Book

!?
SAq GIk ALXK x

!! GÂ q ALW
!? AwpAh x U \v
ZpA_ AeW A^ p A
pAkd V}L @
GHA wj @
\R } @
}q U \WBK p
\WBK AF^
fl\ Zp }q
44
Z}
\WBK AdUv
fl\ Zp }q
74
fl\ ÂL A
ZpA_ AeW A^
Q\ .. }q
GÂ q ALX x
? \WBL
!!! ~A}T ..ApAa
92
N ZFK x :ZF
!!! \L_K
124
~ ZE
12
144
? lkX x
20
150
? \WBK }q A
30
GIkAW ... \WBK
34
L^ \R \L < \KI Ap ev
Z}
qQ
flA fi[ F A AqK AUF^

fi[ p bq [ \O \_ ,Abq
ZR ,q p e KAA Eqa ÂQ LWCE
A \W ZR E ,q fi[ d }b A iqE
nq e^ [ Z d }b \FLq
Aq ,AqK AUF^ fl v .. q , CE \ A
\q v ..}b ZqE hqE \_ _E hqE :A
d Eqd ZR A OZT Q]L %15 \O
AUF^ Ap g\v [ q_ ~\j ZF A ..
q_ fiZ\ A d AqK
] fi]R N \ ^ q^ q^ A A_ ` "
"
41- 39 R fl^
,\W iqF VR iqF VR fiZb A d Aq^

^ nT ..AR [ d \_ A
Ab \OA , AZQ A ZZq ZZq AT
!! q ZT \^ ZQ ,KAT A_ QK
} z_ Za Z}v , \I A p A Z}K A_ AK
eeXL L}T p ]Rq A QK A p kK gA
lbK \R GIk qkL_ A A ZqFv ,AR [
W ]AE dA A AWCE \|AE iFL
AÊ _ A \n ZE ,pAkd V}LAE \q T\
1978 Ap \E ] wk Z [ flZpA_ AeW
E \q AE A_ _Q AW AeW ZE wj \FLqK
\R } }\k wj 1992 ^ Z E , "GHA wk"
Ap E VLv [ hF W ZT T }T
ZQ | Zp Q GF_E Z \O
ALU E ..AT G_ \k fi[ . A
!?flZpA_ AeW A^ \
Z| .. kK Z| T Q] fiZ\ A d q T
M| L_ A Aep \O T\ fi[ W ]L_K
...wk b AnL fl\t fl\ Ght
K Z| A ]L_K Z}v ^Z K T\ fi[ E
]L^ [ GRL LT ..AQ] L A \W A Q\T
??^Z T\ fi[ K GR A Aep \L_
GIk p T\ fi[ AK AQ] ZLq A A FAtv ??x
ZT AR [ eeXL Z \q ..Aq
2
,fi\WBK ZqE ZT q_ [ p v\q V

xAK p GK\L A .. \W GIj F[ A AFAs
AUL Avb \K \ QALU A z A _w
EA Zp dAW p \q E , A Aqa
ALa\ "x " q q A OUE ZZQ GIj
K q T ZB A ..}EA_ Aqa AQq
??^Z T\ K x A .. !!^Z
p EAQ VhLL^ Z H [ AL [ K\| ZqE
AE q_K wLX "\^" q VhLL^ :}EA_ ^
\ k B E k F K \ w L X q A h . . A R
[ ..}q \WBK p fXbL wLX GA^
Bv .. \^ p W .. "^Z" q T K Ah
Av ..q ..Aq zN Q] p ZLq AR Ah Ap
A p A}v [ A ..] \RT GIk ZU [
_ v ..q fXbL ^ GIk T\L}
b AbL^ A AAp \td \F GIk
ZU x ..A UUd fiZ}Lq [ ~\kAE Q] A
.A AL [ ..A Q]
fl\ ÂL A
[ fl\ ÂL A qIk L p \qL GR ,q fXbL T ZF F|

: L
WZ ÂL Ahp -1
V a g i n a F (
T\ ~p fiA_ F p T\ ULv AQAW \w flAF Abs ZLK fiA}

]L hqE _ [ A AN ZL F r_L ,^ 13 8 H Aj \L...A W
W p ovAUK ,qIk \v qwE A Fj F xRK A flAp ._ |q hp
A\LF p ZpA_K q hT Q \v A hwE flAh AE\ F
ZT AT .GIk Aa G_T fl\L_ weE F Z AqL^CE Ve [ ,flAh
fl\LOXL K AE A_TAE EUe \ U fl\]s K Z| \v fi[ Cv AL
\b flZ xeL ZUK qIk \v \v fi[ H \w A GR .AE]A
.T ZUK Ap U | ABE ]LK T\ ~p \wK
U t e r u s T\ (
\p T\ G_T RT xLX ..w^ L| p KZpA|-b \ ,z MH T\
.z RT G_T r_LK ZLK hp A}Fj flZp x .AT \ Zp [ wLX fl\
T\ rg F_AE A .F p VLw [ T\ ~qE w^ Av KA}E p T\ eL
\WBK T\ fiARK GF_ ,x T\ RL AT iqE ,A ARL A A FAtv
.}q ZT
GRL_ v fl\I Abt [ .Endometrium T\ AkFE _ Abs WZ T\ kF
(A \NBK ZE T\ AkE ^) 2 T ^ ] AhI A\w A
xe 14 T \W fl\ ] N \b flZ xe W 12 -10 T
A F_ AwX ZqE flZ fi[ W ZU ,\b flZ AO
.\b flZ ZE \q fld Abt [ ^ flA] ]K iI A\w
AkE bs U} hF "`tK" V}L À T v :x| xLX_v T ZT
.b ]Q ZqE A L^ T\
Zs p T\ ~p LU .^ 25 j F p w_ T\ ULv v Cervix T\ ~p p A
:\b flZ fl\Lv G_T L LQ] Q xLXK ,iI | AvAwa \]s
A^ \wK
T\ ~p r_K jAX A_ Q] M| \b flZ xe W A MZ}K Av
A ZpA_L fl\I QZ L A r A_ Q] } K \b flZ xeL ,A h
AO xe W .hF r |L L LT Av A| T\ F qe p
.T\ A qd rL L }K A_ vAO ]K \b flZ
4
fl\ ÂL A
T\p
Av flA|
T\_Q
iF
T\ kF Abt
T\ hp
Av flA| Z
T\ ~p
F a l l o p i a n T u b e Av flA| (
A .^10 T A j .T\AE hI eK AKA} A ,ALN A ZQ
AQ\W Zp hF A}L iI Vk^ V_ p qK flZZp Z ZQK iI TA flA|
EA}K LT Q ~ÂK \ULK ZQ }| \qa kÊ T\ fiARK flA} W Aqv iI
AU}K ZqE hF }FK [ A Av flA| AeW A Cv [ , A
hF } fl \R M_ Av flA| wm Z .A F\}K A 5 flZ
.}K A r T pAwK Av flA} E \W A z
5
Ovary iI (
15-10 g\p ^ 4-3 H A j \L ,AhI fl\
LU .flAE b PT iI IbK ,^
flQ AhF Zp xLX ,AhF \I Zp p iI
7 T) KAL_ p :fl\ \p G_T iIAE
T W a _W A\p MF K AZp (hIAE hE
hE 2 T e LT A RZK Zq [ } N ,A
fi[ eK .F Zp hE x 400 N fl Zp
400 T iFL N Sh A j AhF
AhF A Zq [ }E A ,fl\ \p W hE
.wLX \q T\ W A RZK \h
fl\ ÂL A
Sh L ,Sh T\ AL AhE flZp ZFK \a

