DEFINITON OF INFERTILITY

Infertility is “a disease of the reproductive

system defined by the failure to achieve a
clinical pregnancy after 12 months or more of
regular unprotected sexual intercourse.”
by WHO
CAUSES OF INFERTILTY

 M ale infertility
 Female infertility
Male infertility

 1.Defective spermatogensis , the cause to this

 A. Congenital ( undescended testis ,
kartogener syndrome, hypospadias)
 B. Thermal factors( raised scrotal
tempertaure, big hydrocale ) other causes
include tight undergarment
 C. Infection- mumps orchitis , damage
spermatogenesis
 D. General factors – chronic debilitating
disease , malnutrition or smoking reduce
spermatogenesis .alcohol
 E. Endocrine – testicular failure due to
gondatrophic deficiency ( kallmann’s
syndrome)
 F. Genetic factors – chromosomal abnormality
like klienfelters syndrome
Iatrogenic

 Radiation , cytotoxic drugs nitro foruantine

cimetidine , beta blockers
Immunologic factors

 Antiobodies aganist spermatozoa

2.Obsturction of the
efferent duct
 Due to infections like gonococcel or by
surgical trauma ( hernioGrhaphy) following
vasectomy
3. Failure to deposit sperm
high in the vagina
 Erectile dysfunction
 Ejaculatory defect
 Hypospasdis

SPERM ABNORMALITY
4.ERRORS IN THE SEMINAL
FLUID
 High or low volume of ejaculate
 Low fructose content
 High prostanglandin
 Undue viscocity
FEMALE INFERTILITY

 1. OVARIAN FACTORS
 The ovulatory dysfunction encompasses
a. anovulation or oligoovulation
b. decreased ovarian reserve
c. Luteal phase defect( LPD)
d. Luteinised unruptured follicle
 Anovulation
 Ovarian activity totally dependent on the
gonadotrophins
 Related with disturbed hypothalamos –
pituitary ovary axis
Luteal phase defect(LPD)

 Inadequate growth and function of the corpus

Luteum
 Inadequate progesterone secretion
Luteinised unruptured
follicular syndrome
 Ovum is trapped inside the follicle which gets
lutenised
 2.TUBAL AND PERITONEAL
FACTORS
 Like pelvic infections , Previous tubal
surgery, tubal endometriosis , polyp
3. Peritoneal factors

 Peritubular adhesions, even minimal

adhesions and endometriosis
Uterine factors

 Uterine hypoplasia , inadequate secretory

endometrium
Cervical factors

 Anatomical defect
 Physiological effect
Vaginal factors

 Atresia of the vagina , transverse vaginal

septum , separate vagina or narrow introtitus
Combined factors
Management of infertility

 Nonmedical
 Simple changes in lifestyles ( wearing loose
clothing , long periods of sitting , avoiding
prolonged hot baths )
 Using water soluable lubricants during
intercourse
 Treatment available to the women – who
have an immunological reaction to sperm
 CHANGES IN NUTRITION AND HABITS – like
well balanced diet , exercise , alcohol
 HERBAL AND ALTERNATIVE THERAPY
 Relaxation , osteopathy , stress
management , nutrition and exercise
counselling shown increases pregnancy rates
 Herbal remedies promote fertility like red
clovers flowers, nettle leaves
 Vitamin E and vitamin c , gluthathione and
co- enzyme
 Herbs to avoid while trying to conceive
include licorie, ephedra , fennel , goldenseal
lavendra
Pharmacological therapy

