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1. rotunda.co.in
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Home Welcome to the official website of Rotunda Fertility Clinic and Keyhole Surgery
Programs and Services Centre. This clinic is the latest venture of Rotunda-The centre for Human
Reproduction and one step forwards in creating a chain of well equipped and State-
Infertility Surgery
of-the-art IVF centres in the city of Mumbai.
All you need to know
In addition to Infertility treatments, we also have facility for patients to undergo
Pictures and Videos keyhole surgery which is performed by reknowned specialists when indicated.
About us
Glossary of terms Facing infertility and undergoing treatment for the same is without doubt one of the
Our Success rates most distressing situations that a couple can face. It fosters uncertainities, doubts,
fears, guilt and apprehensions. We at Rotunda strive towards making the whole
Contact us
process as simple and transparent as possible, providing guidance and counselling
at every step. We boast of a team sensitised to the needs of our clients and have a
long track record to prove this. Most of all, we respect our clients' need for privacy
and offer this and much much more at very reasonable and competitive rates.
Egg donation may offer
the only chance of.....
Success rates at Rotunda
Centre of Human.....
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http://www.rotunda.co.in/[12/22/2010 5:36:08 PM]

2. Male and Female
Infertility

3. Goals
 Enhance comfort level with workup
 Basic Management Strategies
 TRICARE
 www.rotunda.co.in

4. Definition
 12 months of unprotected intercourse
 Earlier for certain historical factors
 Older than 35

5. Infertility Etiology

6. Female Factors

7. Male Factors
General Causes Meds
 Unknown: 40-50%  1 or 2
Hypogonadism
 1 Hypogonadism: 30-
40%  Common medications
 Ketoconazole
 Altered Sperm  Cimetidine
Transport: 10-20%  Spironolactone
 2 Hypogonadism: 1-2%

8. The Scenario
 Tech: “Husband and wife can’t get
pregnant.”
 You: OB rotation was last infertility workup
 What now?

9. Workup
 History is KEY
 Focused Physical Exam
 Labs and Specialized Tests

10. Workup: History
 Coital Practices
 Gestational History
 PMHx/PSHx
 Meds
 Menstrual History
 Substances
 Recent High Fever

11. Our Couple: History
Female Male
 G1 P0010  No previous partner
pregnancies
 No hx of STIs
 Gonorrhea hx
 Normal menses
 No meds
 Unprotected sex for
15 months  Occasional EtOH

12. Workup: Physical Exam
Female Male
 Breast Formation  Infection
 Hernia
 Galactorrhea  Vas deferens
 Androgen deficiency
 Genitalia  Testicular mass
 Varicocele
 Hyperandrogenism?

13. Workup: Labs
Female Male
 Ovulation problems  CBC
 FSH, Testosterone
 Ovulatory Dysfunction  GC/Chlam, UA
 Renal and Liver
 Ovarian Reserve Function
 Semen analysis
 Postejaculatory
urinalysis

14. WHO Seminal Fluid
Analysis (1999)
 Volume: >2ml
 Sperm concentration: >20 million/ml
 Total Sperm Number: >40 million/ejaculate
 Sperm Motility:
 >50% motile and/or
 >25% progressively motile
 Sperm Morphology: >14% normal forms

15. Workup: Special Tests
Female Male
 Transvaginal  Scrotal
Ultrasonography Ultrasonography
(TVUS)
 Hysterosalpingography  Transrectal
(HSG)
Ultrasonography
(TRUS)
 Hysteroscopy
 Laparoscopy

16. Our Couple: Exam,
Labs & Tests
 Normal male exam
 Normal initial labs
 Oligospermia on 2 separate semen
analyses
 TRUS and postejaculatory UA normal

17. Management: General
Concepts
 41 different methods
 “Fertile window” intercourse
 “E-type” vaginal discharge
 Avoid lubricants and douches

18. Management: Female
 Treat underlying cause
 Hyperprolactinemia
 PCOS
 Gonadotropin therapy

19. Management: Female
 Ovulatory dysfunction (Unknown etiology)
 Clomiphene 50mg PO daily x 5 days
 Start on days 3-5
 Can increase to 100mg daily next cycle
 Results
 80% will ovulate
 Hyperstimulation and Twinning
 Higher-order multiples rare

20. Management: Female
 Clomiphene Failure?
 IVF
 Injectable ovulation-inducing agents

21. Management: Female
 Tubal/Pelvic/Uterine Issues
 Reparative Surgery (low success)
 IVF
 Endometriosis
 Laparoscopic ablation
 Laparotomy
 Ovulation induction +/- IUI and IVF

22. Management: Male
 Hyperprolactinemia
 Surgical repair
 Fertility Specialist

23. Stress and Infertility
 69% Women and 21% Men have
preexisting condition
 Greater risk for psychological stress
 No significant difference in
psychopathology

24. Stress and Infertility
 Men have increased stress over time,
same as women
 Watch for normal grief vs. psychopathology
 Same rates of depression as other chronic
disease

25. Stress and Infertility
 Bottom line: Not a means to improve
pregnancy rates.

26. Management: Our Couple
 Male: Imipramine Mar 08
 Pregnant in www.rotunda.co.in June
2008!
 Separated from USAF in July 2008

27. Questions?

28. Infertility treatments
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Home Programs and Services Infertility treatments
Infertility treatments
Rotunda offers all services pertinent to infertility under one roof. We are known for our innovation, integrity, medical
and technical excellence, personalized service, and consistent willingness to accept patients facing the most difficult
medical challenges. We offer the following services:
Intrauterine Insemination
In vitro Fertilisation (IVF)
ICSI
IVF Lite (Mild IVF/Minimal stimulation IVF)
Surgical Sperm retrieval
Donor Egg program
Sperm banking and donor sperm
Embryo freezing
Gestational Surrogacy
Embryo donation
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