AeW fiZqL_ [Zp K AhF fi[ ZT A
Sh ANBv ,\W wm iI .iI A|k ZqE
Q\L^ ) Z A \v L AhF
AF}L^ T\ kF Abt ZqL_ (\_Q\F
Awe Ah A fi[ ULK A .U} hF
._ Ab T fl\ _
(\w) QA ÂL Ahp -2

Aq (
A ] p flQ Z A ]\LK flA^ p flAFp
fi[ ZQ kt F fl\Lv ZqE .. AO A .. np
,dAW b [ ..} PO p ZqR \qa }k
[ \tL Z}v fl\ _RE \[ A F_ AwK AT v
.Zq PO b
AK\I AK\wb (
JAQ p A j ZLK Z A ]\LK Z ALzN A
kt . Aq }k Zp [ F w^ ZULK F ULv
iqE p AK\wb AKA LUK .Ah \qb }k fi[ ZQ
flZs p LUK A .fl] U \v \wK Zt
R \w jAX A^ \wK Bartholin Gland NAF
fi[ flA} Z_ ZU Z| AT iqE ._ flAOL^
AL ZU Z| E flZt XhK \v rRK A flZt
\W ^CE \q (ZZd rRK) \W K \
p \Q Qp ALU [ Bartholin Abscess NAF
.ZZe \W \ [ VLv
6
fl\ ÂL A
AK\te AK\wb (
\I \wb W A j ZLK Z ALzN A
}k fi[ ALK ,F ULv \nF v AA ZULK
Aep AA \I Zp p ALT fl\I Â_AE
.Â_
\nF (
p \te \wb W Q \td _Q p flAFp
]\ ZT v dAW \nF .F v F ULv
AA \I Zp p LT fl\ Zp _ flANAE dA
Zp ZU AeL dAW A h \nF .Â_ Aep
. _ flAN ZT
_ flb
ÂL AhpAE _ flANAE dAW ]\ flZp ZQK
dAW F WZ \wb \nF A (\w) QA
_ flAN ZLqK .A F ZQ MUK Aq np xW
~jA TA_ O p flZp p flb Ad fl\ Zp
Z A ~F_K FpZ ._ IL RT Â_
Ahp dAW _ K _ flb d A
}K F Fj\ \v iqE \ ÂL
ZFK dAW \p flb ._ A AK ZE
\KK ZOAE A}LT ZT r F \v flA]E
r hp iqE hp ARbK ZT N
.flb ZT Zp AXK
H y m e n flAF Abs (
Aa Abt [ .[q Zp F ULv kt ~| Abs
xLX ...fl\O \W Aa Fb } v fl\O
\q ,\W fl\ ]L LA} Z Abt [ ^
[WB Z| E AQ Zp Abt [ ]L T \O
iw [ "jAk" ^ p ~k A ,\ flZp [
.GIk T\ WZLAE
N ZFK x :ZF
!!! \L_K
wj AE \K flA fl\Lw K
qIk A AK flZqL_ fl\ VFeK
r\_ nTE fl\Lw K ZFK ..flA
ZO RT \F O \W O Awe m N ALE _Q
wLX _ ~jA Z rK Aq lE \qb rK
-11 ^ T i ] ZF LT k M| \ ..
F Zp ZUK flZZq \tL fi[ GF_. ^ 14
AX flZt Aa A^ ZF \q \s A GF_ Y
N \v iI AKA ^\K LT Y A|
Oestrogen Hormone Q\L^ E _
fLK ._AE ZUK \tL \O p _
:T F fl\Lv W _AE ZUK \tL
\WBLK ^ 9 ^ Zp ZFK ,ZOAE ZUK \tL >

.^ 13 ^ LT
Zp flAp ZFK ,Aq }k \qb E ZUK \tL >
.^ 15 ^ Zp LK ^ 12 ^
lE }k \qb >
A\ \v flA]E ZF ,_ Zq flA >
GTAe A ,hF lbK AX flZt Ee
._AE \v flA
.(i fl) Pk ZT ZE >
F fl\Lv \tL_K ,Z E ^ F| flAp MF uFK
\Fp F ^ \tK AFj oT Z| .^ rE ^
T ^16-15 H F ^ A ^ 100 [v ,eq
GF_ Z}Lq ,A M| ^ 14-11 H \L
p flZ} Sh AK i ZE {q .[tL L_ _UK
8
N ZFK x:ZF
!!! \L_K
iFL ZU
Z %15
_ \b
bE flAp ZF iFL \b flZ PT ,A \a iFL

^ \m Z}v .AAnL F| | \O ^ fl\Lw nL \s
_ \b Z %15 T ZU iFL BE Ij
T ZU iFL T ,\b flZ ZE ZqE
flZ ZE ZqE ^ 6 \ ZqE \b Z %80
j \Lw \b flZ AnL Zp \[AE \Z .\b
B_ [ ,
F}L_ AR p flZ} iFL p \N Z|
.fl\Lw fi[ p }q \WBK AT Aq GIk
AF^ m AF^ A \b flZ ZE ^ \WBL Z|
,A iqE FTAe Z| [ iI `K AT O g\
AF^ ZZq ZQK A .flZ ZE ^ \WBK ,A `
.Ae}AE flA]AE A |Z flZt W O \W g\
:AL A GIk flAbL^ QE A fi GR

.^ 18 ^ p flZ ZE \WBK .AF| AO ^ ZO \F BE \F E ZT .fl\aAq ^ F| \b flZ ZFK BE \F E ZT ZT b QZ \b flZ W Z ] flA .(Ay) Z \}v
.\b flZ AN AE T\F Q nL qk}L \Lv p AE T\F Q .\b flZ ] ZE
p \N Z| A ] \ AqK MF MA F
.|Z flZt \ Q 9
\b h flZ
\wd _
RgA\s hE
\b flZ ZFK
ZqE `) Z ]
A Z ] AL
ALAE ,(iqF AF_U
flZ fi[ LK
] ZE F| \W
hE
\tL_K .AL flZ