 CLOIPENE CITRATE – ovulation induction ,

treatment of luteal phase
 Dosage – starting with 50mg /day by mouth
for 5 days beginning on the 5 th day of
menses
 Side effects – vasomotor flushes , abdominal
discomfort
 MENOTROPINS( human menopausal
gonadrotropins) – ovarian follicular growth
and maturtion
 IM INJECTION – variable based on ovarian
response
 Side effects – ovarian enlargement , ovarian
hyperstimulation
 FOLLITROPHINS – treatment of polycystic
ovarian disease , follicular stimulation for
assisted reproduction
 Dose – sc or im injection
 Side effects – ovarian enlargement ‘ ovarian
hyperstimulation
 HUMAN CHORION GONADOTROPHINS –
ovulation induction
 Dose 5000- 10,000 iu . IM one day after last
dose of menotrophins
 Side effects – headache , irritability
 ANDROGENS ( danazol)
 Treatment of endometriosis
 Dose 200- 800 mg/dl by mouth for 3 to 6
months
 Mild hirustism, acne , edema , weight gain
 GNRH AGONST
 Treatment of endometriosis
 Dose 200 mcg intranasal twice daily for 6n
months
 Side effects – irritation , nose bleed
 PROGESTERONE – treatment of luteal phase
inadequacy
 Dose – vaginal or rectal suppository 50 to 100
mg daily
 Side effects breats temderness, local
irritation , headache
 Gnrh antagonist – controlled ovarian
stimulation for infertility treatments
 Dose 250 mg daily subcutaneous usually in
the early to mid follicular phase of the
menstrual cycle usally follwed by hcg
administration
SURGICAL MANAGEMENT
 HYPERSALPINGOGRAPHY
 Useful for the identification for tubal
obstruction and also for the release of
blockage
 During laproscopy delicate adhesion may be
divided and removed and endometrial
implants may be destroyed by
electrocoagulation or LASER
 Laprotomy or even microsurgery may be
required to do extensive repair of dammaged
tubes
 RECONSTRUCTIVE SURGERY
 EG: unification operation for bicornate uterus
Surgical removal of tumours or fibroids
involving endometrium or uterus eg
myomectomy
 CHEMOCAUTERY – Destruction of tissue with
chemicals
 Thermocautery – destruction with heat
usually electrical
 Cryosurgery – destruction of tissue by
application of extreme cold usually liquid
nitrogen
Conization –excision of a cone shaped piece of
tissue form the endocervix- effective in
elimination chronic inflammation and
infection
Surgeries for male infertility
Surgical repair of the variocele
Microsugery: to reanastomse the sperm duct
after vasectomy can restore fertility
ART OR ASSITED REPRODUCTIVE
THERAPIES
 Treatments include
1. INVITRO FERTILIZATION EMBRYO
TRANSFER( IVF-ET)
 Common approach for women with blocked
or absent uterine tubes OR with unexplained
fertility and men with very low sperm count
 99% of all arts use this procedure
 Generally only three or fewer embryos' are
transferred to minimize the risk for multiple
pregnancy
 Procedure termed successful when embryo
continues to develop in the uterus and
pregnancy proceeds
 Potential for successful pregnancy in IVF is
when maximum 3 to 4 embroyo’s are placed
in the uterus
 For this reason fertility drugs are used to
induce ovulation prior to the process
 Follicular development and oocyte maturity
are monitored frequently with ultrasound and
hormonal assays
Procedure for IVF

 Before the procedure the women is

administered an ovulation agent such as
clomiphene citrate or human menopausal
gonadotropin
 Beginning from 10thday of the cycle ovaries
are examines by usg for follicle development
 When follicle appears mature , a women is
given an injection of HcGin 38 to 42 hours
 a needle introduced intravaginally , guided
by usg , and oocyte is aspirated form the
follicle
 Because drugs are given to induce ova
maturation many oocytes ripen at once as
many as 3 to 12
 3 to 12 oocyte can be removed
 Meanwhile Husband or donor supplies a fresh
semen species

 Sperm cells and oocyte are allowed mixed and

allowed to incubate in a growth medium

 Genetic analysis is done to reveal any

abnormalities
 After fertilization of chosen oocyte occurs ,
the zygote formed almost immediately begin
to divide and grow
 After 40 hours after fertilization , they will
undergo their first cell division
 In past multiple eggs were chosen and
implanted to ensure a pregnancy resulted
 This techniques also resulted in multiple
pregnancy
 Once the eggs are fertilized and progress to
the embryo stage , the embryos are placed in
the uterus
 After the procedure the women is advised to
engage in only minimal activity for 12 to 24
hours and progesterone supplements are
prescribed
 Newborns from multiple births have a much
lower chance of surviving the neonatal period
than others
 If couple desires any egg not used be frozen
and used any time
 Proof that zygote had implanted can be
demonstrated by routine serum pregnancy test
 Overall pregnancy rate by ivf is as low as 38 to
42% per treatment cycle

