Ebook Textbook of clinical embryology: Part 2 - Cambridge medicine
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Ebook Textbook of clinical embryology: Part 2 - Cambridge medicine
Chapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinegations then, in the majority of cases, a diagnosis can be made. A minority will have the rather unsatisfactory diagnosis of exclusion, ‘unexplained infertility’. A treatment plan can then be made. The patients should attend the consultation together.Pre-pregnancy counsellingWomen who arc trying to Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinebecome pregnant should be informed that drinking no more than one or two units of alcohol once or twice a week, and avoiding episodes of intoxication,Ebook Textbook of clinical embryology: Part 2 - Cambridge medicine
reduce the risk of harming a developing fetus. Men who drink up to three or four units of alcohol per day are unlikely to affect their fertility. ExcChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinereferral to a smoking cessation programme. Passive smoking may also affect female fertility. While there is an association between male smoking and reduced semen quality, the impact of this on fertility is unclear.Dietary supplementation with folic acid before conception and up to 12 weeks’ gestatio Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinen reduces the risk of having a child with a neural tube defect, rhe recommended dose is 0.4 mg per day, though for women with diabetes, on anti-epilepEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
tic medication or who have previously had a child with a neural tube defect, a dose of 5 mg per day is recommended.A female body mass index (BM1) overChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinely to improve their chances of conception by losing weight. Similarly there is a correlation between male obesity and reduced fertility. Women with low BM1 of less than 19 and who have irregular or absent menstruations arelikely to improve their fertility by increasing their weight.While there is an Ebook Textbook of clinical embryology: Part 2 - Cambridge medicine association between elevated scrotal temperature and reduced semen quality, it is not clear whether wearing loose-fitting underwear improves fertilitEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
y.Some occupations involve exposure to hazards that can reduce male or female fertility, and appropriate advice offered.A number of prescription, overChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicineual intercourse every 2-3 days through the cycle optimizes the chance of conception.For couples with a diagnosed cause of infertility, the treatment will depend on the cause.Ovulation disordersFollowing investigation, the cause of ovulatory dysfunction should be classified (see Chapter 20):WHO Group Ebook Textbook of clinical embryology: Part 2 - Cambridge medicine I Ovulation disorders (hypogonadotrophic hypogonadism)Women with WHO Croup 1 anovulatory infertility can improve their chances of conception and an uEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
ncomplicated pregnancy by moderating high exercise levels and increasing the body weight if the BMI is less than 19. Pulsatile subcutaneous administraChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinehe pump constantly limits the use of this technique. Ovulation induction with once daily sub-cutaneous gonadotrophin injections for two weeks or so is more commonly used. The absence of endogenous LH pituitaryTextbook of Clinical Embryology, cd. Kevin Coward and Dagan Wells. Published by Cambridge U Ebook Textbook of clinical embryology: Part 2 - Cambridge medicineniversity Press. © Cambridge University Press 2013.161Section 2: Infertilityproduction means that a gonadotrophin with LU activity should be used in aEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
ddition to FSH. The ovarian response needs to be closely monitored with ultrasound to reduce the risk of hyperstimulation and multiple pregnancy. An hChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinetion disorders who are overweight should be encouraged to normalize their BMI. This may promote spontaneous ovulation or increase the response to ovulation induction drugs and also reduce risks during pregnane)'.Gomifene citrateThe anti-estrogen clomifene citrate has for decades been the first-line Ebook Textbook of clinical embryology: Part 2 - Cambridge medicineovulation induction drug for PCOS. Clomifene blocks the estrogen feedback from the ovaries to the pituitary and hypothalamus, ‘tricking’ the pituitaryEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
into releasing more FSI1 which may be sufficient to result in follicular development. Clomifene is taken as a tablet, usually at an initial dose of 5Chapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinest be stopped and an alternative treatment used. The most important side effect is a 10% multiple pregnancy rate, nearly always twins, though the author has seen two sets of quadruplets following clomifene treatment. It is good practice to offer ultrasound monitoring in the first cycle to recognize Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinethe development of too many dominant follicles, cycle cancellation and dose reduction in the next cycle. Failure to respond at all to clomifene (‘clomEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
ifene resistance’) leads to a step increase in the clomifene dose each cycle to a maximum of 150 mg daily. If still clomifene resistant even at the maChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicine (over 12 months) has been linked with a possible increase in the risk of developing ovarian cancer.MetforminAs discussed in Chapter 20, PCOS appears to be a condition of insulin resistance. Obese women with anovulatory PCOS, who reduce their weight by 5% or more, will also reduce their insulin resi Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinestance and may begin to ovulate spontaneously. If not then the insulin sensitizing agent metformin can be used. Metformin is taken in multiple doses eEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
very day, unlikeclomifene which is only taken for 5 days per cycle. Metformin’s side effects include nausea, vomiting and other gastrointestinal distuChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicine-line ovulation induction in women with PCOS. A recent NICE (National Institute for Health and Clinical Excellence) meta-analysis suggests similar cumulative live birth rates with the different treatments. An advantage of metformin is that it promotes mono-ovulation so there’s no need for ultrasound Ebook Textbook of clinical embryology: Part 2 - Cambridge medicine follicular tracking. In addition, metformin may normalize testosterone levels and consequently reduce hirsutism, thus having additional non-fertilityEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
benefits. The need for daily multiple doses and the gastrointestinal side effects are disadvantages. The main disadvantage of clomifene is the multipChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinendergo one of the following second-line treatments: laparoscopic ovarian drilling, gonadotrophin therapy, or combined treatment with clomifene and metformin if not already used first line. Success rates appear similar between the options.Laparoscopic ovarian drilling (LOD)During a laparoscopy the ov Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinearies arc each ‘drilled’ using a diathermy electrical current for a few seconds in multiple places. This technique has replaced the now obsolete ‘wedgEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
e-resection’ procedure. An advantage of LOD is that other pathology such as endometriosis or adhesions can be diagnosed and treated during the same prChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investig Ebook Textbook of clinical embryology: Part 2 - Cambridge medicinean increased risk of multiple pregnancy or the need for ultrasound follicular tracking. Furthermore, if successful, the effect can last for many years after a single procedure. Disadvantages include the need for surgery and the associated risks of anesthesia and intra-abdominal organ damage. There i Ebook Textbook of clinical embryology: Part 2 - Cambridge medicines a risk of causing the formation of peri-ovarian adhesions which could reduce fertility. Rarely, premature ovarian failure has been reported secondarEbook Textbook of clinical embryology: Part 2 - Cambridge medicine
y to the ovarian trauma. It is not clear how LOD has its effect. The ‘drilling’ disrupts the ovarian stroma and appears to reset the milieu allowing fChapter17Treatment of male and female infertilityTim ChildOnce a couple experiencing fertility problems have undergone appropriate and timely investigGọi ngay
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