RgA
Z| ,A 28 T flZ
iI
eT
iqE Z kK \e}K
qIk flZ j ,Z_
nL flZ \FLqK .A 35 21
flZ j l^L p A 3-2 p Aj LW ]
.flZ^ F_AE
N ZFK x:ZF
!!! \L_K
!! A d @
,flZ fi[ W iIAE ZU A \b flZ w

Y ]\ ZT ZFK A ...A d \q GR
ZA| Gq [ Hypothalamus `NFAE _
wLX Ahp p n } `NFAv q ..\L_
AW ^ ZA| A .. iFL p _
Aa ~\j p LK A_ _Q A flA} ^ Cv ,flA}
\NK dAW A\E p flAFp .. A _K dAW
A fi[ wK dAW F}L_ p LU [ hq
..Ek wm K
ÂL A F AE _ `NF \w
Vg A , Gonadotophin Releasing Hormone (GnRH)
A}E ZQK ) AX flZt \U F [v ^
K EeX fl\Lv p
V}L fl]AQ hF
flZ r \kK hF V}K

\b
nK A
A A
:ÂL
AhF lbK @
kF Abt \hUK @
T\
\L^ @
28
U} hF A}L \tL_
A 5 T\
10
p q A :AN A ÂL A \wK (Y

iIAE (fl\td A eT p flQ) AhF
e F AE _ [
Av flA| , Follicle Stimulating Hormone (FSH)
ARw p _ v AO A
Z E _ hF \W `
.Luteinising Hormne (LH)
hE
N ZFK x:ZF
!!! \L_K
p AhE flZp ZFK flZ

_K fl\td eT A
\wd _ (Graafian Follicles) \Q eT
A Sh T\ AL hI
F \NBK MUK wLX
Abt Stimulating Hormone (FSH) e
T\ kF
ZT A Sh L .Follicle
T\ ~p BE) e AhF fi[
fiZqL_ [Zp K L (hI
L ,Av flA}E ALT ZFL k
LK . Luteinising Hormone (LH) \NBK MUK
14 F| Oj H q| fl\Lw xeL A F\}K iFL p
!A} flZ ZE A
iI
Q\L^ flZ xe AhF \wK

iIAE \wd _ L iFL p ZqE . Oestrogen
[ \N .Progesteron \_Q\F \w [
]AQ ^ ] T\ kF Abt p A
AeW L Cv . AFeXK ZqE hF AF}L^
AwX p GF_L A iIAE \wd _ UL hF
]Q U fiZE [ A [ L_
.i fld ] T\ kF Abt Uk_
Q\L^
(iFL) e F
\v L_
K LH
11
flZ
\w hF
qR [ Q\L^
T\ kF Abt
z AF}L^ ZqL_
5
F lb
AhF e
14
17
QAw AwK
iI hF \W qFL [
~ ZE
ZE p ZR e} fi[ L PTAE ,~ ZE e| A
A AFI_K ZqE ZT Lv ..AUF^ ~A
[ \^ A hqE \_ A..GRqLK v ~A ..fiZQ
ZZ Aq OTAF xbL [ r\ ZE
:~ ZE T\ ZZ
hF T
A T\ W iI hF \W iFL
v ,fl\ \p W fl\ 400 T iFL L .. hF h
AhF \I Zp lb \a fl ZE
Hormone (FSH) e F \NBK MUK hI
ZU iFL A} A Ud v [ ... Follicle Stimulating
\Q eT p ZLq iI fl\ LAE
A Sh Md hI BE (Graafian Follicles)
ZT iFL .k fiZqL_ AWZE L hF K PUE
R ZU Cv }| }| \O \tL_ s\AE K
AX flZt \wK BE ZFK flZ}q AZ Aq __
) fl\I AE Luteinising Hormne (LH)
(hF \W e ` ARw p _
n AAE jAU hF fld

iI AQ\W
12
~ ZE
ZqE jAU hF [}E AZ Aq fi[ LK..

\qbK .ALT W A[tK M| `w AUK A
Z| A ,hF \ R l_F iqFE Z_ iqE
p LK .iFL ZT R Z A} iqE ] oT
14 F| Oj H q| fl\Lw xeL A F\}K iFL
! A} flZ ZE
Z qK ,\ p flA| \s AK ZT hF
A}L iI Vk^ V_ p Av flA} QA \kAE flZZp
fiARK flA} W Aqv iI AQ\W Zp hF
EA}K LT Q ~ÂK \ULK ZQ }| \qa kÊ T\
,A|k [ pA^ 24 T hF cqK . A
hF AeW ZU fi\Lw fi[ A K Cv
\hLv fl\Lw fi[ W hF GeXK A . AE
.LK hF
AU ZT
Av flA}E AQ AN
13
A T
T 300 T [| L A W
ZFK A ,T\ ~p A F \O
^ 19 -16 T Aj uF k T\
ZE ,hF A eK LT
T OK A eLK v fl\e| vA_ fi[
ZT k xqg _W
!!! \L1,8 j fXb \L 9 Aj T
iqE MA ,ApA^ flZp T\ fi[ \tL_K
hF eK kb q\_ A
[ rFkAE e .N ~A| flZp W
AZp E Av flA| A Zq
Q p \q \s .| A p Z]
Abq z] fl\Lw }
fl\ ÂL A W
p KZ| Z}w Z}Lq ,A 5 T eK
A K AeW \v Z]K .pA^48 T ZqE AeW
. `w iFL
AeW
AwjBE \q A dAW flZpA_ AeW A^ p Ag Z}
A VgK }|Z Aq \O \O GHA
A flZp eK AZp
Ov ..fl\ _Q W AeW ZT
ZeK , Av flA| A A
A \I Zp A [RL A iqE hF
ZFK hF ALEA} v , Av flA| W flQ
kU A \LW AU wLX A
A \wK hF \LW AU T\ W ..hFAE
Z| [ R hF ZRE G}N ZT \W A
A T A hFAE kU ws W A \O [w
v ,AFeX hF W [w [ l}v ZT A
hF s ZQ q\^ A \tK ZUK ZT
\q .hF W \W T W rL
v\q N flA p LU [)
wW A AK hF \LX [ ZT ] (A^\AE
l_FL [ s\AE .. l^ ] [

A A b r| Cv ,hF AeW q q
\O AA A A ]Q Av\p wLX Aq
ZT AL wLX fl\O q ~A} AbL
.A_ _Q W AeW
~ ZE
A ZT fld
hF ZQ \LXK
14
~ ZE
AW A_} VgK dpR

