A presentation about treatment options for infertility by Dr. Arlene Morales of Fertility Specialists Medical Group. (FSMG) This presentation includes statics, procedure explanations, images, and related data. http://ivfspecialists.com/
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Fertility Diagnosis & Treatment Options
Arlene J. Morales, MD, FACOG Fertility Specialists Medical Group
AJM 4/2011
Diagnosis of Infertility
“unprotected coitus of 1 year
duration” “active” versus no contraception exposure Age:
< 35 years 35-39 years > 40 years
AJM 4/2011
1 year 6 months 3 months
Time Required for Conception: An Inefficient Process
Time of Exposure 1 month 3 months 6 months 1 year 2 years % Pregnant 22% 57% 72% 85% 93%
Traditional Algorithm
Detailed History and Physical Exam Ovulation Cavity and Tubal Status Ovulation Induction Timing of Intercourse Ovulation Induction Intrauterine Insemination IVF
IVF Directly
Semen Analysis
AJM 4/2011
Traditional Therapy
Ovulation Induction (OI)
Clomiphene Citrate (1-3-5 eggs)
• 2 to 3 visits over 2 weeks
Gonadotropins (5-8-10 eggs)
• 5 to 7 visits over 2 weeks
Cumulative preg rate was 22.3% vs 14.6% (3 cycles) Monthly fecundity of 9.5% (148 cycles) vs 3.3% (150 cycles) Cumulative preg rates was 13.2% vs 5.6%
AJM 4/2011
USA: 67 patients with Unexplained (50 mg)
Canada: 148 couples with Unexplained (100 mg)
Efficacy of Gonadotropin and IUI for Infertility
Guzick and National Cooperative
Reproductive Medicine Network N Engl J Med 1999;340:177-83
Couples: no identifiable etiology & motile sperm 4 cycles of treatment
IUI alone n=234/717 18 % 5%
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COH & IUI n=231/618
Cummulative 33 % Per Cycle
COH & ICI n=234/637
ICI alone n=233/706
15 %
19 % 4%
10 % 2%
IVF
Completed Check-list
Including Sonohysterogram and Mock-Transfer
Medication Protocol
Prep “stuff” 2-4 weeks
Medication Class
Treatment 4 to 5 weeks
Your Stimulation Cycle Retrieval (2 to 4 weeks)
Embryo Transfer (3 to 6 days later)
Pregnancy Test (7 to 10 days later) Prenatal care
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10-30,000 motile sperm 1-4 eggs in a 50 l drop of media Incubate overnight Check for fertilization
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Fertilized Egg From IVF
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ART Lab Techniques: ICSI
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ICSI (cont)
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Embryo Development (D2-D4)
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Blastocyst Development
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Holding pipette
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Hatching pipette
Assisted Hatching
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Preimplantation Genetic Diagnosis (PGD)
Consists of taking a single cell (biopsy) from each embryo, followed by genetic analysis to determine the normalcy of the embryo. Subsequent replacement to the patient of those embryos classified by genetic diagnosis as normal. Three PGD methods of analysis
FISH (Fluorescent In Situ Hybridization) PCR (Polymerase Chain Recation) Whole Genomic
AJM 4/2011
Preimplantation Genetic Diagnosis
Fluorescent In Situ Hybridization (FISH)
What is a good ART program?
High Quality Laboratory Comprehensive Services Excellent Documentation Professional management Psychological Support High Quality Clinical Care Patient Choice Research Cost-effective care Ethical Care