 If usg shows multiple pregnancy more than two

zygotes – selective termination of gestational
sac until two are remaining

 This termination is done by intra-abdominal

injection of potassium chloride into the
gestational sac chosen to be eliminated
 IVF IS A EXPENSIVE PROCEDURE – ABOUT
10,ooo dollars per cycle
Intra-Uterine Insemination
(IUI)
 Definition
 Intra-uterine Insemination (IUI) is the placement
of sperm directly into the uterus of the woman, 
bypassing the cervix.
 Indications
 This procedure is performed for patients with a
cervical factor (cervicitis, cervical stenosis,
inadequate mucus or hostile mucus), unexplained
infertility, male factor infertility or immunological
infertility
 Procedure
 The female's ovaries are stimulated
hormonally to produce follicles containing
the eggs. 
 An ultrasound scan is performed to
determine the number and size of the follicles
and also the thickness of the endometrium,
lining the uterus, to see whether it is ready for
implantation. 
 Also, blood hormone levels will be measured. 
Ovulation will be induced by an injection of
human chorionic gonadotrophin (hCG), and
the egg will be released 36-48hr later.
 The male partner's semen is processed to
select the highest quality sperm. The
physician will then inject this sperm via a
catheter through the vagina and cervix, into
the uterus.
 This procedure is contra- indicated if a
women’s fallopian tubes are blocked
 Fertilization then occurs in the tube and the
zygote moves to the uterus for implantation
 This procedure is contra- indicated if a
women’s fallopian tubes are blocked
GAMETE INTRA FALLOPIAN
TRANSFER

(GIFT)
In gamete intra fallopian transfer procedures
ova are obtained from ovaries exactly as IVF .
Instead of fertilization to occur in the
laboratory, both ova and sperm are instilled
within matter of hours, using laparoscopic
techniques into the open end of patent
fallopian tube.
 Fertilization then occurs in the tube and the
zygote moves to the uterus for implantation
 Hormones are given for the next 2 weeks to
help maintain a pregnancy.  Any extra eggs
may be fertilized in vitro (IVF), cryopreserved,
or donated
ZYGOTE INTRA FALLOPIAN
TRANSFER
 This procedure involves oocyte retrieved by
transvaginal, ultra sound guided aspiration
followed by culture insemination of the
oocyte in the laboratory.
 Within 24 hrs the fertilized eggs are
transferred by laparoscopic technique into
the end of a waiting fallopian tube.
 ZIFT differs from GIFT
 As in GIFT a women must have one
functioning fallopian tube for the technique
to be successful.
 Complication :
 Congenital abnormalities occur more
frequently from these embryos
 Multiple gestation with increased risk for
both mother and fetus
OOCYTE DONATION

 Women who have ovarian failure or

oophorectomy who have a genetic defect or
who fail to achieve pregnancy with their own
oocyte may be eligible for the use of donor
oocytes.
 Oocyte donation is done by women who are
younger than 35 years and healthy and are
paid to undergo ovarian stimulation and
oocyte retrieval
 The donor eggs are then fertilized in the
laboratory with male partner’s sperm
 The recipient women undergoes hormonal
stimulation to allow development of the
uterine lining.
 In donor oocyte the eggs are donated by AVF
procedure and the donated eggs are
inseminated.
 The embryos are transferred into the
recipient uterus, which is hormonally
prepared with estrogen/progesterone
therapy.
 INDICATIONS:
 Early menopause, surgical removal of ovaries,
autosomal sex- linked disorders, lack of
fertilization in repeated IVF attempts because
of subtle oocyte abnormalities or defects in
oocyte- spermatozoa interaction
EMBRYO DONATION