(A_ ) R
th N 8 - 4 - 2
15
:z T\
( }X \s }X ) th - }p - wk
T ZFK ,Av flA}E (wk) AE hF V}K ZqE
A _}K ,A 5 T \tL_K T\ fi\R
(}p) W 64 N 32 N 16 N 8 N 4 N 2 flZZ fiZT
, `tK T\ kF Abt A fi[ d Zp .[
pR K :pR (th) A fi[ _}K
.(placenta) b Lv \W pR A ,_w z
,T\ z H d fl] v , \F b
b qK A ,hw }K R_ [sAE fi]K
K AE zAE fl\h \O rA ]QAT ARU
\_ F kÊ bAE z eL .
A^ fi LT n K zAE lU .(umbilical cord)
d\w A_ [ kq .(Amniotic fluid) ^z
A h A_ [ q ,fl\ Q p ovAU A , \
kE p lth Zg z AT fiA^
.fl AN T\ hp AhF} O W QAW \N
p [W [ z AW iqE p A_ [ LU
[W _K .z A N L ^Z A_ [
.(Amniocentesis) ^z A_ ]FE q
? N fAe }LK x
~ ZE
flA A ~\j p N fAe UL L

LUK .A^\ p flQ N
-osome 46) ^\ 46 p A_ W
hF LUK ,(chrom
AK Zp .. Zq [ xe p
W A^\ fi[ AUK L ,AeW
A^\ A Zq hL fiZT
p ZF N fiA L
L AZp .z L fi[ A_}
Awd N fiA ~\j p ZUL AeW
.... k \qb q A_
N \ GF_ A^\ fi[E Gp
Gp Z| [ ,z K p
fiQ {q ,z AQ GF_ \Q
. ZqE T \L z [
Gp A A^\ fi[ q
t wkAE ZU A A^\ fi[ ZqE
2 Zp \O Q GF_E A A FAs [
A ^ Zq Z| .21 ^\
.AR nK v _w ^\ G\K Q Gq
!? ME Z >
" XY "_ A^\ ]E z `Q ZUL
MA \ z `Q . \W AZT
." X X" UK MA O ," XY " A^\ UK A
UK AhF v ..AeW n z `Q ZUL [
^\ A xe UK T ,X ^\
hF V}K K Cv .Y ^\ \W xe U ,X
K A , \ Y ^\ U UE
.O z X ^\ U UE AeW
,z `Q ZU [ \W qE
.O \ A z ZZUK _ ( M_)
16
~ ZE
!? L p A
A ,T AT 100 80 ZT L ZT F_ eK
ZT F_ Z]K .T 6400 H fl\ ZU NO
Zp F_ fi[ ]K A , AqE NA AT Q Zp L
ZpA_ AeW A^ AqL^ ,iFL kb [W
O b EAbL \s L A AFAs ."GHA Awj "
: L Ap A .A fi[
hF A_} AT EAbL L ZU :EAbL L 1
flA AEAbL A {q [ , AT\ U}
` `w Av ALAE , "A^\" N
35 L [ ZT F_ . a AEAbL
NA AT QE [ |p .fl 1000 H
. AqE
>
`w wLX hE V}K R ZU :EAbL \s L 2

{q [ ,LX yUE \b flZ `w M|
Av ALAE ,"A^\" N flA AEAbL L
. Awe AEAbL Ah LX ` `w A
\OLv \W ZE L [ ZT F_ xLXK
.AEA }K A\Ry
>
NN L A^ fld
17
? Z A\vK GR q A
p flZp \vLK GR , ZU ~F^ A A VhL
:
~ ZE
:{q [ A ^ A ÂK AQ fl\ 1

\X rkL_ | p ZT iI fl\ Z >
.iFL kb F A \NBK MUK hE
p A m flA| | p flZT Av flA| fl\ Z K >
fiARK A } [ T\ fiARK hF }
A W QALU A R Akp p flA| K iI
.
hp A ^ GF^ A v A^ T\ >
T\ kF Z U} hF At ~q m
. \L^
A T\ A qd T\ ~p ~q >
.Av |
p A I^ \NK m hp AF^ AE ZQ >
.AW ~qK Z| Av flA| AW F| hF
>
p A| PUE A ^ fl\ Zp A \v 2
.A \L_K AhF ZFK LT iI IK
>
[| p A| PUE A ^ A ÂK AQ Q\ 3
.F p A "
A" Z| p A LU A_
>
fl\Lw :AeW fl\Lv W _ |q LK 4

.hF A GeXK
>
wLX A_K
ZT \v Z] PUE _ |q M|K G_ A @
?
K hw [ hF j fl\Lv A cqK
.iFL ZT Zp fl\ ÂL A W A
[ ,A} flZ ZE A 14 F| A F\}K iFL p LK
A GeXK fl\Lw) AeW fl\Lv A_T
L_ W \a fl j \e| v\qE (hF
fl j A 27 \a fl \e| MA
Ov .gA\a
AeW fl\Lv A (14 -27) 13 AeW fl\Lv ZFK :A 32
ZLE _ A} L _UL_ [ , (14-32) 18
.\bp rÂL LT ZqE fl\ A} \L_ 12
18
~ ZE
?A ` ZqE _ A} L hw A @
Zp k_E | Aq ] A A LT An [ hw
A Zp flA ZpA_ T\ Cv , A
.AL fl\
? ZT \v } _ A} AO @
A flZq _ A} p AL A .rAa BkW [ ,
Jj ZQ ,AL fl\ A Zp Z]
\v Z] A flZq _ A} p AL Z A
. ZT
? Â^ _ flb d @
. _ flb H |p A M_ ,
? ZT \v Z] q _Q rg A @
.F W [} L A ,rAa BkW [ ,
ZT \v p \N A ZqE A_ iqE \W @
?
T\ ~p \v W \LXK kb AAv ,
Zp A ZqE A_ iqE \W {q ,}Av p\_E
.\LW [ ZT
A} ZqE q flZ Aq A qg Q] [XLK GR @

?_
20 flZ A\m p }L_ nK hw ...fl\hAE `
.fl\aAF A} ZqE A_Ls Zp r }|
?iFL Aq _ A} K ZU @
Q] Zp flZT qIk flZ ZT d\v
flB rQ MA LT %25-15 T qIk
. Z
19
? lkX x
[ ,_ }E p ]qE ` Q\ fl\ ^ ÂL A

iqE ZFK Z| E ._ Ud p \NK q \OE \NBL v
_w M| ,Q\ fl\ EeW p \NBK M_ q fi[
. [ _\ Aq AF^ fi[ p VUeK
: q fi[ iqE \qL_ A
} Z_ iFL Zp AT \OK rQ\K

