treatment of infertility & ivf - shanyar：不孕不育与体外受精-治疗shanyar

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1、TREATMENTOFINFERTILITY&IVFPresentedby:Dr.ROZHANYASSINKHALILFICOG,CABOG,HDOG,MBChB2013Treatmentofinfertility1.Generaladvice:1.Allcouplestryingforapregnancywillbenefitfromsomegeneraladvicesuchascessationofsmokingandlimitingalcoholintake.2.Pre-treatmentcounsellingshould

2、includeadviceaboutgenerallifestylemeasuresincludingtheneedtoachieveanoptimumBMI.Generaladvice:3.ThiswillinvolveweightlossinwomenwithaBMIofover30,butmayrequiresomewomenwithweight-relatedamenorrhoeaandanovulationtogainweight.4.Periconceptualdietarysupplementationoffola

3、tehasbeenshowntoreducetheriskofneuraltubedefects.2.TREATMENTOFANOVULATION:Womenshouldbemadeawareofpotentialrisksofmultiplepregnancyandovarianhyperstimulation,whenprescribingovulationinductiondrugs.Malefactorproblemsandtubalpathologyshouldbeexcluded.Intheabsenceofahis

4、torysuggestiveoftubaldiseaseitmaybereasonabletodeferformaltubalpatencytestsforthreecyclestoallowlessinvasivetreatmentoptionssuchasclomifenetobeused.TREATMENTOFANOVULATIONInwomenwithweightlossassociatedamenorrhoea,treatmentshouldbedeferreduntilatargetBMIof20kg/m2isrea

5、ched.ThemostphysiologicaltreatmentofanovulationorhypothalamicamenorrhoeaiswithpulsatileadministrationofGnRHagonistsadministeredTREATMENTOFANOVULATION:WeightlossshouldbethefirstlineoftreatmentinobesewomenwithanovulationduetoPCOS.CentralobesityandhighBMIareimportantpre

6、disposingfactorsforinsulinresistance,hyperinsulinaemiaandhyperandrogenaemiaTREATMENTOFANOVULATIONEffectivetreatmentofobesitycanreversetheseeffectsandfacilitatetheeffectsofovulationinductionagents.InobesewomenwithPCOSalossof5–10%ofbodyweightmaybeenoughtorestorereprodu

7、ctivefunctionin55–100%womenwithin6months.-1.ClomifenecitrateClomifenecitrate(clomide):isanorallyactivesyntheticnon-steroidalcompoundwithoestrogenicaswellasanti-oestrogenicproperties,whichhastraditionallybeenthetreatmentofchoiceinwomenwithanovulatoryPCOS.Itdisplacesoe

8、strogenfromitsreceptorsinthehypothalamic-pituitaryaxis,reducesthenegativefeedbackeffectofoestrogenandencouragesGnRHsecretion.Clomif