 On occasion couple decide that theydo not

want their frozen embryo and their release
for adoption by other infertile couple
 INDICATION:
 Infertility not resolved by less aggressive
forms of therapy, absence of ovaries, male
partner's azoospermia or is severely
compromised
SURROGATE MOTHER/EMBRYO
HOSTS/GESTATIONAL CARRIERS
 Surrogate mother can be achieved by two
methods:
 The first is for surrogate mother to be
inseminated with semen from the infertile
women’s partner and to carry the baby until
birth.
 The baby is then formally adopted by infertile
couple
 A less common method is to relieve an ovum
from the infertile women fertilize it with her
partner’s sperm and place it into the uterus
of a surrogate who becomes an embryo host
or gestation carrier.
 These intervention raise considerable legal
and ethical issues that require extensive
counseling of couple and and the women to
choose to become pregnant
 PROCEDURE TO SURROGATE MOTHER:
 1)A couple undertakes an IVF cycles and
 2)The embryo is transferred to the uterus of
another woman(the carrier) who has
contacted with the couple to carry the baby
to term.
 3)The carrier who has no genetic investment
in child.
 Indication: Congenital absence or surgical
removal of uterus a reproductively impaired
uterus, myomas,uterine adhesions or other
congenital abnormalities, amelical condition
that might be life threatening during
pregnancy such as diabetes, immunologic
problems or severe heart, kidney or liver
diseases
 THERAPEUTIC DONOR INSEMINATION
Definition
 TID is the placement of donor sperm directly
into the uterus of the patient
 TDI or therapeutic donor insemination by
donor is when the male partner has
no( previously referred to as artificial
insemination) or very low sperm count( less
than 20 million motile sperm per milliliter),
the couple has a genetic defect, or the male
partner has an antispermantibody
 Procedure:
 1)The procedure is done in the physicians
office or clinic, usually the day after the
woman has LH surge.
 2)The sperm are loaded into a catheter.
 3)The sperm are loaded into a catheter that is
then inserted in the vagina through the cervix
and placed high in the uterine cavity.
 4)The sperms are injected slowly and the
catheter is removed.
 5)The woman lies flat for a few minutes and
then can get up and resume her usual activity
 MICRO MANIPULATION:

 Technique to improve fertilization, embryo

growth and genetic testing are improving at a
rapid pace. Micromanipulation allows the
handling of individual eggs and sperm through
the use of specific instruments and controls
 INTRA-CYTOPLASMIC SPERM INJECTION:
 Definition
 The process whereby a single sperm is injected
directly into the cytoplasm of the egg.
 Indications
 ICSI is the method of choice for patients with
severe male factor infertility, and for patients
who have had previously failed or poor
fertilization resulting from conventional IVF.
 It is a technique that make it possible to
achieve fertilization or to correct abnormal
fertilization by introducing sperm beneath
the zonapellucida directly into the egg.ICSI
offers the opportunity to enhance the
chances of fertilization in cases of a severe
male factor
 Procedure
 The eggs are retrieved from the woman's
ovaries in the same way as for IVF. 
 The eggs are then stripped of all surrounding
cells and placed in a droplet and the male
partner's sperm placed in another droplet.
 The sperm can be obtained via ejaculation or
in severe cases, directly from the testis or
epididymis using microsurgical sperm retrieval
techniques.
 The oocyte is held in place by a specialized
holding micropipette.
   With a microinjection pipette, one sperm is
picked up (aspirated) and then carefully
injected into the cytoplasm of the oocyte. 
This is done for all the eggs.
 The eggs are then placed in the incubator,
and checked the next morning for
fertilization.
 The fertilized eggs are then allowed to
develop for another 24-48hr, after which they
are transferred into the uterus via a thin
catheter.
 Hormonal treatment to help maintain a
pregnancy is given for the next 2 weeks
 PRE-IMPLANTATAION GENETIC DIAGNOSIS:
 It is a form of early genetic testing designated
to eliminate embryos with serious genetic
defects before implantation through one of
the ARTs and to avoid future termination of
pregnancies for genetic reasons.Micro
manipulation allows removal of a single cell
from a multicellular embryo for genetic study
 Definition
 Assisted hatching is the opening of the zona
pellucida , surrounding the embryo, to help
the embryo/blastocyst "hatch" or emerge
from the zona and implant in the uterus.
 Indications
 Assisted hatching is usually indicated in older
women, and those with failed implantation in
previous cycles.
 Procedure
 Prior to embryo transfer, a small opening is
made in the zona pellucida using
microdissection tools. The embryos are then
transferred normally
 . An infrared laser is used to create a hole in
the zonapellucida so that the embryo can
break through and implant.
 This procedure is considered experimental
and research continues(Georgia Reproductive
Specialist,2005)(www.ivf.com).
Indications

