Best prognosis in infeile women is seen in / most reversible form of infeility is :
Ans. is b i.e. Anovulation "Disorders of ovulation account for about 30 - 40 % of all cases of female infeility. These disorders are generally among the most easily diagnosed and most treatable causes of infeility." In couples with infeility ovulatory disorder have the best prognosis. Relatively poor prognosis is observed in male factor infeility and tuba! factor infeility. Prognosis can be arranged as below in descending order on the basis of cumulative pregnancy. Ovulatory factor > unexplained > Male factors > Endometriosis > Tubal factors. Treatment of anovulation is determined by the diagnosis : An elevated FSH along with chronic anovulation indicates ovarian resistance or failure : treatment is steroids / in vitro feilisation in such cases. If chronic anovulation is present along with normal FSH and prolactin : then induction of ovulation can be achieved in 90% of cases. - A treatment plan is done using clomiphene as the first drug : 1. Colmiphene citrate : it is the agent of choice for women with oligomenorrhea or amenorrhea having sufficient ovarian function to maintain estrogen at a serum level of 40pg/ml. Patient selection Normal gonadotropicdeg : normoprolactinemicdeg patients with normal cycle but absent or infrequent ovulation.deg PCOSdeg Post pill amenorrhea.deg Dose Initial dose of 25 to 50mgdeg is given daily from 02 - D 5. Ovulation is expected to occur about 5 - 7 days after the last day of therapy. If ovulation doesnot occur, dose is increased in 50mg steps to a maximum of 250mg daily. Therapy is in given for 4-6 cycles. Clomiphene will be successful in inducing ovulation in about 70% of women, with ovaries producing estrogen. Switch over from clomiphene to more aggressive therapy is done when : There is no response to clomiphenedeg There is ovulatory response to clomiphene but no pregnancy.deg Patients with pituitary insufficiency.deg These patients usually respond to Gonadotropins. 2. Gonadotropin therapy : Prerequisite for Gonadotropin therapy : Ovarian reserve must be present. The Gonadotropins used are : Human menopausal Gonodotropin : - It is a formulation containing equal amounts of FSH and LH (751U each). - It is prepared from hormones obtained from urine of postmenopausal women. - HCG is required as an ovulatory trigger. - FSH : purified urinary FSH and Recombinant FSH are also available. 3. Gonadotropin releasing hormone : Pulsatile GnRH If other methods have failed then pulsatile GnRH is needed in patients with anovulation and hypothalamic insufficiency Other drugs which can be used to for ovulation : 1. Bromocriptine/Cabergoline : Are used to to treat anovulation caused by increase in serum prolactin level. 2. Coicosteroids : Use to treat anovulation due to congenital adrenal hyperplasia. Tamoxifen : It is an antiestrogen. It is an alternative to clomiphene and is used for the same type of cases. Metformin and letrozole : Used to treat infeility due to hyper insulinemia and insulin resistance.
Tubal block
Anovulation
Oligospermia
Endometritis