FUe Z}v K LT ,20 p ( \a ) _ L \a
,T\ W wk xqg fl\F fl AQ O AwpAh
AqL^ F| flA]E A fi[ O A Ve [
p _ L \a) flA Cv \W TA .iFL IL
AwpAh ZUK Z| A ,I^ }\kE iFL p \N (30 A_
GTAe \_ \ AQ F_ flA O A fi[ O
_LE \q) GTAe Z ltg AwK KAwpAh
.fl \OqK KAwpAh Z lRK AT \OK A ,KAwpAh (
q QBLE (}q) \WBK AR eeXL AFj Ve [
.28 | hw 30 | _ L \a VFe LT
(A\QAE) _
= _ L \a
(\LAE) _ j * (\LAE) _ j
A^ _T Body Mass Index (BMI) _ L \a \FLq
.Ee k L_ _ A A AE \q
ALAE _ j p A\QAE _ _}E \a [ A_T
\L 167 j \Q 60 _ A Ov ,AqE\
\FLq .AF\}K 215 = 1,67 x 167/60 :A _ L \a A_T
AL AI ^\ Vg . 25 - 20 H A Ee }q L_
._ kE L|p _ L \a AO L_ () k
k |
A FÂ
_
^
j\w ^
: 20 | _ L \a >
AQ @
T\ W wk xqg @
iFL Zp @
fl\F fl @
: 30 \O _ L \a >
AQ @
iFL Zp @
fl \OqK @ GTAe \_ \ @
AN Z lRK AT @
. GTAe Z ltg AwK @
(R)
20
? lkX x
gA\ AL
\L_ bE gA\ AL p nvAU a
GRK GR ._ T fl| p nvAU Aqw \N
.Z_ AQ\ Zp ^ xzp Z bE gA\ Â
p J_ \NBL wzq gA\ K Z}v Z_ F_AFv
p [ iFL q Â^ AX flZt A
.\b flZ AnL
WZL
Q\ WZL
Fp 1/2 ZqE WZL
A Zp }A
%15 F_E
Z_ WZL
\WBK F_
%11 AWZ
(A \AR^ 10 \O)
A}AE
AWZ \t %5
21
AN WZL OZ flZZq A^Z MLFN Z}

A v ,A q fl\ Q\ EeW p I^
AhF p A_ \N _ WZL p RKA
I_ |q fi[ E ... A p [
\^ W .A WZ \AR_ Zp flA]E ]K
_E BkW \q) flZ Ak} ^ Z} WZL BE
(!AhE Q B q A B
eeXL AFj oT Z} ..^ ZqE
ZqE AhF AeW F_ AwX Ee
F_ A}AE %44 GHA Awj \R } \Q
AN WZL A .%72 v AWZ \t q|L qIk
\td AQ F_ AwK :O Ab \O
\[AE \Z .fl\F fl [ fi f} z RT
\q \AR_ A WZK A Q GRK GR
.WZL Ah iqE [ J_ WZLAE
U
I^ AN AU \b OZ flZZq A^Z MLFN Z}
A p AQ\ U \N ,A q fl\ Q\ EeW p
\wK A [ A K wLX
, Testosterone \^L_L E _ Q\
A .\[ hq AeL Zp _ ]Rq Z| A
iI wm LW AU \a Z}v Z_ Zp
.iFL dAW
[tL
? lkX x
Ee p A\NBL [tLAE AL GR \O Z
`v , A flA [ {q ,fl\aAF fleE
: p nvAU GR [ ..Lp E
wLX [t \dAp p LU [ L [t >
\h _ iI GAQ AF A\^ Ab
A K AZ flZUL AE \Q ^ v .Aw
GHA Awj W MT A [t A}
[s LU :UQA A ZQ ,VRK AAE
A\F [ pL w \h p L_ p
.A^ y
}O Aq \dAp AqFL^ L LT A \Lv ZXL^ hw >
.
.wLX T \dAp LU A iH _q hw >
A ,wLX QAk \Aeq fiAA _ \a hw >
. flAh \dAq fl\L_ weE _ }K
22
? lkX x
?FRK GR A
GRK GR : \ \b W AN AU R\ GRK >
Z| ALUK K AhF A} R\ p
\N Z| A} R\ [ wLX [t \dAq Ap
A p AqL . _AE A p \v fl p
v p ,_ Q AT A} F_AE fiA\
\ fl\Lw }EA_ \Lw R\ qE Zp hv
.A
Ap Z| p LUK [s A}F AO p ZqF >
AwX GF^ p MK ^ v .AQ\ dAW Ae v
ZQ ,MFL }k bq [ AQ\ Zp Ee L_
{q A Zp [ {q .A}F Ap Z| B
.}q Z}E A
.mwU [s p ZqF >
.qIj \s AvAg p LUK [s p ZqF >
:O flAh A\LF p LUK Z| [s GRK GR >
\k F O \L_F \s F reK F @
A|]
k \s iI @
ZQ kK @
O AL Ap F_ p LUK Z| [s GRK GR >
.flZF
wAj
!?!?!?!?!?!?!?
AvA Ap L_ p LUK AE\b [s GRK >

wAj Z^ p ^ v , Ab fl} Kb O
\ flZUL AAE AK bq
ZQ ZQ Ap EeW Q p qLL (mormon women)
.AU E\b WZ Ab fl} E\b
\F^ flA p LUK { AE\b Ik AUE \m >
\q_ | AE\b \_ ZF ZXL_K U flA)
flZt ULK YAE `NF }k p \NK Z| (\
.e iI lbK A \wK AX
23
yZq \dAq AAL
? lkX x
_A ZZA yZq \dAq AAL QA ]K

Aq A GqK PT , folic acid w iT ]
f} wLX q UF Z Z} .wLX
acid w iT f}v , zAE AbK AAL
qAE } AbLAE EAd ALT Z]
O folic
\| [W Cv _w M| ,Jeq A \}w
U folic acid w iT \Q\ 400 p LUK
Z| ] f} A ,%50 \O F_E AbL fi[
A A Gq F_AE A . z f}
fl]Q AW rQ p fl\aAF fleE \NK |Z flZt
ALE AFj nq Ve [ .ÂL A A _
.GIk AZU p\AE yZq \dAq AAL _F
flA] AAL iqE ALE q AUE iqE Md Z}
A Zp flA] Zinc ] ALE Ve .AQ\ EeW
\T xqg AT (Vitamin E) AL [ .
Zp flA] (Vitamin B12) 12 AL Ah , A
A_ A Zp | AT A
AR [ eeXL \O A fi GR ..
A \ ..Q\ EeW flA] AAL AK BE Z}Lq
q }\j \ A \t wLX AAL [W
flA (AÂ^
Ap ` ZBLAE) ZpA_
Ap K Z|
.Q\ EeW
r FT ZXL^ p w|K Z_ F_AE A
dAW yZq \dAq AAL \| [WB hw
\| \n ,G\ AL ]zR ] p LUK
\dAq AAL fi[ G_ AwX K Z| r
._AE }EA_ yZq
T\ [tLAE zq Ik AUE \m Z}
At ApA_ E A dAW , z
Abt [t LU p \I ZT ZLqK , T\ W z
LUK AF\ A] p At ALp T\ kF
.] \ep [ (vitamin E) AL Ap L_ p
24
?w iT A
pR AAL ZT
?w iT flZAv A
w iT \O B\Q\ 400 p LUK \| [W
,Jeq A \}w qAE } AbK U folic acid
AbL \O AbL [ Cv q ,%50 \O F_E
.A NZT
?w iT A Z} [WBK x
[WBK Z}Lq [ Z} Aqg 3 AF\}K [WBK GR W [ z A \vK
: qE eeXL Ve [ . .A BK A W
fl\ p LU [ ]F >
.w iT Ap Z| p LUK [s >
.A Z} [WBK ZBL }\j g ^ fi[ ,( B\Q\ 400) w iT \| [W >
?w iT [WBE \v GR L
F^ 12 z K fl\Lw
AFLW \Q Zp ZK GR A
rHA^ qE \O Av Z| ZT ZBL
GR p , fl\Lw PN \O
. \wL \RE w iT \| [WBK
iT [W IAQ \p ZQK
?w
flZ fleE wLX AUE Aa Z}v , jA_FE EAQ
.w iT [W IAQ \p AN Q Zp
w iT l^LZ| p LUK [s
(flZT \Q\ 50-15)
Ae v
lI
`jAkF
f
fi\ep A}K\F
iI
w iUE zt [s
AhI AdAw
fl\
WFk
YAF_
fl\ \^ ]F
_F
AL Ah Ap Z| p Ah LUK A w iT Ap Z| p LUK flZF oT