When sperm are unable to move through the

genital tract due to uncorrectable damage,
sperm can be extracted directly from the
epididymis or testes via microsurgical
techniques.  Congenital absence of the vas
deferens (CAVD) or failed sterilization
reversal are other indications.
Procedure

 the woman has her eggs retrieved, the

husband/male partner will undergo a surgical
procedure that will either take a very small
piece of testicular tissue (TESE) or aspirate
the fluid from the epididymis (MESA).
 For TESE/MESA the testicular
tissue/epididymal  fluid will be examined for
the presence of sperm cells. These can then
be injected into the oocyte via ICSI. In cases
where no sperm are seen, round spermatids
(immature sperm seen on right) can be used
for ICSI (ROSI).
Sperm Cyropreservation and
Thawing
 Definition
 The process of preserving sperm by means of
freezing for use at a later time.
 Indications
 Sperm can be cryopreserved if they are
difficulty in producing a specimen at a given
time.
 patients planning to undergo chemotherapy
or radiotherapy (for cancer), sperm may be
cryopreserved as the (therapy may diminish
sperm production). Sperm also frozen for
people if they want to donate
Procedure

 Sperm retrieved by , testicular biopsy or

microsurgical epididymal sperm aspiration
are placed together with a cryoprotectant
and stored in cryostraws in liquid nitrogen at
a temperature of -196°C.
 Then they are thawed at any time, and the
cryoprotectant can be removed and the
sperm used for ART procedures.
Embryo Cryopreservation and
Thawing
 Definition
 The process of storing embryos by means of
freezing in liquid nitrogen for use at a later
time.
 Sperm Donation
 Definition
 The donation of sperm for the use by infertile
couples with severe male factor infertility
Indications

 Donor sperm used when the male partner

has azoospermia or severe male factor, has a
know hereditary/genetic disorder that could
be carried over to biologic offspring,
 has had previously failed IVF attempts
 do not choose to have ICSI.
 Donor sperm may also be used in females
without male partners. 
Gender Selection

 Definition
 In this process it increases the chance of
having a female or male child, by separating
sperm that bear the X chromosome (female)
and those that have the Y chromosome
(male), and inseminating with whichever
sample is desired.
Indications

 The procedure can be employed for couples

who want a child of a specific gender
Procedure

 procedure used is the sedimentation method.

 takes approximately 2-2½ hours to process.
   On average, it takes about 3-4 cycles to
achieve a pregnancy with this method.
Journal review ......
 TTILE: An alternative medicine study of herbal
effects on the penetration of zona-free hamster
oocytes and the integrity of sperm
deoxyribonucleic acid.
OBJECTIVE:
 To analyze the effects of certain herbs on
sperm DNA and on the fertilization process.
 DESIGN:
 Prospective comparative study.
 SETTING:
 Clinical and academic research environment.
 INTERVENTION(S):
 Zona-free hamster oocytes were incubated
for 1 hour in saw palmetto (Serenoa repens),
echinacea purpura, ginkgo biloba, St. John's
wort (Hypericum perforatum), or control
medium before sperm-oocyte interaction.
The DNA of herb-treated sperm was analyzed
with denaturing gradient gel electrophoresis.
 MAIN OUTCOME MEASURE(S):
Oocyte penetration and integrity of the sperm
BRCAI exon 11 gene
 RESULT(S):
 Pretreatment of oocytes with 0.6 mg/mL of
St. John's wort resulted in zero penetration. A
lower concentration (0.06 mg/mL) had no
effect. High concentrations of echinacea and
ginkgo also resulted in reduced oocyte
penetration. Exposure of sperm to echinacea
purpura and St. John's wort resulted in DNA
denaturation
 CONCLUSION(S):
 High concentrations of St. John's wort,
echinacea, and ginkgo had adverse effects on
oocytes.
 St. John's wort was mutagenic to sperm cells.
2.Chinese herbal medicine for
infertility with anovulation: a
systematic review
 AIM:  of this systematic review is to assess
the effectiveness and safety of Chinese herbal
medicine (CHM) in treatment of anovulation
and infertility in women
 Method : Eight (8) databases were
extensively retrieved. VIP Information,
CMCC, and CNKI. The English electronic
databases included AMED, CINAHL,
Cochrane Library, Embase, and MEDLINE
 There were 692 articles retrieved according
to the search strategy, and 1659 participants
were involved in the 15 studies that satisfied
the selection criteria
 RESULT:Meta-analysis indicated that CHM
significantly increased the pregnancy rate
and reduced the miscarriage ratE compared
to clomiphene
 CHM also increased the ovulation rate
 CONCLUSION:CHM is effective in treating
infertility with anovulation. With no side
effects
The role of antioxidant
therapy in the treatment of
male infertility
 The aim of this study was to
review the current literature on the effects of
various antioxidants to improve fertilisation
and pregnancy rates
The sources of
literature were Pubmed and the Cochrane data
base
 Result

