Obstetrics and Gynaecology
Infertility and Assisted Reproduction
Infertility evaluation and assisted reproduction for MBBS, including semen analysis, ovulation induction, IVF and ICSI, mapped to NMC code OG28.
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Infertility and Assisted Reproduction
Infertility evaluation and assisted reproduction for MBBS, including semen analysis, ovulation induction, IVF and ICSI, mapped to NMC code OG28.
This chapter covers the definition, causes and evaluation of infertility and the assisted reproductive technologies used to treat it. It describes the parallel investigation of both partners, ovulation confirmation and tubal testing, ovulation induction and intrauterine insemination, and IVF, ICSI and cryopreservation within the Indian legal framework.
High-yield: Infertility and Assisted Reproduction
- Infertility is the failure to conceive after one year of regular unprotected intercourse.
- Primary infertility is when the couple has never conceived, and secondary infertility follows a previous conception.
- Causes are shared roughly between male factor, ovulatory disorders, tubal and pelvic factors, and unexplained infertility.
- Both partners are investigated together, since a male factor contributes in a large proportion of couples.
- Semen analysis is the first and simplest test in the male partner and is repeated if abnormal.
- Ovulation is confirmed by a mid-luteal serum progesterone about seven days before the expected period.
- Tubal patency is assessed by hysterosalpingography or by laparoscopy with dye (chromopertubation).
- Ovulation induction uses letrozole or clomifene, and gonadotropins in resistant cases.
- Intrauterine insemination places prepared sperm into the uterus around ovulation and suits mild male-factor or unexplained infertility.
- In vitro fertilisation involves ovarian stimulation, egg retrieval, fertilisation in the laboratory and embryo transfer.
- Intracytoplasmic sperm injection injects a single sperm into an egg and is used for severe male-factor infertility.
- Ovarian hyperstimulation syndrome is a complication of stimulation, with enlarged ovaries, ascites and a risk of thrombosis.
- Cryopreservation allows storage of gametes and embryos for later use.
- Assisted reproduction in India is regulated by the Assisted Reproductive Technology Act and the Surrogacy Act.
Infertility workup and treatment
- **Male factor:** Semen analysis is the first test, repeated if abnormal.
- **Ovulation:** Confirmed by mid-luteal serum progesterone.
- **Tubal patency:** Hysterosalpingography or laparoscopy with dye.
- **ICSI:** Single sperm injected into egg; used for severe male-factor infertility.
NMC competencies in this chapter
- **OG28.1:** Infertility: definition, classification, epidemiology and causes
- **OG28.2:** Investigation of the infertile couple
- **OG28.3:** Ovulation induction and intrauterine insemination
- **OG28.4:** Assisted reproductive technology, IVF, ICSI, cryopreservation and Indian law
Frequently Asked Questions
How is infertility defined?
Failure to conceive after one year of regular unprotected intercourse. It is primary if the couple has never conceived and secondary if it follows an earlier pregnancy.
What is the first investigation in an infertile couple?
Semen analysis in the male partner, as it is simple and male factor is common. The couple is investigated together rather than the woman alone.
What is the difference between IVF and ICSI?
In IVF, sperm and eggs are combined in the laboratory to fertilise, whereas in ICSI a single sperm is injected directly into an egg, used for severe male-factor infertility.
What is ovarian hyperstimulation syndrome?
A complication of ovarian stimulation with enlarged ovaries, fluid shifts causing ascites, and a risk of thromboembolism, requiring careful monitoring during treatment.
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