Treatment of infertility

All couples trying for a pregnancy will benefit from some general advice such as cessation of smoking and limiting alcohol intake. Pre-treatment counselling should include advice about general lifestyle measures including the need to achieve an optimum BMI. This will involve weight loss in women with a BMI of over 30, but may require some

Table 45.14 Techniques used in assisted reproduction and their outcomes

Technique Major indications Outcome

Table 45.14 Techniques used in assisted reproduction and their outcomes

Technique Major indications Outcome

Intrauterine insemination (IUI)

Unexplained infertility Mild male factor infertility

SO/IUI: 13% pregnancy rate per cycle* IUI alone: pregnancy rate per woman 24%+

In vitro fertilization or intracytoplasmic sperm injection (IVF or ICSI)

Prolonged infertility (see below)

Live-birth rate per cycle started 22%t Live-birth rate per cycle started 28%§

In vitro fertilization (IVF)

Tubal disease Intractable pathology Failed primary treatment

Pregnancy rate per oocyte recovery 25%* Live-birth rate per oocyte recovery 34%§

Intracytoplasmic sperm injection (ICSI)

Severe oligozoospermia in the male Failed fertilization with IVF

Pregnancy rate per oocyte recovery 26%* Live-birth rate per oocyte recovery 32%§

Donor insemination (DI)

Azoospermia

Infectious disease in the male partner Prevent transmission of genetic conditions

Pregnancy rate per cycle 16%* Live-birth rate per cycle 11%$

Oocyte donation (OD)

Absent or non-functioning ovaries Prevent transmission of genetic conditions Repeated poor response with IVF treatment

Live-birth rate per transfer 50%§

* Nyboe Anderson et al. 2005. + Goverde et al. 2000.

£ Human Fertilization and Embryology Authority, 2005.

§ US Department of health and Human Services, Centres for Disease Control and Prevention, 2004.

* Nyboe Anderson et al. 2005. + Goverde et al. 2000.

£ Human Fertilization and Embryology Authority, 2005.

§ US Department of health and Human Services, Centres for Disease Control and Prevention, 2004.

women with weight-related amenorrhoea and anovulation to gain weight. Periconceptual dietary supplementation of folate has been shown to reduce the risk of neural tube defects (OR 0.28,95% CI 0.13-0.58) and a daily dose of 0.4 mg is recommended for all women (National Collaborating Centre for Women's and Children's Health (NICE) guideline, 2004). The investigation of couples with infertility will result in a number of diagnostic categories - each with its own management pathway (Fig. 45.3). Details of management for each group are discussed below. Regardless of the diagnosis, prolonged infertility refractory to conventional treatment is treated by in vitro fertilization.

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