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Infertility = no pregnancy after 12 months of regular unprotected intercourse.
It affects 1 in 6 people worldwide, regardless of country income level.

🔹 Why this matters

• Infertility is a health and human rights issue.
• People deserve accurate information, access to diagnosis/treatment, and support without stigma.
• WHO emphasizes cost-effective, evidence-based care that avoids unnecessary testing.

• Educate the public early about fertility, age-related decline, and when to seek help.
• Lifestyle actions: quit smoking, reduce alcohol, maintain healthy weight, exercise.
• Prevent and promptly treat STIs, a major global cause of tubal disease.

Female

• If cycles are regular → confirm ovulation with mid-luteal progesterone, not routine ultrasound.
• Assess hormones only if clinically indicated: FSH, LH, E2, PRL, TSH.
• Check tubal patency with HSG or HyCoSy.
• Evaluate the uterine cavity with SIS (preferred) or 3D ultrasound.

Male

• Semen analysis:
  • Abnormal → repeat after ≥11 weeks
  • Normal → no need to repeat

Unexplained Infertility

• Normal exam, normal ovulation + tubes, and normal semen → classify as unexplained.

Female

• PCOS:
  • First-line: Letrozole
  • If unsuccessful → Gonadotropins → IVF
• Tubal disease:
  • Age <35 + mild/moderate disease → Surgery first
  • Severe or age ≥35 → IVF preferred
• Hydrosalpinx:
  • Salpingectomy or tubal occlusion before IVF improves outcomes

Male

• Varicocele:
  • Treat surgically or radiologically rather than observation
  • Microsurgical repair preferred when available

Unexplained infertility

1. Begin with expectant management (3–6 months)
2. If unsuccessful → Stimulated IUI (S-IUI) with letrozole or clomiphene
3. If unsuccessful → IVF
4. Use IVF alone, not routine ICSI, unless true male factor exists

• Listening to patients, addressing psychological stress, and offering support
• Using systematic, not excessive, diagnostic testing
• Choosing treatments based on effectiveness, feasibility, and cost
• Documenting treatment outcomes for continuous quality improvement

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Of course. Here is an edited, more readable version of the video script.

Your Uterus is Getting Old, Too

Hello and welcome to the channel. Most people know that when it comes to fertility and age, the focus is often on the ovaries. Ovarian aging is a well-understood process where the quantity and quality of eggs (oocytes) decline over time. This leads to a higher percentage of embryos with chromosomal abnormalities (aneuploidy), making pregnancy more difficult.

However, it's not just the ovaries. Your uterus is also getting old, and this can significantly impact your ability to conceive and carry a pregnancy. But how exactly does a uterus age?

How the Uterus Ages

The aging of the uterus happens in two main ways: functionally and structurally.

Functional Changes 🧬

The way the uterus works on a cellular level changes with age.

• Microenvironment: The cellular environment and the function of endometrial stem cells can change, making it less receptive.
• Blood Vessels: Blood supply to the uterine wall can be reduced, and the vessels may become less compliant, affecting the overall health of the tissue.
• Hormonal Response: The endometrium (the lining of the uterus) may become less responsive to hormones, which can disrupt the "window of implantation" when an embryo can attach.
• Myometrium: The muscular wall of the uterus (myometrium) can lose its ability to contract effectively, which is important during both implantation and labor.

Structural Changes 🏗️

The physical structure of the uterus can also change over time.

• Fibrosis: The muscle of the uterus can develop fibrous, scar-like tissue, making it harder and less flexible.
• Adenomyosis: This is a condition where the endometrial lining grows into the muscular wall of the uterus, causing it to become enlarged and less functional.
• Fibroids: The likelihood of developing benign tumors called fibroids increases with age.
• Uterine Surgery: Previous surgeries, such as a cesarean section, can cause scarring and alter the structure of the uterus.

The Effects of an Aging Uterus

These age-related changes have significant consequences for fertility and pregnancy. They can lead to:

• Decreased fertility and difficulty conceiving.
• Increased risk of pregnancy complications, such as pre-eclampsia, pre-term birth, and miscarriage.
• Overall cellular and structural degeneration, making the uterus a less optimal environment for a developing baby.

A Novel Concept: 'Uterine Freezing'

As more people delay childbearing, researchers are exploring new ways to preserve uterine function. One emerging idea is a concept called 'Uterine Freezing'.

Now, this doesn't mean your uterus is literally removed and frozen like an embryo! Instead, the concept is to "stop the clock" on uterine aging using medication. The proposed method involves using a GnRH antagonist—a drug currently used in fertility treatments and to manage endometriosis—along with "add-back" estrogen and progesterone therapy.

The goal of this treatment would be to suppress the natural cycle, potentially slowing down the progression of age-related conditions like adenomyosis and myomas. This could help ensure that when you are ready for a child, your uterus is in a healthier, more "youthful" state to match your frozen eggs or embryos.

It's important to note that this is still a theoretical concept and not yet a proven or available treatment. However, it represents an exciting future direction in fertility preservation.

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PCOS is a complex hormonal disorder that affects individuals in various ways, impacting not only fertility but overall health. We explore the symptoms, diagnosis criteria, treatment options, and emerging research highlighting the connection between gut health and PCOS, emphasizing the importance of a multifaceted approach to management.

• Definition of PCOS as a hormonal disorder
• Rotterdam Criteria for diagnosis
• Role of lifestyle changes in managing symptoms
• Importance of medications like metformin and ovulation induction
• Overview of reproductive technologies such as IUI and IVF
• Gut health's influence on insulin resistance and hormonal balance
• Tips for promoting a healthy gut microbiome
• Encouragement to seek personalized care and support