Treatment of Infertility using Follistim and

Intrauterine Insemination to

Achieve Pregnancy

Polycystic Ovarian Syndrome• Traits

•Irregular or absent menstrual periods.•Menorrhagia (heavy menstruation).•Hirsutism (facial hair).•Obesity.•Depression.•Anovulation (absent ovulation).•Hyperandrogenism.

Hirsutism• A condition of unwanted, male-pattern hair growth in

women.• This may arise from excess male hormones called

androgens, primarily testosterone.

Diagnosing AnovulationBloodwork

• Follicle stimulating hormone (FSH) (normal or low).

• Lutenizing hormone (elevated).

Diagnosing AnovulationBloodwork

• Estradiol is the primary female sex hormone (normal or elevated).• Estradiol level in blood rises during time before ovulation.

• Testosterone (elevated).• Elevated testosterone causes hirsutism.

Semen (Sperm) Analysis• For the male, a semen analysis is performed to measure the

number and shape of sperm, and sperm morphology (sperm size and shape) is evaluated as part of a semen analysis to evaluate male infertility.• Normal sperm have an oval head with a long tail. • Abnormal sperm have head or tail defect (misshapen head or

tail) which can affect the ability of the sperm to reach and penetrate an egg.

Diagnosing AnovulationEndometrial Biopsy

Diagnosing AnovulationEndometrial Biopsy

• Sound the uterus by measuring the depth from the external os of the cervix to the fundus. A pipelle curette is marked in centimeters so you can measure sounding depth.• An endometrium showing little

or no progesterone on pathology indicates anovulation.

Menstruation Before Beginning Treatment

• If a patient is not menstruating, a prescription for (synthetic) Provera is provided to induce a period.

• Progesterone is one of the hormones that controls the menstrual cycle and ovulation, the monthly release of an egg from the ovaries.

• Progesterone also helps to prepare the womb lining for pregnancy and shed the lining each month when pregnancy does not occur (a process you know as your monthly period).

• A transvaginal ultrasound study that measures a woman’s ovarian reserve (remaining egg supply) which reflects her fertility potential. • An antral (resting) follicle is a small, fluid-

filled sac that contains an immature egg.• Follicles can be seen, measured and

counted on Cycle Days 2, 3, and 5 by using ultrasound.

Basal Antral Follicle Count

Transvaginal Probe

Basal Antral Follicle CountUltrasound Image

Oral Meds: Femara or Clomid• Both Clomid and Femara are

medications used to treat infertile women who have an ovulation problem.

• These medications work by helping the pituitary gland (located at the base of the brain) improve the stimulation of developing follicles (eggs) in the ovaries.

IVF Drugs: Follistim

Follistim and Monitoring

•Follistim is started at 150 mg by subcutaneous injection for 7-14 days with the physician adjusting the dose in order to get 1 or more follicles to grow. •Blood sample is drawn for serum estradiol every other day along with transvaginal ultrasound evaluate follicles until they reach a mature size.

Follistim and Monitoring•When mature size follicles are seen on ultrasound, an injection of HCG (human chorionic gonadotropin) is given which induces ovulation to occur in about 36 to 40 hours. • Intrauterine insemination is performed to release the processed sperm sample inside the uterus near the egg for fertilization.

Results•A pregnancy test can be taken in 2 weeks.

•A yolk sac can be seen and heartbeat heard in 6 weeks.

Maturing Follicles

Sperm Washing

Intrauterine Insemination

Successful Results