• Credits
  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

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• Q. What are the lifestyle advice given to couples with infertility?

  • Avoid smoking
  • Avoid Alcohol
  • Normal weight- 20-25 kg/m2
  • Limit caffeine
  • Avoid environmental toxin
  • Frequency of coitus – every 1-2 days during the time of ovulation

• **Ovulatory disorders **

• Q. What is done for ovulation induction?

  • Depends on WHO class of ovulatory dysfunction
  • Class I – hypo hypo- treat with gonadotropins
  • Class II- Normal normal- PCOS  treat with ovulation induction
  • Class III- hyper hypo- gonadotropins + IVF- -> if it fails donor oocytes
  • Hyperprolactinemia- cabergoline
  • Ovulation induction- see Ovulation Induction

• Q. What is the first-line treatment for obese anovulatory women (BMI >27)?

  • Weight loss
  • 5-10% weight loss improves ovulation dramatically

• Q. What is done for women with low weight (<17 kg/m2) with hypothalamic amenorrhea?

  • Weight gain
  • Reduce exercise
  • Gonadotropins

• Q. Enlist the options for ovulation induction?

  • Weight loss
  • Clomiphene
  • Metformin
  • Letrozole
  • Gonadotropins
  • GnRH pulse therapy
  • Laparoscopic ovarian drilling
  • Tamoxifen

• **Tubal factor infertility and adhesions **

• Q. What are the options for women with bilateral tubal disorders?

  • Corrective surgery to reverse tubal blockage – preferred in younger women with milder disease and poor access to IVF – high risk of ectopic
  • IVF- preferred in older women, women with access to IVF, and severe disease

• Q. What is done for unilateral tubal block?

  • Controlled ovarian stimulation is done
  • Proximal disorder- better prognosis than distal disorder

• Q. tubal surgery is more effective for proximal obstructions or distal?

  • More useful for distal obstructions

• Q. What is done for proximal obstructions?

  • Hysteroscopic treatment may be done
  • Surgery is more complicated for proximal obstructions – prefer IVF

• #Pearl

  • Distal obstruction- surgery
  • Proximal obstruction – Hysteroscopy

• Q. If IVF is planned and the patient has hydrosalpinx, what is done?

  • Salpingectomy may be done when IVF is planned
  • It gives a better outcome
  • It removes embryotoxic substances which may impair uterine implantation

• **Endometriosis **

• Q. What are the options for endometriosis?

  • Surgery for endometriosis
  • Ovulation induction  + IUI
  • ART

• **Uterine abnormalities **

• Q. In which uterine abnormalities is surgery done to correct infertility?

  • Fibroid- submucous or intracavitary
  • Endometrial polyps
  • Synechiae
  • Septate uterus
  • Other congenital anatomical abnormalities

• Q. What is done if the uterine abnormality cannot be corrected?

  • Surrogate mother

• **Others **

• Q. What is done for women with cervical factor infertility?

  • IUI (usually combined with ovulation induction)
  • If it fails IVF

• Q. What is done for unexplained infertility?

  • Attempt for IUI with ovulation induction
  • If it fails – IVF