Managing Subfertility in SAFOG Region Rohana Haththotuwa, Narendra Malhotra, Yousaf Latif Khan
INDEX
ABCDEFGHIKLMNOPQRSTUVWXY
Page numbers followed by f refer to figure, fc refer to flowchart
A
Acquired immunodeficiency syndrome 62
Activated partial thromboplastin time 75
Adoption 69
Advice regarding hygiene 33
Alanine aminotransferase 71
Albumin 71
Alcohol 66
Alkaline phosphatase 71
Amenorrhea 18, 19, 35, 77
American Society of Reproductive Medicine 31
Anemia 61
correction of 33
Angiotensin-converting enzyme inhibitors 60
Anovulation 77
Antagonist protocol 45
Anti-Mullerian hormone 34
Antral follicle count 30, 34
Anus 6
Anxiety 63
Apareunia 20, 77
Aromatase inhibitors 34, 35
Aspartate aminotransferase 71
Assisted reproductive technique 32, 36, 38, 39, 43, 44
procedures of 83
stages of 44
Asthenospermia 16
Azoospermia 4, 16, 18, 22, 24, 41, 53, 77, 79
factor region 52
nonobstructive 82
obstructive 44, 51, 82
B
Bacterial vaginosis 19, 62
Bartholin's glands 6, 77
Basal body temperature chart 26
Beta-human chorionic gonadotropin 73
Bicarbonates 72
Bilirubin 71
Blood
complete examination 71
pressure 58, 60
high 60, 63
urea nitrogen 72
Body mass index 30, 39
Borderline high cholesterol 72
Brain 13
C
Cancer 61
irradiation 55
Cervical mucus
hostility 39
self-test of 26
Cervix 7, 13, 26
Chemotherapy 17, 61, 77
Chlamydia 19, 62
Chloride 72
Cholesterol 72
high 72
Chorionic villus sampling 61
Chromosomal defects 16
Chromosome 77
studies of 24
Cilia 14, 77
Clomiphene 35, 36
citrate 33–35, 38
Coagulation profile 75
Coital difficulties 22
Coitus 6, 7, 10, 13, 64, 77
infrequent 20
Controlled ovarian stimulation 38, 44
Convulsions 60
Cornual block 29f
Corpus luteum 78
Creatinine 72
Cryopreservation 49, 78
bank 17
Cyclical fashion 78
D
Deep vein thrombosis 59, 63
Delivery, mode of 49
Depression 63, 67
Diabetes mellitus 58–60, 63
Diet 59
Donor
egg 55
sperm 55
pregnancy 55
Down's syndrome 58
Ducts 3, 5
Dyspareunia 78
E
Eclampsia 60
Eggs 49
fertilization of 10, 11
freezing 50
retrieval of 44
Ejaculation 4, 78
premature 20, 22, 40
Embryo 14, 43, 49, 54, 55
cryopreservation 49
transfer 32, 43, 44, 47, 48, 78
Endometrial biopsy 27
Endometrial receptivity array test 47
Endometriosis 19, 44
Endometrium 7, 78
Epididymis 5
Epilepsy 63
Epithelial cells 76
Erectile dysfunction 20, 22
Erectile tissue 4, 78
Estimated glomerular filtration rate 72
Estradiol 73
hormonal estimation of 26
Estrogens 8, 9, 12
European Society of Human Reproduction and Embryology) 31
Exercise 63
F
Fallopian tubes 6, 8, 13, 14, 30
Fatigue 35
Female eggs 10, 12
cell 10
defect in production of 18
production of 8, 25
Female front passage 6
Fertilization 8, 10, 11, 13, 43, 44, 78
failure of 54
Fertilized egg, embedding of 10
Fetus 10, 79
Fibroids 19, 30, 64, 78
Fimbrial block 29f
Fine-needle aspiration cytology 24, 79
Fits 60
Flu 63
Follicle-stimulating hormone 11, 24, 33–35, 73, 79
Frigidity 13, 80
Frozen embryo transfer 38, 49
Fructose, absence of 24, 51
G
Genital organs 3, 79
female 6, 6f, 7f, 10
male 3, 3f, 5, 6, 10
Genital tract, congenital defects of 39
Germ cells 5, 84
absent of 53
male 10, 11, 16
Globulin 71
Glutamyl transferase 71
Gonadotropin 34, 36, 46, 79
preparations 37
releasing hormone 35
analogs 79
antagonists 79
Gonads
female 6, 8
male 4
Gonorrhea 22, 62
H
Hair, excessive growth of 21
Hard drugs 66
Head piece defects 76
Headache 35
Heart disease 65
Heat flash 36
Heavy periods 61
Hemoglobin 61, 71
Hepatitis 66
screening for 66
Hernia 79
operation for 21
Herpes 62
Hormone 5, 79
female 8
male 10, 11, 81
profile 24, 27
Hot climate 17
Human body, structure of 77
Human cell, normal 11
Human chorionic gonadotropin 35
Human immunodeficiency virus 62
