Subfertility solutions;

. Prevalence, Routine Investigation schedule  & pre-induction salient features:- Q.1:-Prevalence & when to initiate investigations?

The overall incidence of infertility has remained stable but  the infertility evaluation is typically initiated after 1 year of trying to conceive, but in couples with advanced female age (> 35 years), most practitioners initiate diagnostic evaluation after an inability to conceive for 6 months.

Q.2:- Investigations of Infertile couple.

INVESTIGATINS ONLY AFTER PROVISIONAL DIAGNOSIS. Part I: Tests for fitness for pregancy .

A)Complete haemogram, B) Blood group, C) Viral screen(Rubella, HBsAg, HCV, Rubella, HIV) ,D) Serological tests for Syphilis- TPHA, E)  Hormonal Profile, F)  Metabolic screen, G) Pelvic USG,

 Part II : Routine Investigations of subfertility? Standard infertility evaluation 1) It includes a semen analysis,2)  assessment of ovulation,3)  a hysterosalpingogram, and, if indicated, tests for 4)  ovarian reserve and laparoscopy.

Part III: What are the special Investigations:-?

Assessment of ovarian reserve, and the potential role of B) laparoscopy in the complete workup of unexplained infertility   C) SIS/ HSG D) Hysteroscopy.but no

No routine FSH, LH, DHEASO4

Fluctuating PRL between: 25-50 ngà do not Ry. if USG machine is good enough then no need to measure midcycle E2 or Progesterone. Hysteroscopy is preferred to HSG.

Normal PCT rules out male factor infertility for all practical purposes.

Q.3:-Does CC cause rise of LH and minimizes cycle fecundity?? Ans:-Should we routinely insist on Day 3 LH estimation before prescribing CC in all Cases?

Ans:-It is reported that CC administration itself causes rise of LH in fair number of cases. Researchers claim this CC-induced iatrogenic rise of LH is an important cause of CC insensitivity (also termed as CC failure).  Researches also noticed disproportionate rise of serum LH in response to CC in comparison to rise of FSH. This temporary change in FSH: LH ratio may impede the desired proper growth of Follicle. (Source: Balasch J et al Hum Reprod 1995; 10:1678-83.)

Q.4 :-Does extended course of CC really advantageous? or it is detrimental for continued follicular growth? What is the personal experience of the Forum members? Ans:-Some researchers have  noticed administration of CC  for more than 5 days resulted in an initial rise of FSH  levels, despite continuation of CC beyond 5 days, whereas LH level remained high throughout the entire treatment period(Source: Soham Z. “The clinical therapeutic window for LH in COH” Ferti Steril 2002;77:1170-7.) . Should we, therefore, refrain from extended days of CC Ry?   Members opinion?

. : How many of us trigger for ovulation by HCG in Clomiphene/Letrozole cycles?? Ans: Myself don’t approve thye policy of  routine HCG as trigger in timed intercourse cycles . But one should add trigger HCG in cycles only when IUI is planned. Not in only CC -TI cycles.  Dexamethasone along with CCà only in cases with Chr. anovulatory obese PCOs.

Start low dose FSH- Step Up: - in anovulatory PCOS as initial first line Ry. For this r-FSH is superior.

For thin lean PCOS: - gonadotrophins, Antagonists and IUI have an immense role.

Tips of Tr. Of Infertility.

.

Baseline day 3 USG before initiation of stimulation is a must to maximize fecundity . By doing so one can differentiate between responding or unresponsive ovaries in fair number of cases. It can also pick up any UCL (unruptured CL) at the beginning of cycle.Baseline day 3 USG before initiation of stimulation is a must to maximize fecundity . By doing so one can differentiate between responding or unresponsive ovaries in fair number of cases. It can also pick up any UCL (unruptured CL) at the beginning of cycle.

Tips of Tr. Of Infertility.

Baseline day 3 USG before initiation of stimulation is a must to maximize fecundity . By doing so one can differentiate between responding or unresponsive ovaries in fair number of cases. It can also pick up any UCL (unruptured CL) at the beginning of cycle. Tip 2:  CC-Estrogens have no role to combat CC induced thin ET

obese PCOs Tip 3 :  Dexamethasone along with CCà only in cases with Chr. anovulatory obese PCOs. Should a woman with normal BMI be advised life style modification to maximize fecundity?? Ans: Even with normal BMW life style modifications in terms of reducing  carbohydrates in diet and active exercise would be the key for life long