**IVF** (in-vitro fertilization)

12 Enhancing Success of Assisted Reproduction

breast development.


**3.5. Differential diagnosis** 


**3.6. Therapy** 

**Exercise** 



**3.7. Symptomatic treatments** 

Finasteride (Propecia, Proscar)

**3.4. Standard diagnostic assessments** 





Other causes of irregular or absent menstruation and hirsutism, such as:

PCOS has been reported in other insulin-resistant situations such as acromegaly

**Diet**: Where PCOS is associated with overweight or obesity, successful weight loss is the

**Anti-Androgens**: Spironolactone (Aldactone), Cyproterone acetate, Flutamide (Eulexin),

**Metformin:** National Institute for Health and Clinical Excellence recommended in 2004 that women with PCOS and a body mass index above 25 be given metformin when other therapy has failed to produce results. Metformin treatment reduces hyperinsulinemia, LH levels, free testosterone concentrations, in overweight women with PCOs. Metformin

**Clomiphene citrate** (Clomid, Serophene) alone or in combination with weigh loss can be used to induce ovulation or with other, more aggressive, treatments for infertility. Including injection of gonadotropin hormones and assisted reproductive technologies may also be


most effective method of restoring normal ovulation/menstruation

**Anti-Obesity Drugs**: Orlistat (Xenical), Sibutramine (Meridia)

improves menstrual cyclicity and increases the frequency of ovulation.

**Steroid hormones**: Oral contraceptives (birth control pills), Progesterone (bioidentical), Estrogens, and Corticosteroids

**Bilateral wedge resection** of ovaries were abandoned due to peri - ovarian adhesion formation.

**Ovarian drilling:** Surgical procedure which can help induce ovulation in some women who have not responded to other treatments for PCOS. In this procedure a small portion of ovarian tissue is destroyed by an electric current delivered through a needle inserted into the ovary. This is less invasive technique and less chances of multiple Pregnancy and ovarian hyperstimulation. Laparoscopic Ovarian Drilling is a safe and cost effective procedure and increases the sensitivity to gonadotrophins.

### **Tubal factor**

### **Physiology of the fallopian tube**

The fallopian tube has complex task:

	- Transport the spermatozoa towards the ampulla
	- Sperm activation
	- Fertilization support
	- Embryo cleavage
	- Zygote transport

**Tubal infertility** includes the changes due to inflammation which affect the fallopian tube and its relation towards the ovary in a way that will affect ovulation, the transport of the egg, sperm, or embryo, or alter the function of the tube as the site of fertilization. Injury the distal oviduct resulting in a complete or partial occlusion is the most common tubal lesion. Microsurgical or laparoscopic repair is the primary method of treatment with pregnancy rates. Hydrosalpinges produces an adverse impact on results of *in vitro* fertilization. Removal of Hydrosalpinges will improve IVF success rates. The surgeon has to distinguish between the pathological findings according to the site which is affected.

#### This are:

