PCO how to treat

Empirical Decadron in follicular phase and or Bromocriptin to combat transient hyperprolactinaemia : Coming to empirical Decdac which will hopefully will decrees serum testosterones..

F)  Letrozole 3 cycles :-In such case after few cycles of letrozole with Decadron if there is letrozole resistance then after G)  tubal evaluation and exclusion of  pelvic endometriosis by clinical methods  Chr low dose protocol insisting with 37.5 IU of HMG/ p-FSH and IUI may yield good result. But there is scope for Lap Ovarian Drilling which has some inherited drawbacks of destroying some amorous of ovaries (like endometrioma)  , AMH pre procedure and 3 months post LOD should be done and such rule apply to ovarian endometriomata excision (> 4 cm diameter) , ART(IVF- mostly nowadays antagonist cycle with Freeze all have become routine in most centers and this is more so in cases of PCO where hyperstimulation and life threatening OHSS are not uncommon).

Your case: 2: ..pt with pcod ,secondary infertility : In such case there may be a history of induced abortion ,In absence of that mode of previous delivery, Postop period, sepsis have to be probed into .Tubal evaluation should follow after 3 cycles of letrozole with proper monitoring but if there is reason to believe that there is H//O miscarriage then SIS/HSG will be initial step. A large women globally undergo induced abortion (medl/ surgical ) after first childbirth .The exact figure in India can be viewed in Web National Family Health Survey-No 4 and most pof the couple have an firm belief that there is no risk of conception in lacto ameno which is untrue.  OCP ingestion after first childbirth and Duration of lactation must be enquired . If she is sec ameno phase then UPT should be done and hen withdraw bleeding should in instituted

Your third type of  couple: 3.Pt who tried 3 OI,1 IUI, with  irregular cycles. How to work them out? “Ans: As because her cycles are irregular most likely there are some endocrine disorder is there and unless that is diagnosed and rectified it will be difficult for her to conceive. Try to normalize insulin, androgens and PRL, TSH ,etc . Having said that If she is aged > 30 yrs then ART will be better option. The causes of IUI failures are 1) Minimal endometriosis which was unsuspected with resultant poor quality oocytes, and failure to fertilize or poor onward growth potential of fertilized ova  to progress beyond blastocyst. 2) Local endometrial pathology 3) abnormal sperm functions, morphology in particular 4) suboptimal training of  staff deployed for sperm prepn techniques. 4) Faulty/ poor quality media delayed servicing of incubator or centrifuge machine. SDemen analysis is ofen done by  Hemocytometer method, rarely by Makler's chamber(costly approx Rs 32,000/-) , Micro Cell.N

Laminar flow is not essential but will add to the result as is change of IUI canula. These have to rectified in consulation with your senior known colleague to whom U personally are acquainted.

UNEXPLAINED INFERTILITY.

When to declare?  1) Normal semen   2) Normal ovulatory      3) Tubal patency-assessed. & No cavitary distortion of uterus.What optimum treatment for UI? Ideally for last three decades the OI & IUI was the standard TR protocol. But time and aging it has been evidenced that this procedure yields=ds only 7-9& per cycle. So modern data shoes that if such UI cases are directly planned FOR ivf then success rate will be quite high in the range of > 30% per cycle.

In fact cumulative data reveals the success rate of 17% in CC-FSH –IUI, 21% for CC-IUI but as high as 50% for IVF. This more trues for elderly women those who are > 38yrs.

If semen viscosity was high in your case, it may be necessary to reduce the viscosity before the semen can be processed otherwise prepared sample will be poor. Viscosity reduction can be achieved by aspirating the semen in and out of a hypodermic syringe fitted with a 18 gauge blunt needle. Treatment with an enzyme such as chymotrypsin may also decrease the viscosity improving distribution of sperms.

Functional tests for sperms may be done if there is repeated IUI failure for which no cause could be established including Kochs /minimal endometriosis:  Such tets are A) Hypo osmotic swelling tests: Sperm fertilizing capability—B) nuclear chromatin deconden­sation test, C) reactive oxygen species.

Hypo-osmotic swelling.

These tests determine the sperm membrane structure and function. The presence of large number of vital, but immotile sperms may be indicative of structural defect in flagellum. Hypo-osmotic Swelling Test offers  different information about sperm membrane function, than that offered  by viability test.Basis: This test is based upon the fact that fluid transport occurs across the intact cell membrane under hypo- osmotic conditions until equilibrium is reached between the inside and outside.HOS values may be selectively altered with certain procedures like:Cryopreservation,Presence of sperm antibodies

Increase in free radicles, which occurs when there is increase in number white blood cells in semen.