Management of infertility

Question 1

Vitamin supplements?

Answer 1

• 400 micorgrams Folic acid during 12 weeks
• 5mg daily planning Folic acid
• 10 mg Vit D

Question 2

Ovulation conditions?

Answer 2

Regular menstruation
Irregular cycles usually indicate oligo /anovulation
Upto 9% of regular cycles ( duration 25-35 days) are thought to be anovulatory

Question 3

Treatment of Anovulation?

Answer 3

Group I- Hypothalamic amenorrhea-includes stress, excessive exercise, anorexia, Kallman’s syndrome, isolated gonadotrophin deficiency
Findings: low FSH, LH,Estrogen levels, normal prolactin, negative progesterone challenge

Group II- Hypothalamic pituitary dysfunction- normogonadotrophic- normoestrogenic, anovulation –PCOS (85%)

Group III- Ovarian failure- high gonadotrophins (FSH/LH) with low estrogens- all variants of ovarian failure and resistant ovary

Other causes- Hyperprolactinaemia

Question 4

Management of hypothalamic anovulation?

Answer 4

• Stabilise weight (BMI >18.5)
• Pulsatile GnRH to induce ovulation in hypothalamic amenorrhoea
• 90% ovulation rate, Cumulative conception rate 73% in 6/12, 92% in 12/12 = normal fecundity.
• Multiple pregnancy rate 4%
• Gonadotrophin (FSH+LH) daily injections- higher multiple pregnancy rates
• Both need ultrasound monitoring of ovarian response (follicle tracking)

Question 5

the aims of laparoscopy

Answer 5

• Removing the tube
• Blocking the tube