Bangladesh Institute Of Medical Science (BIMS)

Louise Brown

Since medical scientist first opened the doors to couples seeking treatment for Infertility , we have enhanced our knowledge of how to provide an opportunity for gametes to join and to begin a new human life. The 91’s was an eventful decade for the field of Infertility. Male infertility was reauthorized with the advent of ICSI while the field of prelim plantation genetic diagnosis opened new vistas in gene technology. Imospects foe controlled ovarian stimulation. Not only has the process of uniting egg and sperm outside the body become a commonly practiced, but we have now entered the era of blast cyst culture, intra maturation and assisted hatching.

HSG

IUI Procedure

In such an age when conventional treatment measures are being challenged and replaced by newer innovation natural wisdom suggests that clinicians keep abreast of the latest development in this field.

This curriculum on Infertility and Sterility encompasses the entire range of human reproduction providing important information for both scientists and clinicians at all levels of training . Though the emphasis is upon the clinical management of patients undergoing assisted conception treatment, the reader will benefit from the detailed accounts of sperm physiology , stimulation protocols, ovulation, fertilization and implantation as well as the potential obstetrical complications of Assisted reproductive Technology (ART) . As is inevitable, some overlapping of subject matter has occurred, in our attempt to cover every aspect of Infertility treatment. We have tried to give readers a clear perspective of assisted reproductive technology, it’s advantage and it’s limitations, and ability to start an infertility practice with confidence.

ICSI Procedure

The treatment of infertility has been challenging. There is maximum degree of development in the field of infertility management. But foes that mean that we clinicians are clear about what, when and which type of management is to be followed in the infertility couples? The question is simple, cost effective and proper protocol for the problem of infertility, it is clear that management will be following by investigations. What are the investigations? Do we perform the entire investigations for all the patient or is it tailor- made ? The investigations have to be planned in the most appropriate manner. Many of the investigations would be repetitive because the patients tend to change doctors frequently . This has to be curtiled down bery judiciously, which in turn will avid patients getting exhausted physically, mentally and spiritually. By this step itself a number of infertile patients would go ahead further with the treatment and there by conceive.

Management is based on age, The younger the age group the more conservative attitude towards treatment can be taken . Older the age, treatment has to be quick without wasting much time and more aggressive . it is a berry well known fact that as the age advances the quantity and quality of oocytes and sperms reduces, making it difficult for conception. The period of married life is also important and effects in a similar fashion as that of age.

The treatment of Infertility in Bangladesh is fast catching up with the . West a contemporary perspectives on infertility practices is essential for every physician. This curriculum offers an authoritative and in depth review available on the treatment of infertility and brings up to date the many important advance that have now become an essential part of Assisted reproductive technology. We hope that The Infertility course and curriculum “ will be enjoyed by all those of you who read it to bring invaluable smile at the lips of parents.

Normal Sperm

Contents

Section -01- A General overview

1. Introduction
2. Anatomy, Physiology & Reproductive Endocrinology of female & Male
3. Patient and Infertility
4. Infections and Infertility
5. Immunology Infertility
6. Unexplained Infertility
7. Declining Fertility

Section – 02- Endocrinological Disorders of infertility

1. Hyperprolactinaemia and Thyroid Disorders
2. Gonodotrophic Hormons
3. Luteal Phase Defect
4. Polycystic ovarian Syndrome
5. Hirsutism
6. Basal Body Temperature and Endometriosis
7. Obesity in Infertility practice
8. Male infertility in relation to endocrinology
9. Infertility treatment in Primary and Secondary Amenorrhea

PCT

Section -03- Male Factor Infertility

1. Cytogenetics of Male Infertility
2. The Human Sperm : It; Contribution to fertilization and Embryogenesis
3. Male Infertility
   a. male Infertility Spermetogenesis
    b. Current trends in the management of Azoospermia
    and Oligosathenoteratozoopermia
    c. Sexual Dysfunction in Male factor Infertility
  d. Assisted Reproduction for male factor infertility
4. Why male infertility is more common then female infertility?

Section – 04 Female Factor Infertility

1. Utrine and Cervical Factors in Infertility
2. Tubal Factor of Infertility and Assisted reproduction
3. Evaluation of fallopian Tube in Infertility
4. female Inferlity and Surgery
   a. Hysteroscopic Cannulation for proximal Tubal Block
   b. Laparoscopic Tubal Mocrisurgery
   c. Hysteroscopic Surgery in Infertility
   d. Role of Micrisurgery in Infertility Management
   e. Endometriosis and Infertility
   f. A Surgival perspective
   g. Medical management
5. Modern Management of Ectopic pregnancy

Endometriosis

Section 05- ovulation Induction

1. Super ovulation strategies in Assisted Conception
2. Monitoring of Ovulation Induction
3. Ovarian follicular Stimulation Regimens in ART
4. Recombinant FSH in ovulation Induction
5. Role of GnRH agonists as an ovulation trigger
6. Altering management Stratifies in Women with a poor Response to Ovarian Stimulation
7. Ovarian Hyper stimulation Syndrome
8. Ovulation Induction and ovarian Malignancy
9. Prognostic Blue of Reproductive outcome

Section -06 Assisted reproductive Technology

1. Intrauterine Insemination (IUI)
2. Oocyte Retrieval and embryo Transfer for in-vitro Fertilization(IVF)
3. Prognostic Markers in vitor Fertilization – Embryo transfer
4. Semen Intra fallopian tube transfer
5. Gamete Intra fallopian tube Transfer
6. Oocyte Donation
7. Alternatives to ART
8. Surrogacy and Adoption
9. Oocyte and Embryo Donation program
10. Improving success rats in ART

Section -7- Laboratory Management

1. Setting up an ART Unit
2. Oocyte Maturation
3. Assessment of Embryo Quality A as prediction of IVF Outcome
4. Intra cytoplasm in an ART Program
5. Pre implantation Genetic Diagnosis
6. Histopathology and it’s Role in Infertility

Section -08- Related Issues

1. Pregnancy after infertility treatment
2. Miscarriage & ectopic pregnancy after ART
3. Cryo preserration in ART
4. Surgical treatment for female factors infertility
5. Endometrium associated factors infertility
6. Management of male factors fertility
7. Surgical treatment for Male factors infertility
8. Ultrasound of male infertility
9. Evaluationg and managing psychological factors

PESA

Section-09—Evaluation of causes of Infertility

1. Endocirinological Evulation of female infertility
2. TVS in infertility
3. HSG & SIS
4. Ultrasound color Doppler 3D & 4D Ultrasound
5. Cervical factors infertility
6. Evaluation of ovarian factors
7. PCOS
8. PCT
9. PESA
10. MESA

Section -10- Ethical and Legal Issues

1. The regulation of Assisted Reproductive technology. The Bangladesh Experience
2. Need for national Guidelines for medically Assisted reproductive techniques in Bangladesh
3. Social impact to women with infertility
4. Religion and infertility treatment