Jensen TK, Andersson AM, Jorgensen N, et al. Clomiphene citrate 100 mg by mouth is administered on cycle days 5-9 and a serum FSH level is drawn again on day 10. Patients with this type of uterus can have a normal term pregnancy. Bilateral cornual obstruction. Operative procedures such as laparoscopy and hysteroscopy are often necessary for confirmation of the final diagnosis.The HSG is the most frequently used diagnostic tool to evaluate the endometrial cavity. Infertility. salicylates, sulfonamides, penicillins and anticoagulants, are highly bound to plasma proteins or are not lipophilic enough to distribute intracellularly, and have therefore small volumes of distribution (< 20 litres). Cervical os changes during the menstrual cycle.
Kaufman RH, Binder GL, Gray PM Jr, Adam E. Upper genital tract changes associated with exposure in utero to diethylstilbestrol. In addition, Vd is helpful in predicting the initial maximum concentration for an IV bolus and can be used to predict the effectiveness of dialysis in treating drug intoxication during an emergency Drugs that are extensively tissue bound (e.g., digoxin) have a large VThere are many physiologic changes that occur during pregnancy that can result in altered volume of distribution for medications. Diethylstilbestrol-induced upper genital tract abnormalities. Laparoscopy used to investigate tubal patency must be combined with hysteroscopy.Women with a septate or subseptate uterus should undergo hysteroscopic septum dissection before fertility treatment is initiated. Image courtesy of Jairo E. Garcia, MD. Metroplasty - Strassman technique.
Infertility. A TSH value exceeding 2.5 mU/L should prompt testing of anti-thyroid antibodies.At least 100-150 µg iodine supplementation/day should be given to women before conception.L-thyroxine should be used in women with a TSH level of 2.5 mU/L or more to decrease the TSH level to less than 2.5 mU/L.Definitive thyroid treatment must be completed in women with hyperthyroidism before ART is initiated and prior to conception.Women with antiphospholipid syndrome or systemic lupus erythematosus (SLE) must undergo treatment by an interdisciplinary team prior to conception. Infertility. Infertility. If the response is exaggerated, with more than 5 sizable follicles (18 mm in diameter), and the EOnce the diagnosis is established and any other endocrinopathy has been excluded, the ovulation induction agent of choice depends on a functioning hypothalamic-pituitary-ovarian axis. Image courtesy of Jairo E. Garcia, MD. Image courtesy of Jairo E. Garcia, MD. Palermo G, Joris H, Devroey P, Van Steirteghem AC. The success of the procedure is related to the diameter of the hydrosalpinx and to the damage to the cilial epithelium. Renal failure and thrombosis can occur if the patient is not treated correctly.Some patients have a greater risk of developing ovarian hyperstimulation syndrome.
Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Strathy JH, Molgaard CA, Coulam CB, Melton LJ 3rd. Attention should be directed to the following:Congenital abnormalities of the genital tract (eg, hypospadias, cryptorchid, congenital absence of the vas deferens)Testicular size, urethral stenosis, and presence of any varicoceleAny previous inguinal hernia repair: Can indicate accidental ligation of spermatic arteryLaboratory, radiologic, and/or surgical assessment of the female includes the following areas:Uterine and endometrial: Hysterosalpingogram—most frequently used diagnostic tool to assess endometrial cavity (see the image below); pelvic ultrasonograms; saline infusion sonograms; pelvic magnetic resonance imaging; hysteroscopy; endometrial biopsyTubal and peritoneal: Laparoscopy and hysterosalpingogramOvarian: Progesterone levels and/or serial ultrasonography to assess ovulation; follicle-stimulating hormone and estradiol levels (or antral follicle counts, ovarian volume, inhibin B level, and antimüllerian hormone level) to assess ovarian reserve; clomiphene citrate challenge test for dynamic ovarian reserve testingLaboratory evaluation of the male partner includes the following:Semen analysis: Volume, pH level, concentration, motility, morphology, WBC countSperm function tests: (1) The acrosome reaction test with fluorescent lectins or antibodies, (2) computer assessment of the sperm head, (3) computer motility assessment, (4) hemizona-binding assay, (5) hamster penetration test, and (6) human sperm-zona penetration assayTreatment plans are based on the diagnosis, duration of infertility, and the woman's age.
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