.zAE \h Z| [
25
\ Q lkXL
? lkX x
:O Ee p fl\aAF fleE \ iqE \NK Z|

\_ F \ >
lth AwK >
Ap weE G} \ >
\e >
|Z flZt LW >
lRL p\_E }qL dAW Z \ >
. weE A [WB [ \ >
\NBK A flZZp \ fi[ Aq GIk qQ\ GR
vAgAE . h\ p \NBK [ \v p \
\NBK [ \v p A\NBK F_AE LqQ\ GR
T\ A AhF p fi[
.z K
\_ F
\E _ [ \_ F \ Z Q] ZT A
: AFK GR \_
A} OZ ] fl]Q ZXL^CE dAW \L_ ZBL >
F| ^ A| rQ \_ F_ Z v \_ F_
.qwK\ \s \_ F_ K PUE fiZqE
wLX A| W wLX \_ G_ R_K >
fl\L_ weE ZBL LT feXL GIk r ALqQ\
\_ F_ UL
feXL GIk r [t qQ\ >
q A| ^ ZBL >
_E dA AUL p >
A AT p\_E A q\^ \^ flA T L >
Z| [ \O Z v \_ F_ AwX
.FAE A_T
26
? lkX x
AqkL
T\ p \aAF bE \NK Z| \ iqE ZQK
zAE AbK K Z| A Fe O wLX
MA A AT NO b W MEAd
.A Fe Zg eU \s
A Fe pA
LT F\} ALUK Zq \ A Fe
flAh A_Q nE \ pA _ LK ,Zq }LK
fi[ LK ,\W fl\ EAd rK flA Z ZAE }FK \
.qkLAE \AE EAdAE A flAh A_Q
O b A FeAE A EAd AT
,A %30 F_E fibL A g\q z Cv ,
flkW rwK\Lv ,EAd Zp \p G_T p fibL F_ xLXK
EAd MNZT %90 T z Â^ AbK ZT
AFj nq Cv [ . rHA^ 10 - 8 W
A Fe Zg pA ZBL U \WBK qE eeXL
Lv\q p ALp GR A flAa ZRK.. ZAE UK qE
,A FeAE F| MFd Z| BE (
O ) }EA_
A_Q _ AqkL %5 T qkL [W Z|
pA ZBL flZT Âv [ ... \ [ flAh
GR ..A qkL [W GR eU K Cv ...UL \Q
\a flZ qkL ZqE NO \a W ZU
\[ |A qg A^ AqL^CE Ve [ | p ZT
. fl\Lw fi[ W
GIk flA
.flZZp Ab AQ] AE GRL fl\I lkXL Zp feXL GIk flA a
: \Q fi[ bK ,Q] Ue A ZBL wLX \Q flA] fi[ hLK
Q] Jk YAL >
lth A| AE Jk xb >
Q] wLX ÂL Ahp ^ ZBL e v AQ ARE xb >
A Fe Zg pA Q ZBL :Z fUv >
ZE %10 ZU A AEAL Q Zp ZBL F UK >
ZqE A Ab AEAL fi[ K Z| ,\[K \p
\ ] N AUK >
A G_T p zq AUL >
}q \WBK A| >
27
U \WBK A|
? lkX x
Q] A|
Z| q iqE GRK AW VAe iqE
: \WBK K
Zp \ Zp nL ^ G ZXL^ Zp >
\n , r }T p AqLE [ , F| fl ~F_
Zq \L^ L LT j fl\Lw ALUK A
.iFL qIk
..] \Lw GRK Fs\ Zp >
\WBK K r \| nT GR
ZqE ..AZXL^ x|L ZqE
F}L_
AK\^ rQ\L^ AZXL^ x|L
rQ\L_v F| A nL \b flZ MA Cv
. rQ\L_v \s MA A AK\^
.AZXL^ F| GIk flAbL^ GR p
A AU Aw WZL p A AL >
iqF A_L Z| ..AhF EeW p A I^ \NBK
p \dAq K \NK \O v\q BE
v\q _ EA| rQ\K fi[ O :EAQ
AL GR _w M| !! fl\jAX Zp GR [ A }F_
I_ AN AUE Av Z}v Ab flA GRL v Ap
[W A qRb \ep xh A w ALAE AAwK
.EeAE \h A p ALAE \}
\W A^ ZXL^ A Z}E qa \qL GRK >
. fXbL
A|AeL K Z| T\ Aq \Q GRK >
:O AE
A \I Z ZBL ZqE Z flZ] AeL^ \Q 1
,A GF_
^ 5 p A\k| xe } iI A AeL^ \Q 2
e AQ flZpA_E AkwbE T\ GRK
, p ART
p fl\N \s R fl\td AeL^ GRK 3
T\ xRK
A pa Aq \O MU r^L p \Q GRK 4
,%100 jAW ^ "xnK p" ^ \ \O E
>
>
>
>
28
? lkX x
AkE Â^ ]Q O ZUK Z| I_ AN

