, environment and occupational hazards are affecting male and female infertility.
  • Radiofrequency, electromagnetic waves (RFEMW) utilized by cell phones have detrimental effects on fertility.
  • Soft plastic and plasticizers are also supposed to affect sperm motility.
  • Bisphenol is used to produce plastic polymers and used in barrier coatings for the inner surfaces of food and beverage cans. It is endocrinal disruptor and causes male infertility. In females, it produces insulin resistance leading to polycystic ovarian syndrome.
  • Lead used in batteries, paints, ceramics, pipes. Mercury used in thermometers, batteries. Boron in glass, cement, soaps. All these metals interrupt hypothalamic–pituitary axis causing subfertility.
  • Pesticides and insecticides use has increased, thus affecting fertility.
The whole world is moving toward industrialization. Due to career, stress, luxurious lifestyles, there has been dramatic 8slump in infertility. So when the couple is demanding child, one should consider all these factors before starting major investigations.
Remember! stress is to be given on healthy lifestyle management, because—
We Doctors are witnessing
A dramatic slump in infertility
Sperm parameters are deteriorating
Oocytes are exhausting and aging
Late marriages, late planning,
Modern gadgets, tobacco, alcohol and smoking
Plastics, insecticides, environment pollution
Junk food, adultration, mobile, internet addictions
No exercise but only stress, mentally and physically
And the chances of conceiving being wreaked
So the Lifestyle Management is to be considered!
—Sushma Deshmukh
BIBLIOGRAPHY
  1. Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol. 2004;117(2):126–31.
  1. Md Hosen B, Md Islam R, Begum F, Kabir Y, Hossain Howlader MZ. Oxidative stress induced sperm DNA damage, a possible reason for male infertility. Iran J Reprod Med. 2015;13(9):525–32.