Husband's low count 44
Husband's test 23f
Hydrocele 4, 17, 23, 79
Hydrosalpinx 29
Hymen 7
Hypertension 58–60
Hypospadias 8, 40
Hysterosalpingography 28, 34, 39
I
Implantation 10, 14, 44, 54, 80
Impotence 13, 16, 18, 51, 80
In vitro fertilization 17, 27, 32, 43, 52, 70, 79, 80
Infections 17–19, 34, 39
Injury 17
Insemination 44
Instinctive desire 80
Intestinal tract 6
Intracytoplasmic sperm injection 17, 32, 49, 53, 70, 79
Intrauterine growth restriction 65
Intrauterine insemination 40, 80
indications for 40
repeated failure of 44
Intrauterine sperm injection 41, 42
Introitus 80
Irradiation 85
K
Karyotyping 24
Klinefelter syndrome 16
L
Lactation 18, 80
Laparoscopic ovarian diathermy 34, 38
Laparoscopy 28, 30, 80
Letrozole 34, 35
Leukorrhea 81
Leydig cells 12, 81, 84
Libido 5, 22, 81
Lipid profile 72
Lipoprotein
high-density 72
low-density 72
very-low-density 72
Liver function tests 71
Low sperm count 51
Luteal phase support 44, 47, 81
Luteinizing hormone 11, 24, 26, 33, 35, 73, 79
Lymphocytes 71
M
Malformation 81
Maturation 12
Measles 63
Menopause 8, 81
Menstrual cycle 30
Menstruation 8, 19, 81
absence of 18
heavy 21
irregular 21
Metabolic disease 81
Metformin 34
Microsurgical operation 53
Mid-cycle peak 73
Mid-piece defects 76
Miscarriages 48, 81
history of 21
Misconceptions 4
Monocytes 71
Monopolar diathermy 38
Mood swings 35
Motility 82
Multiple births 37
Mumps 17, 22, 55, 82
Muscle aches 35
N
Nausea 35
Nervous system 13
Neurosis 63
Neutrophils 71
Noninvasive prenatal testing 61
O
Oligospermia 4, 16, 41, 44, 51, 82
Oral contraceptive pill 63
Organs 82
external 78
function of 3
internal 80
male 3
structure of 3
Orgasm 82
Ova 10, 12
Ovarian cysts 64
Ovarian hyperstimulation syndrome 37
Ovarian stimulation 40, 41, 45, 82
Ovaries 6, 8, 30, 55
controlled stimulation of 33, 44
hyperstimulation of 36
monitoring of 44
overstimulation of 37
stimulation of 37
Overweight 21
Ovulation 12, 18, 82
absent of 34fc, 44
induction of 32, 33, 80
infrequent 44
phase 73
predictor kit 26
tests of 25
Ovum 8, 10, 12
pick up 44, 46
P
Painful sexual intercourse 20
Passages, obstruction in 16, 18, 19, 53
Pelvic inflammatory disease 83
Pelvic organs 21
Penis 3, 4
malformation of 18
Periods 8, 12
Peristalsis 14, 83
Phallus 3
Piles 61
Pipelle test 27
Pituitary gland 11
Placenta 83
Platelet count 71
Polio drops 63
Polycystic ovarian
disease 38, 63
syndrome 33, 34, 38
Postcoital test 34
Potassium 72
Preeclampsia 60
Pregnancy 1, 3, 5, 10, 48, 58, 73, 65
establishment of 14
loss, early 48
multiple 36, 48, 82
spontaneous 58
Preimplantation genetic testing 83
Premature ovarian insufficiency 55
Progesterone 8, 9, 12, 25, 73, 83
test 27
Prolactin 24, 73
Prolapse 39, 83
Prostate gland 5, 83
Prostatitis 21
Prothrombin 75
Psychiatric disorder 63
Psychological disease 83
Puberty 8, 83
Pus cells 76
presence of 24, 51
Q
Quacks 83
R
Renal function tests 72
Reproduction 3, 83
organs of 4
Royal College of Obstetrics and Gynaecology 31
Rubella 63
S
Saline infused sonography 34
Scrotum 3, 4
local diseases of 17
Secretions 84
production of 5
Semen 18, 51, 78, 84
absent sperm in 51
acidic pH of 24, 51
analysis 23, 39, 52, 76
failure to deposit 16, 18
preparation 44, 46
quantity of 24, 51
Seminal vesicles 5, 85
Serum glutamic oxaloacetic transaminase 71
Serum glutamic pyruvic transaminase 71
Sex 13
Sexual intercourse 10, 13, 20, 64
Sexually transmitted infections 19, 21, 62, 84
Single embryo transfer 84
Sodium 72
Sonohysterography 28
Sperm 10, 11, 49
count 4, 76, 84
defect in production of 16
deletion test 52
DNA fragmentation test 52
freezing 50
motility 4, 84
per millilitre, number of 24, 51
production 5, 10, 17
suppression of 17
