1.Professional history and age
2.Detailed menstural history
3.Duration of infertility
4.H/O Ab,EP, previouse delivery
5.H/O surgery,TB, medical illness
6.weight,heigh,BP,signs of pcos,Br ex for galactorrhea,spa/exam
1.complete professional history/age
2.frequency of coitus,H/O of smoking,alcoholism,STD
5.Local examination of external genitalia
- After examination always try to counsel them together,Reviwe their past investigation
- Transvaginal sonography in first visit (uterus, fibroides, adenexal mass, hydrosapinx, polycystic ovaries
- Female: CBC, urine, BG RH,VDRL, FBS,Cr BUN,.HIV ,HbsAg,prolactin,TFT,FSH,LH, Test,DHEAS,ESTRADIOL,17OHP,and in case of RPL:specific study
- Hormonal assay must do in2,3day of mense.
- Male:semen analaysis,general tests
LH/FSH more than2.5 or LH raised:pcos
TEST more than200:rarely adrenal or ovarian virilizing tumor,in pcos we see some elevation
DHEAS 2900-8000ng/ml:hyperinsulinemia or AH(late onset).Levels more than 9ooong/ml:tumor
17OHP more than5ng/ml:late onset AH
- HSG still cosidered an important test to know tubal status.
- When and how todo?
- False positive and negative.
BASELINE OVULATION STUDY
1.With TVS :9th or 10th day of menstural cycle.Wemust see dominant follicle(18-22)
2.Progestrone measuring in luteal phase.
LAPAROSCOPY AND HYSTEROSCOPY
1.When there is pathology in uterus cavity.
2.When there is suspected pathology in uterus or ovaries.
4.Special situations like unexplained infertility.
- 1.NON PCOS:ovulation induction with cc+-hcG or+hmG/FSH
- Hyperprolactinemia or thyoid problem, proper treatment If no response then cc or cc/hmG or hmG with IUI.
- If no response then cc or cc/hmG or hmG with IUI.
- 2.IN PCOS:RX with above+ body weight reduction and metformin
- Tubal factor may be unilateral or bilateral.
- In cornual tubal blocks hysyeroscopic cannulation be possible.
- Other blocks need laparascopy.
- 1.Sperm count :at least 20million/ml
- 2.sperm motility:more than50%with forward progression
- 3.sperm normal morphology:at least 30%
- At least 2-3 S/A need for correct diagnosis
- Of oligo,oA,oAT
- Some drugs use for men but their efficacy are not approved.
►A:mild tominimal:if there is good tubo-ovarian relationship I/O +-IUI.
►B:moderate to severe:operative laparoscopy,
►GnRH agonist and ART.
- A;in young couples conservation for 3-6cycles
- B;for age group 30-35 years :cc or HMG/FSH with IUI for 3-6 cycles if no response ART
- C;for age group more than 35 years :ART
►1.gross tubal damage
►5.male factor infertility
►6.immunological causes of infertility
►7.premature ovarian failure