 Reviewing the current literature revealed that

Carnitines and vitamin Cand E have been
clearly shown to be effective
 Conclusion there is however a need for
further invetigation with RCT’S
 4.Weight loss results in significant
improvement in pregnancy and ovulation
rates in anovulatory obese women
 a weight loss programme was assessed to
determine whether it could help infertile
overweight anovulatory women to establish
ovulation and assist in achieving pregnancy,
ideally without further medical intervention
 METHOLODOLOGY:They underwent a
weekly programme of behavioural change in
relation to exercise and diet over 6 months;
those who did not complete the 6 months
were treated as the comparison group
 RESULT:Women in the study group lost an
average of 6.3 kg, with 12 of the 13 subjects
resuming ovulation and 11 becoming
pregnant, five of these spontaneously.
 CONCLUSION
  weight loss with a resultant improvement in
ovulation, pregnancy outcome, self-esteem
and endocrine parameters is the first
therapeutic option for women who are
infertile and overweight
Acupuncture on the day of embryo
transfer significantly improves
the reproductive outcome in
infertile women: a prospective,
randomized trial
 Objective
 To evaluate the effect of acupuncture on
reproductive outcome in patients treated
with IVF/intracytoplasmic sperm injection
(ICSI).
 Design
 Prospective, randomized trial.
 Setting
 Private fertility center.
 . On the day of oocyte retrieval, patients were
randomly allocated (with sealed envelopes) to
receive acupuncture on the day of ET on that day
and again 2 days later or no acupuncture (control
group, n = 87).
 Intervention(s)
 Acupuncture was performed immediately
before and after ET (ACU 1 and 2 groups),
with each session lasting 25 minutes; and one
25-minute session was performed 2 days later
in the ACU 2 group.
 Main Outcome Measure(s)
 Clinical pregnancy and ongoing pregnancy
rates in the three groups.
 Result(s)
 Clinical and ongoing pregnancy rates were
significantly higher in the ACU 1 group as compared
with controls (37 of 95 [39%

Conclusion(s)
 Acupuncture on the day of ET significantly improves
the reproductive outcome of IVF/ICSI, compared
with no acupuncture. Repeating acupuncture on ET
day +2 provided no additional beneficial effect
. Title : female infertility and chiropractic
wellness care : a case study on the autonomic
sytem response while under
subluxationbased on chiropratic care and
subse quent fertility
 Objective: This case study describes a
woman, previously diagnosed with a lazy
(reproductive) system, who became pregnant
after commencing subluxation-based
chiropractic care
 Clinical Features: A 31 year old woman
underwent medical treatment for infertility as
they had been attempting to become pregnant
for over 12 months, and the woman had been
taking Clomiphine Citrate (clomid) for 3
months.
 conceived naturally.