survival test 24, 52
Spermatogenesis 16, 84
Spermatozoa 5, 10, 11, 13, 16, 18, 19, 84
absence of 24, 55
morphology of 51
motility of 24, 51
shapes of 24
Stimulation
monitoring of 46
protocols of 38, 83
Subfertility 16, 19, 21, 33, 33fc, 39, 84
causes of 16, 18
investigations of 21
primary 21
treatment of 32, 51, 55
unexplained 16, 32, 40, 44, 54, 84
Surgery 17, 18, 32, 65
Surrogacy 55, 57
Swelling, local 21
Syphilis 17, 62
Systemic lupus erythematosus 61
T
Tail piece defects 76
Test tube baby 43
treatment 27
Testes 3, 4
atrophy of 53
biopsy of 24
hormones 24
tumors of 17
Testosterone 5, 12, 24, 52, 79, 84
hormone 11, 12
Tetanus toxoid 63
Thalassemia 61
Thyroid
disease 63
function tests 24
peroxidase 34
stimulating hormone 24, 34, 74
Total protein 71
Total testosterone 74
Toxoid vaccinations 63
Transvaginal sonography 26, 46
Triglycerides 72
Trophoblast 84
Tubal insufflation test 28
Tubal ligation, bilateral 39
Tube, X-rays of 24, 79
Tuberculosis 17–19, 22
Tumors 17, 19
U
Ultrasonography 26
Ultrasound 26
scan 79
Undescended testes 17
Urea 72
Urethra 4, 6
Urethritis 21
Urinary human menopausal gonadotropins 37
Uterus 6, 7, 30
fallopian tubes of 13
V
Vagina 6, 7, 16, 18, 43
hostility of 32
Vaginal ultrasound 36
Vaginismus 18, 20, 84
Varicocele 4, 17, 23, 84
Vas deferens 5, 16, 18
Vasectomy 85
Viral infections 63
Viscosity 24, 51, 76
Vision, blurring of 35
Vitamin B12 74
Vomiting 35
Vulva 6
W
Weight 39, 59
White vaginal discharge 7
Womb 6, 7
biopsy of lining of 27
World Health Organization 51, 81
X
X-rays 17, 24, 28, 79, 85
Y
Y-chromosome microdeletion test 53
×
Chapter Notes

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Managing SUBFERTILITY in SAFOG Region
Managing SUBFERTILITY in SAFOG Region
Editors Yousaf Latif Khan MBBS FCPS Dip Endoscopy (France) Professor, Obstetrics and Gynecology, Rashid Latif Medical College Lahore, Punjab, Pakistan Secretary General, SAFOG Narendra Malhotra MBBS MD FIAJAGO FICMU FICOG FICMCH FRCOG FICS FMAS AFIAP Director, International Affairs SAFOG Managing Director, Global Rainbow Healthcare Director, ART Rainbow IVF, Agra; Director, MHMH (P) Ltd., Agra Director, MTTBC, Agra, Uttar Pradesh, India; Director, IAN Donald School President, INSARAG (2020); Vice President SAFOG (2020) and WAPM (2018) Past President, ISAR/ISPAT/IFUMB/FOGSI/AOGS/ICMU (Dean) Founder Editor, SAFOG Journal Director, SMRITI Manyata CSE Chairman, SMRITI (NGO)—New Level of CarePresident, Rotary Club Agra Taj City Rohana Haththotuwa MBBS (SL) MS O&G (Col) FICOG (Hon) FSLCOG FRCOG Founder Chairman, Ninewells CARE Mother and Baby Hospital, Colombo, Sri Lanka Secretary General, AOFOG Immediate Past Chairman, Menstrual Disorders Committee, FIGO President Elect, South Asian Federation of Obstetrics and Gynaecology (SAFOG) President, World Gestosis Organization Past President, Sri Lanka College of Obstetricians and Gynaecologists (SLCOG) Past President, Menopause Society of Sri Lanka President Elect, South Asian Federation of Menopause Societies Treasurer, Asia Pacific Society for Infections in Gynaecology and Obstetrics (2010 till date) Country Representative, ASPIRE (Asia Pacific Initiative in Reproductive Endocrinology) Foreword Gabor Kovacs AM
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Managing Subfertility in SAFOG Region
First Edition: 2022
9789354656040
Printed at:
the health of women in SAFOG countries
Foreword
Most of the information and research on fertility has traditionally come from Europe or America, but as 60% of the world's population (4.3 billion people) live in Asia-Pacific, it is great to have a book written in Pakistan for the Asia-Pacific community.
