Female

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

Male

1.complete professional history/age

2.frequency of coitus,H/O of smoking,alcoholism,STD

3.Medical dis,trauma,surgery

4.General eximination

5.Local examination of external genitalia

Counseling

Counseling
Counseling

Laboratory investigations

RESUTES

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

HYSTER SALPINGOGRAPHY

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.

3.Unpatened tubes.

4.Special situations like unexplained infertility.

ANOVULATION

ANOVULATION
ANOVULATION

TUBAL FACTOR

MALE FACTORE

ENDOMETRIOSIS

ENDOMETRIOSIS
ENDOMETRIOSIS

►A:mild tominimal:if there is good tubo-ovarian relationship I/O +-IUI.

►B:moderate to severe:operative laparoscopy,

►GnRH agonist and ART.

UNEXPLAINED INFERTILITY

ART INDICATIONS

►1.gross tubal damage

►2.grade 3-4endomeriosis

►3.unexplained infertility

►4.perimenopausal patients

►5.male factor infertility

►6.immunological causes of infertility

►7.premature ovarian failure

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