Conclusion: After vertebral subluxations, the
practice member showed marked
improvement in autonomic and motor system
function as demonstrated on her sEMG and
thermography scans. In
 Additonal, she became pregnant nine months
after commencing chiropractic care
 Title :Study of Combined Use of Clomiphene
Citrate and Gonadotropins on the Infertile
Patients with PCOS
 Objective
 To investigate the efficacy and safety of
combined use of clomiphene citrate (CC) and
gonadotropins (Gn) on the infertile patients
with PCOS.
 Methods
 A total of 367 infertile patients with PCOS
were included in this retrospective study.
Patients received CC from menstrual cycle
day 3 until the day of triggering and human
menopausal gonadotrophins (hMG) from
menstrual cycle day 5 until the ovulation day
 GN duration and doses , serum LH and
estradiol levels , frozen thawed embroyo
implantation and clinical pregnancy rates
were compared with patients with cc and
Gnrh
 Results
 Gn duration and doses, blood estrogen level,
transferable embryos and incidence of OHSS in the
group of CC plus hMG were decreased significantly
than those of long and short protocols. No
differences were observed in the frozen-thawed
embryo implantation and clinical pregnancy rates
among three groups.
 Conclusion
 Mild stimulation of CC combined with hMG
on infertile patients with high risk for OHSS is
safe and efficient.
 title: Human menopausal gonadotropins: a
justifiable therapy in ovulatory women with long-
standing idiopathic infertility.
 Methodology: A group of 97 couples, with long-
standing idiopathic infertility received up to four
cycles of empiric human menopausal gonadotropin
therapy before in vitro fertilization.
 This group was compared with a control group of 48
couples who did not receive human menopausal
gonadotropin before in vitro fertilization
 Result:The 12 (12.4%) conceptions and eight
(8.2%) term births resulted from human
menopausal gonadotropin therapy in the
study group was significantly higher than the
number of spontaneous conceptions and
births (1%) in the study group
 Title: Timed intercourse after intrauterine
insemination for treatment of infertility.
 OBJECTIVE:
 To compare the pregnancy rates, between
intrauterine insemination (IUI) followed by
timed intercourse and IUI only for treatment
of the infertile couples.
 STUDY DESIGN:
 A prospective study of two different protocols
of intrauterine insemination in two hundred
and one infertile couples with a normal
spermiogram was carried out
 101 couples were treated with IUI alone and
100 couples had both IUI and timed
intercourse within a 12-18 h period. The
pregnancy rates were compared between
groups.
 RESULT:The pregnancy rate per cycle
increased with increasing numbers of total
motile sperm per insemination in the IUI
alone group (. Timed intercourse increased
pregnancy rate in patients with lower motile
sperm number, but not in patients with
higher sperm number
 CONCLUSIONS:
 In IUI with low number of motile sperm
inseminated, timed intercourse significantly
increases the pregnancy rates over IUI alone
in infertile couples with a normal
sperminogram
 title: Efficacy of Superovulation and
Intrauterine Insemination in the Treatment of
Infertility
 Objective : to assess the efficacy of
superovulation and interuterine insemination
over intracervical insemination alone
 METHODS
studied on 932 couples in which the woman
had no identifiable infertility factor and the
man had motile sperm.The couple was
randomly assigned to receive intracervical
insemination , iui insemination, superovlution
and intracervical insemination or
superovulation and iui
 RESULTS
 The 231 couples in the group treated with
superovulation and intrauterine insemination
had a higher rate of pregnancy (33 percent)
than the 234 couples in the intrauterine-
insemination group
 CONCLUSION among the infertile couple
treatment with the induction of superovlution
and iui in three times are likely to result in
pregnancy as treated with either
superovulation and intracervical insemination
or iui
 Title: Follicular flushing and in vitro
fertilization outcomes in the poorest
responders: a randomized controlled trial
 Objective
Does follicular flushing during oocyte
retrieval improve the number of oocytes
retrieved in the poorest responders?
 STUDY DESIGN, SIZE, DURATION:
 This randomized controlled trial compared
the effects of follicular flushing and direct
aspiration on IVF outcomes in the poorest
responders. Fifty patients were randomized
during the 12-month enrollment period.
 MAIN RESULTS
  Patients who underwent follicular flushing
had significantly fewer embryos transferred {
a lower implantation rate and a lower clinical
pregnancy rate . The difference in pregnancy
rates remained significant after adjusting for
embryos transferred.
 Title : role of laproscopic ovarian drilling as a
first line mangement in infertility with poly
cystic ovarian disease
 Aim: main objective of the study was to
evaluate the effectiveness of laproscopic
ovarian drilling in pcos in terms of prenancy
rate
 Study design: retrospective study with 50
patients

 RESULT : majority of the women had a sucess

full cumaltative ovulation rate of 72%was
observed and a pregnancy rate of 48% a
mean duration of 3 to 9 months

 CONCLUSION: laproscopic ovarian drilling is

effective in induction of ovulation and
increasing the pregnancy in case of PCOD
 Title: Nonsurgical fallopian tube
recanalization for treatment of infertility.