The book is to be commended on using the term “subfertility” as the concept of infertility is no longer valid. With all the developments in reproductive medicine and its applications, “barrenness” is no longer a reality and any woman can potentially be fertile.
The authors are experienced gynecologists, who have provided the A to Z of fertility treatment. This is a very comprehensive review of all the possible investigations and treatments that a couple with subfertility would have suggested to them, and enables these consumers to get all the information they need to expand on what is covered in the medical consultation.
The book commences with a thorough and easily understandable description of both male and female anatomy and physiology, which all readers need to understand. They then explain the physiology of how pregnancy occurs, before launching into the area of subfertility.
There is an extensive list of the possible causes of difficulty to conceive, both male and female, before describing the investigations that can be carried out.
The book then concentrates on the possible treatments that may be considered, as well as general advice about personal health such as weight control and avoidance of smoking.
The book also describes the value of counseling including explanation and reassurance.
The second half of the book is devoted to a detailed description of available treatments.
The authors are to be commended on a very readable but detailed description of available treatments. A whole chapter is devoted to assisted reproductive technique (ART) which is probably the most important and widely used treatment in 2021, with detailed description of each of the steps involved.
The authors have also devoted a chapter to practices that are not practiced in all clinics because of religious or moral objections, but are carried out in others, such as sperm and egg donation and surrogacy, so it is important to include these for a complete reference.
The book is concluded by a chapter on adoption and accepting childlessness which is helpful to the minority of couples who do not proceed with treatment, or do not succeed.
I believe that this book would be a very worthwhile read for all couples with difficulty conceiving, it is easy to read, and can be understood by the lay people without extensive medical knowledge, as well as introductory reading for medical, nursing and scientific staff commencing work in this area.
Gabor Kovacs AM
MBBS HONS MD FRCOG FRANZCOG CREI Grad Dip Mgt (Macq)
Professor of Obstetrics and Gynecology
Monash University
Melbourne, Australia
Editor-in-Chief, Fertility and Reproduction
Preface
Subfertility: Failure to achieve a pregnancy
Generally, speaking even if a healthy couple does not practice contraception it may take up to 1 year to conceive. Even after a year of regular coitus (2–3 times a week) without contraception, there is only 70–80% chance of conception. Those couples who live separately due to social and professional reasons, and do not have regular and frequent coitus may take longer to conceive. In couples where the wife is above 35 years, coitus is infrequent (only over the weekend) and if there is some abnormality, it may take longer than even 2 years for the couple to conceive.
There is 15–20% probability of a married couple seeking advice for their involuntary subfertility. Couples who have this problem face heavy social, psychological, and family pressure. They suffer from great disappointment, anguish, frustration, and depression. Every month they hope and pray for pregnancy but with the onset of menstruation their hopes are shattered. However, they never give up, and keep trying and hoping each month.
In South Asian countries, cultural norm is to expect the bride to become pregnant within the first few months of marriage. If she does not become pregnant within 4–6 months the family in general, and mother-in-law in particular, gets anxious. The family start worrying, without realizing that it may be a planned action on the part of the couple. The whole family starts pressurizing the couple to seek medical advice.
For such couples, there is now genuine and real hope. These couples are living in an era where most of them can be successfully treated. The latest technology can be useful in the treatment of most of the factors responsible for their subfertility. Unfortunately, a large number of these couples are unaware of the available help. This may be due to a lack of knowledge about the physiology of the reproductive system or due to a lack of information about the methods of assistance available.
Finally a word of caution. Although it may seem that a cure is possible in every case and therefore the rate of successful treatment should be nearly 100%. It is unfortunately not so. Nature has many secrets which, we have not been able to unfold as yet. This explains why a large number of couples suffer from unexplained subfertility. For such couples all the investigations remain negative and no one can pinpoint the causative factors. There are bound to be a few disappointments. We should accept this as God's will and hope that in the near future new breakthroughs will make their treatment possible.
We hope the readers find this book informative enough and also hope that after reading this book, the readers' perception about your possible problems and their treatment is clearer.
We wish you good luck.
Yousaf Latif Khan
Narendra Malhotra
Rohana Haththotuwa
Editors Note
This book is intended to acquaint subfertile couples with and young practitioners with the basic functioning and the mechanism of the human reproductive system. It has been written in simple language so that the readers can understand the problem and appreciate possible remedies. To some of the readers this book may seem too simple and brief. For those interested in advanced reading, advanced medical books can be consulted. On the other hand, some may find it too technical for lay persons. In that case we would suggest skipping first four chapters and straight away to go on to investigations of subfertility.
Yousaf Latif Khan
Narendra Malhotra
Rohana Haththotuwa