School of Medicine MDSG topics

Evaluation of subfertility treatments relating to the female partner

Oligo/anovulation. Ovulation induction by means of

Medical therapies

Weight adjustment
Anti oestrogens (clomiphene/tamoxifen/cyclophenyl)
[R] Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea
GnRHas and gonadotrophins
[R] Gonadotrophin-releasing hormone antagonists for assisted conception
Gonadotrophins (various preparations, regimes and modalities of administration)

Subfertility associated with endometriosis

Medical therapies

Danazol
[R] Ovulation suppression for endometriosis
GnRH agonists
Progestins
Surgery (open and laparoscopic)
[R] Laparoscopic surgery for subfertility associated with endometriosis
Assisted conception techniques
[P] Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis

Unexplained subfertility

Medical therapies

Danazol
[R] Danazol for unexplained infertility
Bromocriptine
[R] Bromocriptine for unexplained subfertility in women
Clomiphene
[R] Clomiphene citrate for unexplained subfertility in women
Gonadotrophins
Combinations of the above
[R] Oral versus injectable ovulation induction agents for unexplained subfertility
Other
[P] Low-dose aspirin for in vitro fertilisation Assisted conception techniques
[P] Intra-uterine insemination for unexplained subfertility
[R] Intrauterine insemination versus fallopian tube sperm perfusion for non tubal infertility
[R] In vitro fertilisation for unexplained subfertility
[R] Single versus double intrauterine insemination (IUI) in stimulated cycles for subfertile couples

Infertility associated with polycystic ovary syndrome

Medical therapies

Clomiphene
[P] Oral agents for ovulation induction in subfertility associated with PCOS Bromocriptine
Steroids
Gonadotrophins (hMG and FSH)
[R] Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome
[R] Recombinant FSH versus urinary gonadotrophins or recombinant FSH for ovulation induction in subfertility associated with polycystic ovary syndrome
GnRH-agonists and gonadotrophins
[P] Gonadotrophins and gonadotrophin-releasing hormone agonists for assisted reproductive technology in subfertility associated with polycystic ovary syndrome
[R] Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome
[R] Gonadotrophin-releasing hormone analogue as an adjunct to gonadotropin therapy for clomiphene-resistant polycystic ovarian syndrome
Pulsatile LHRH
[R] Pulsatile gonadotrophin releasing hormone for ovulation induction in subfertility associated with polycystic ovary syndrome
Insulin sensitising agents
[R] Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome

Surgery

Wedge resection
Laparoscopic ovarian "drilling"
[R] Laparoscopic "drilling" by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome

Mechanical infertility (tubal blockage, pelvic adhesions)

Medical therapies

Surgery

Tubal flushing
[R] Oil-soluble versus water-soluble media for assessing tubal patency with hysterosalpingography or laparoscopy in subfertile women
[R] Tubal flushing for subfertility
Techniques of tubal surgery
[R] Techniques for pelvic surgery in subfertility
[R] Surgical treatment for tubal disease in women due to undergo in vitro fertilisation
[P] In vitro fertilisation versus tubal reanastmosis (sterilisation reversal) for subfertility after tubal sterilisation
Adjuvant peri-operative therapy to prevent adhesion (re)formation
[R] Barrier agents for preventing adhesions after surgery for subfertility
[R] Liquid and fluid agents for preventing adhesions after surgery for subfertility
Post-operative procedures to prevent adhesion (re) formation
[R] Postoperative procedures for improving fertility following pelvic reproductive surgery

Subfertility associated with fibriods

Surgery

[P] Surgical treatment of fibroids for subfertility

Assisted conception techniques

Procedures (non-surgical)

Culture media or oocytes and/or embryos
[R] Effect(s) of assisted hatching on assisted conception (IVF & ICSI)
[R] Cleavage stage versus blastocyst stage embryo transfer in assisted conception
[P] Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection
[P] Techniques for intrauterine embryo transfer
[R] Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection
[P] Follicular flushing during oocyte retrieval in assisted reproductive techniques
[P] Conscious sedation for oocyte retrieval during in vitro fertilisation procedures
Luteal support (hCG; progesterone)
[R] Luteal phase support in assisted reproduction cycles Technique modalities (IVF, GIFT, ZIFT)
[R] Gonadotrophin-releasing hormone agonist protocols for pituitary desensitization in in vitro fertilization and gamete intrafallopian transfer cycles
[R] Growth hormone for in vitro fertilization
[P] Interventions for 'poor responders' to controlled ovarian hyperstimulation (COH) in in-vitro fertilisation (IVF)
Ovarian stimulation protocols (drug regimes and modalities)
[R] Intra-venous albumin for preventing severe ovarian hyperstimulation syndrome
[R] Follicle-stimulating hormone and human menopausal gonadotropin for ovarian stimulation in assisted reproduction cycles
[R] Recombinant versus urinary follicle stimulating hormone for ovarian stimulation in assisted reproduction cycles
[R] Depot versus daily administration of gonadotrophin releasing hormone agonist protocols for pituitary desensitization in assisted reproduction cycles
[R] 'Coasting' (withholding gonadotrophins) for preventing ovarian hyperstimulation syndrome
[R] Embryo freezing for preventing ovarian hyperstimulation syndrome
[P] Recombinant versus urinary human chorionic gonadotrophin for ovulation induction in assisted conception
[R] Gonadotrophin-releasing hormone antagonists for assisted conception
[R] Human menopausal gonadotropin versus recombinant follicle stimulation hormone for ovarian stimulation in assisted reproductive cycles
[P] Glucocorticoid supplementation during ovarian stimulation for IVF or ICSI
Embryo cryopreservation
Endometrial preparation
[P] Cycle regimes for frozen-thawed embryo transfer

Surgery

Methods of oocyte retrieval
Methods of sperm preparation and oocyte insemination
Methods of embryo transfer
[P] Techniques for intrauterine embryo transfer
Tubal surgery
[R] Surgical treatment for tubal disease in women due to undergo in vitro fertilisation

Sperm-mucus interaction impairement; "cervical" infertility

Medical therapies

Mucus enhancing treatments
Artificial insemination by husband's sperm (AIH)
[P] Intra-uterine insemination versus timed intercourse for cervical hostility in subfertile couples
Other