 Aim – whether non surgical fallopian tube

recanalization was help full in treatment ,
caused by proximal tubal obstruction
 Methodology ; fluroscopic fallopian tube
recanlization was performed in 100 consecutive
patients with infetility and proximal tubal
obsturction
 RESULT Recanalization of one or both tubes
was successful in 19 of these women (95%).
Nine patients conceived (47%) without
receiving any other therapy, and the average
time from procedure to conception was 4
months. All pregnancies were intrauterine.
Eight of the 10 patients who did not conceive
underwent follow-up hysterosalpingography
an average of 6 months following the
procedure; four (50%) demonstrated
reocclusion of both tubes
 CONCLUSION
 The authors conclude that nonsurgical
fallopian tube recanalization is an effective
treatment for infertility caused by proximal
tubal obstruction.
 Title : Metformin in polycystic ovary syndrome:
systematic review and meta-analysis
 Objective To assess the effectiveness of
metformin in improving clinical and
biochemical features of polycystic ovary
syndrome.
 Design Systematic review and meta-analysis.
 Data sources Randomised controlled trials that
investigated the effect of metformin compared
with either placebo or no treatment, or
compared with an ovulation  induction agent.
 Selection of studies 13 trials were included for
analysis, including 543 women with polycystic
ovary syndrome that was defined by using
biochemical or ultrasound evidence.

 Main outcome measure Pregnancy and

ovulation rates. Secondary outcomes of
clinical and biochemical features of polycystic
ovary syndrome.
 Results Meta-analysis showed that
metformin is effective in achieving ovulation
in women with polycystic ovary syndrome
 Conclusions Metformin is an effective
treatment for anovulation in women with
polycystic ovary syndrome. 
 TITLE :Safety and efficacy of clomiphene
citrate and L-carnitine in idiopathic male
infertility: a comparative study.
 PURPOSE:
 To compare the effects of L-carnitine with
clomiphene citrate in idiopathic infertile men.
 MATERIALS AND METHODS:
 Fifty-two men with idiopathic infertility were
recruited in this randomized controlled trial.
They were randomly assigned into 2
treatment groups, group 1 (n = 20) and group
2 (n = 32), who received L-carnitine 25
mg/day and clomiphene citrate 2 gr/day,
respectively, for a period of 3 months
 RESULTS, both medications had influence on
sperm count and motility (P = .01). L-carnitine
significantly increased the semen volume (P =
.001), while clomiphene citrate was
significantly associated with the motility
percentage and normal morphology (P = .
008).
 CONCLUSION:
 It seems that the use of clomiphene citrate
and L-carnitine, either individually or in
combination, as the first step of idiopathic
male infertility treatment is reasonable, safe,
and effective
 Title : day three versus day two embryo transfer
following in vitro fertilisation or
intracytoplasmic sperm

 Objective: to detremine if there is any difference

in the live births and pregnancy rate when et is
performed on day 3 compared to day two
 SELECTION CRITERIA –RCT that compared
day 3 versus day 2
 Conclusion : although an increase in clinical
pregnancy rate with day three embryo transfer
was demonstrated
 TITLE : LOW OXYGEN CONCENTRATION
FOR EMBRYO CULTUE IN ASSISTED
REPRODUCTIVE TECHNOLOGY
 Objective – to detremine whether embroyos
culture at low 02 conc , improves treatment
out come
 Population- seven study with 2422 participant
were included in this systematic review
 Main results- evidence of a benefical effect of
culturing in low oxygen concentration was
found
 Clincally improve live birth by 30% using
atmospheric conc than 32% and 43%using
low o2 conc
 TITLE – the morphological normaly of the sperm
nucleus and pregnancy rate of intracytoplasmic
injection with morphological selected sperm

 AIM to detremine whether increased pregancy

outcome attributed to the nuclear morphology
of the sperm

 Result – implantation and pregancy was

significant higher and abortion rate significantly
lower
 TITLE –use of carnitine therapy in selected
cases of male factor infertility a double – blind
cross over study

 Objective – to determine the efficacy of l-

carnitine therapy in selected cases of male
infertility
 Population – 1oo infertile males
 RESULT – A statically significant
improvement in semen quality ,was seen
after the use of l- carnitine
 TITLE : Smaller fetal size in singletons after
infertility therapies : the influence of
technoolgy and underlying infertility
 AIM to determine whether fetal size
differnce exist between matched fertile and
infertile women

 Result – compared to the matched fertile

women had smaller neonate at birth and mor
e lbw infants
NEW PAPER ARTICLE IN THE
TIMES TRENDS DATED
JUNE28,2O13