.A iqE \W fl\ hqK A ,T\
Ee PT A\Q \F q fi[ ` A h
Z}L F E .. q fXbL ^
.A }k q fi[ ZXL_K
LT 34 ^ ZqF q AjAFK ] ^ \WBK Zp >
.AqIj ZT \v }K
AqLR v ..wq flZ WAE AqK AUF^ AAT >
\WBK AT Z]L AwK ZQ _ TAEAE V_
fi[ \n \bLK ÂL \ G_ AwK \n
.wLX \kE \WBK GF_K TAE
] A|
A ,Aq E F| we È e ] Zp Aq >
.b fi[ A p flA QK qK GkL
AE EAe LT A flZt AL Zg [ Awj qkK >
.e W A K p \N A \F
p A I^ \NBK A AU Aw WZL p A AL >
. AT LU A A_ EeW
p \NK Z| \jAX AEAUd \qK iqE nT >
:O Ee
Aqa AR Aq
.Ad\ dAW A ApAe AR Aq
A \ZXL B Z ApAe AR Aq
AN O O A}Lb p LU re Z
.\L^
.AE qL ,A flZ^ ApAd AR Aq
}A^ O j \Lw AE {qK AR Aq
p \N ,e fl\T Q rv\ A ATAb
. A T K
>
>
>
>
>
29
? \WBK }q A
\WBK }q x\qK
H nL _ |q s\AE wj AR AU Ap \ ZqE p flZ} Zp
ZE \WBK } |Z oT . ZT r ZXL^ Zp rFkAE Q]
~L ZU N AAp \bq p Z]K fl\Lw ZT Zp QK A iqFv ,}p
\O \O qwAE ZT A ) flZpA_ AeW A^ ZXL^ AR AqK AUF^
A A }p MA A , A \WBK fl\Lv ABE ^ \bq fl\Lv _ G_ v ,(A
\WBK p ~k GR MAj A z fl\Lw ZT Zp xd Cv [ ! ZT
.A}p _ hw
: Ap \WBK
\WBK 1
j p ZT Zp
>
AO \WBK 2
R p \n itE flZT fl\ ZT Z| {q [
.wj fl
A
T A gAQ A ^
>
\WBK AbL Z
M Z} ,Q]L H %15 T \WBK ZU
ZR A OZT Q]L %25 T OZ AAeT
Z]K A AeT Ap \q . d Eqd
GF_ Aq \O rQ\ ,fl\W ^ _ b fi[
_ fl\ ^ \WBK A AF^ flZp b Z]K
L vAgAE ,gA \} p A A \O fl\W
flZ^ ZXL^ O qIj \t p] \j ZXL^ I
fl\O [tK p A ZXL^ ZI pAe
!![ Zp dAW Ee G_ AwX y
\tL eeXL Aq \O Z}Lq _w M|
AEqe \bq \} ZE flAh MFTAd
\L_ AwX _w q A A_ AQ
.] \WBK Zq AwK fl\ Q\ EeW
30
? \WBK }q A
?] ZqE ZU r|L L
A Cv ,Q] ^ p \I ZT _ [ p EAQ ZLqK
T K ZT LT Cv A\bq Q] ^
_ %85 L F_ fi[ rwK\K \a L_ W %60
Cv A OZT Q]L 100 {q [ . .
flZ^ 85 VFe Zp rwK\ ,AT flZ^ 60 ZR \a L^ ZqE
Cv \O ^ 35 Q] \p A . _ A
fi[ rwK\K _ W %60 K ZT LT
LT iwXK \W qE .yAO _ %85 L F_
.\OBv ^ 35 ^ F_ xe ZT
F_AE _ \b ZT ALT : 1 ZQ
fl\ _
_ A ALT
ZT \b ALT
%94
%25 - 0
A\bq
%85 - 70
%15 - 0
A\bq \W
%60
%10 - 8
- ANO
ANO \W
F_AE \a L_ W ZT ALT : 2 ZQ
fl\ _
ALT
%75
%47
%38
%24
25
A\bq \W
ANO
ANO \W
%22
31
40
!!?Ee p fl\N q _
:A AF^ flZq Ee p fl\N j p q fl\ ^ \FLq

hE 7 T) KAL_ p iI E flQ AhF Zp } z_ \E 1
e LT ARZK Zq [ } N ,A T W À\b O K AZp (hIAE
x 25 T VFe Zq [ } ,F Zp hE x 400 N fl Zp hE 2 T
^ ZqE \OE \^ AhF Zp AwX Zq \[AE \Z .^ 37 ^ Zp hE
.^ 37
>
(AF\}K) hIAE flQ AhF Zp

7
2
x 400
x 25
x
_
T W a 5
fl Zp
F Zp
^ 37
^ 45
_ F_AE AhF Zp : ZQ
.35 ^ ZqE AQ F_ ]K [ ,z_ \E AKQ AhF p }K 2
\b Z F_ ]K ,\b Z rQ %100 F_E ZU iFL \q 3
.\q Z}LE iFL A ZU
lbK W A qIj A ^ iFL kb A p F_ AhF ALUK 4
.\q Z}K A AE iFL
_ Z}LE T\ kF Abt W U} hF At Eqd \bK Ij AUE A 5
Z^ AhE A MZXL^ K dAW \W Ij UE Z ..(AO AF qQ)
\ H F ) _ AZ}L Z^ RKA Q } K _ \td
Ap \O }K _ AZ}L Z_ Z Q At F_ ([E A} A V_
._ Z}K A AQ F_ \O ,_ \td
. \WBK A Z| [ ]\LZ \ AE EAd F_ ]K \q Z}LE 6
Av A| T dAW A}eL K ÂL A AEALCE EAd d\v ]K [
.}q \WBK A iI AQ\W Zp hF A}L rK ALAE
>
>
>
>
>
?AhF "R\L^ ]X" r|K x
\k iqE ZQK ..AhIAE AhF Zp p flZ Ug fl\v kqK q }\j ZQK

:\k fi[ ,"R\L^ ]X" [ p fl\v kqK Z|
FSH e lb : À PAO L flZU A A| -1
.Estrdiol Q\L^ [ LH
AhI T Z p }| fleE xb e v AQAE fUw -2
p Aq Z p xb r iFL kb \| ZXL^CE AhI lbK AU -3
.iFL p _ A
32
? feXL GIk flAbL^ GR L

