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INVESTIGATION OF INFERTILE COUPLE Evidence Based Medicine In a climate of DR. JEHAD YOUSEF FICS , FRCOG ALHAYAT ART CENTRE AMMN, JORDAN

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Investigations of Male Factor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Assessment of ovulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Investigations of tubal factor ,[object Object],[object Object],[object Object],[object Object],[object Object]

Other investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Controverses ,[object Object],[object Object]

Investigations of infertile couple Evidence Medicine Based Era National Evidence-Based Clinical Guidelines “ Assessment and treatment for people with fertility problems developed by the National Collaborating Centre for Women and Children's Health on behalf of the National Institute for Clinical Excellence (NICE)” February 2004

Grading – Evidence Based Recommendations ,[object Object],from expert committee reports or opinions and/or clinical experience of respected authorities non-experimental descriptive studies, such as comparative studies, correlation studies and case control studies II a - at least one controlled study without randomisation II b - at least one other type of quasi-experimental study I a- meta-analysis of RCTs trials, I b- at least one RCT. D recommendation IV evidence C recommendation III evidence B recommendation II evidence A recommendation I evidence

Semen analysis The results of semen analysis conducted as part of an initial assessment should be compared to the following WHO reference values : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Semen analysis ,[object Object],[object Object]

Assessment of Ovulation ,[object Object],[object Object],[object Object]

Assessment of Ovulation ,[object Object]

Assessment of Ovulation ,[object Object],[object Object]

Assessment of tubal factor ,[object Object],[object Object]

Assessment of tubal factor ,[object Object]

Screening for Chlamydia trachomatis ,[object Object],[object Object],[object Object]

Assessing uterine abnormalities ,[object Object],women with infertility and a normal HSG had no abnormalities of the uterine cavity when subsequently examined by hysteroscopy.

Post-coital testing of cervical mucus ,[object Object],. The post-coital test may be of value in the diagnosis of sexual dysfunction and ejaculatory problems. . Results of post-coital testing may have little influence on treatment strategy in the light of the widespread use of IUI for fertility problems associated with sperm-cervical mucus interaction. . The lack of effective treatment for anti-sperm antibodies may render PCT unnecessary.

Until it is demonstrated conclusively that treatment of abnormalities diagnosed by any of infertility testing, results in a significantly better pregnancy rate than placebo or no treatment, the advisability of performing such test, remains unproven and should not be performed.

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[object Object],A simplified approach will lead to a significant reduction in both the time and cost of investigating an infertile couple. The diagnostic process of investigating infertility has evolved more by discarding old tests than by finding useful new ones

THANK YOU FOR YOUR ATTENTION DR. JEHAD YOUSEF FICS, FRCOG E-mail:ramoamman@yahoo.co.uk

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