Anovulation: correct the cause of anovulation, controlled ovarian hyperstimulation.

 

Tubal factor: Previously evaluation with hysterosalpingography.

Not permeable tubes (through hysterosalpingography): Perform diagnostic laparoscopic surgery.

Bilateral hydrosalpinx or pelvic infection (frozen pelvis): Laparoscopy plus tubal ligation, followed by antibiotic treatment, followed by IVF.

Endometriosis: Endometrial fulguration, followed by IVF.

 

Endometriosis: Laparoscopy plus removal of adhesions, plus a neosalpingostomy of the affected tube, plus endometrial fulguration,  followed by intracavitarias 3-4 insemination cycles, followed by IVF.

 

A permeable tube (through hysterosalpingography): Perform diagnostic laparoscopic surgery.

 

Unilateral Hydrosalpinx or pelvic infection: Laparoscopy plus removal of adhesions, plus neosalpingostomy.

If the Hydrosalpinx is less than 3 cm, followed by antibiotic therapy, followed by interactive insemination with 3-4 IVF cycles.

 

Anatomic factor (endometrial): A surgical hysteroscopy in case of submucosal fibroids
or polyps.

 

If Pg levels are <10 ng / dl (21th) and luteal phase defect is suspected, based on evaluation, then we use controlled ovarian stimulation vs. intracavitary insemination, followed by support of the luteal phase with Progesterone until the first positive pregnancy test.

Antiphospholipid syndrome evaluation: Request anticardiolipin antibodies and lupus anticoagulant. Mostly related to recurrent abortions. Positive results are treated with aspirin 80 mg / day, starting a month before the beginning of a cycle in which the patient plans to conceive, and maintained throughout gestation. 5000 units s.c of Heparin twice a day, starting 48 hours after ovulation and up to 34 weeks.

 

 

 

Male factor infertility: Is initially evaluated through a basic spermiogram, if there is azoospermia or severe degrees of oligospermia then proceed to verify FSH levels.

In case of high FSH levels then a karyotypic analysis is performed. If the FSH is normal or low, then some obstruction is likely, or an idiopathic case which requires testicular puncture.

Step 1	3 – 4 stimulated insemination cycles with clomiphene plus gonadotropins.
Step 2	IVF

 

 

 

Step 1	IVF + ICSI
Step 2	If no fertilization occurs alter performing a ICSI, or no sperm is recovered alter washing, then donor sperm is used.

 

 

 

Step 1	Epididymal sperm aspiration or testicular extraction of sperm.
Step 2	If no fertilization occurs alter ICSI or no SPZ are recovered alter processing sample, then donor sperm is used.