^ A ] p A Ap \ F| ZT Zp AOZT Q]L ~} GR
:flZpA} fi[ OL_ .^ 30 | Q]
: Q]AE q ZT Q -
A \q ,\a 6 ZqE GIk flAbL^CE Ve
\O ^ 30 Q] ^ A >
AzNO \W %30 F_E LT Ee F_ }K ~EA_ AF T\a ~F^
.Az\bq p
j\w _ AT A AwX AT >
:AT O j \Lw \b flZ AE\kg >
j \Lw \b flZ x|K
j z \Lw ANZT \ Zp } PUE \b flZ AnL Zp
A 35 p Z]K A 21 | H fl\Lw K
.Ap weE flZ AnL Zp
ZO H A Q ~jA fim qIk KZq p _AE \qb m F_ flA >
.fl\aAF fl\_ w^
. AT AL g\ Q] YAK ZT >
.F| Av AARw [ Z flZ] AT AL A ZT >
.AE kFAE Ap \Q K >
A AN W ZT >
. \tK A hL}K Z| vW \_ lthA ] g\ AT Q >
.\L AQ AT >
Z_ \Ov ,}q \WBK {q A\ ~EA_ q ZT Q Z A GR
,A\ ~EA_ q ZT Zp ] ZqE fl]Q fl\Lv W U A OZT AQ]L
.q fi[ ZT AZp A feXL GIk flAbL^ flZ_ \WBLK hv
>
>
>
>
: ]AE q ZT Q -
fl\OE A \b ZI ZXL^ p \q >
\AR_ | Zq WZL >
Ap fl\T AQZ \qL p GkK >
F ZqE A \E EAd >
ÂL A AEALCE EAd >
we È e ] Zp >
.ALw VeK T\Q \Q >
?z_ \E Q\ EeW }K
.k_E QZE MA A RZK ^ 60 ^ ZqE Q\ EeW }K
33
GIkAW .. \WBK
Z| T Q] fiZ\ A d \WBK p T
feXL GIk p T\ fi[ AK AQ] ZLq .. kK
N fl\O GIk ^ p EAQAE T\ fi[ ZFK ..AR [
F| AnAE AbL^ p \ ALU Z| wLX AUK p
j T A..wLX flZpA_ AÂE q T ZFK
: p A AR ZLq
yBk }O .. GIk AW
AR ] \RT Aq feXL GIk AW
N AFj ZT flAbL^ h\ ZFK A \Ov ,q fXbL
GR [ .[ \W GIj p PUFK AZR LT j fl\Lv \K
.Aq GIk p A^ F_ vAE ~|ZL PUF L
!! flA] ZqE GIk AW _T ZBL AZqE
34
GIkAW .. \WBK
.. A e}
A gAE }qL Aq \T ZE GIk \[K GR
GR A ` LT Z}LqK A ..\td A A \F
O L| rh GR "tb GIk" BE Z}LqK
PUF A Z| A ` Z}LqK Av , \s AqE
tb A [ Qp GIk _K . GIk p
!!! Lh\ MBv p tb A ZQ
.. A p
T\ W ZU AE A pAE h\ ULK GR
B_K GR \t [ ~}UL ..q fXbL wLX
" Zp \ \LK ..p UK p ZQ p GIk
p p UK GF_ \p `
Ik fi[ v .. Z\ A \q GIkAv
\q [ feXL GIk q .."flZ}q eeXL
^ GF_ Zp .. q AUL Z
Zq ALAE GIk E Ve qw AE }O Zq E
.\L^ p
LK GR
r \L^
k A
q fXbL
\L^
F_AE _ AE }q \WBL p AR À} A}K
ZqE q AR F_ :k_F }\kE Z \L
{q [ .\ q Zq flZU z fl\Lw fi\K
q Zq flZU z] fl\Lw W q p \L^
q r GIk r \L^ Zq .\
LK a ZE A AK Z A .bw
Qq eXbL k AL r \L^
\L^ {qK LT flZU q z kXE GIk Aqg
.\ep ] M| qh
qL^
Aq [ ...\wK Z A p GIk B_K
[ Z}LqK ..|ZE L| q dAwK p ..AAK AwK
,fi\^ p [ p d [ E GIk Ght
p AR p A v\q p eL [
.GIk
35
AL SA\F
L Z| A fi\s p (}q) \WBK p xLX
Z| E wLX AdUv AUK flZp p ZqE EAF^ AbL
Ahp A AbL^ p \Q A \O \ ALU
flZpA_ AÂE q T ZFK AZqE .T\ WZ
[ ...\ e LT ARZK T\ p ~FkK wLX
Qq SA\F N (eXbL SA\F) GF_ v\q SA\F
AAK Z GR A ... \W flZ^ rFkAE xLX
: NN
GIkAW .. \WBK
eXbL SA\F AL^ a ZE GR 1

A GF^ AbL {q ,ZU Z flkW v ,fi\W
LA eXbL SA\F \WBL ~\k xeL
Zp | ,GF^ \O A Z| A \O
\O q h Z| (SA\F AL^ ZE) q GF^
p Aw| \W AF^ p ZE Qp flZAv Z
. AeXbK
>
Z q fXbL SA\E flkW GR

GR .. d p fl\aAF }\kE \N ZU
.fi\NBK }\j Z [E A p p Q]
L Aq A z ZQ AFIj h\ \qK GR 2
Ug V K GR [ q ZF fXbL
Ik AeT UF Z ZqE .ZU { ZQ
p q fl\ ^ a AE flZqL fl\O
,E AL^ M| Ap Cv ,Ee p fl\N j
\O AqR A_w h\ V\ ZU { ZQ v\q Cv [
.Qq eXbL SA\F F}K
>
eXbL T\ LK ZFK F| q ZF Ve 3
A \q^ ) AdUw AUL Z
flA] ZqE q {q [ ,(AO AF
,q AE Z La\AE _ A q wd [WBE fl\aAF
E AqK qK A weE h\ rkLK A
.}\k fi[ A eK wLX Ik AeeXL
>
36
GIkAW .. \WBK
GIk flA]
}qL T v\q flA] fi[ W GIk q_
[ E ,Ue T F_AE l}v ` ,AAE
A flAp [ ..KAT dAwK Aq m eXb
\A GIk iqF Z}Lq Z| ..j AL| flA] fi[ \tL_K
fl\Lv k ALU \e| M| W p\_E b Z A
\WBK p fXbK dAW VUeAE ` [ .. flA]
Z|) Ap \O \Lb T nq v .. }q
ZT e| Ze [ _ ..b flAN (A k_E AZT
AT ZF A AT \WBK GF^ A Ug A Ah\
(p \n) Gt AQ ALe| A ,"iI `K"
`L q p [WBE [ GIk AUe Z| .\b A iqE
\WBK GF^ ALT A\n Mw [ iI
fl\Lw ) Ee fl\Lv Ae AQ As
,
AT LAQ AL fl\ ... ( L hF A GeXK
ZFK F| }EA_ fl\Lw \vA_ AQ GF_ A
GIk flAE Ik flAbL^ fl\Lv \e} |p v [ .q
.!!`q AE E
fl\Lw ALU ,p\_E b Z A \A GIk
Zp flZZp fl\O E p | fl\e}E M_ z
O ^ AW p T Aqv \NBK \NK Q]
fl Z d ,q fXbL
.pAv A\O \k \e|BE
37
: wLX AAI [WBE flAp GIk ZF
Q] eXb AAI
GIkAW .. \WBK
AAI N A eXb AAI [WBE flAp GIk ZF

dAW AH Q] flA [ flZ PT ]AE dA
r AL|L F_AE dAW AAnL [ Q] A \ Zp
A W Z F_AE A h ,\b flZ
A Ap [ .fl\aAF A ZqE AN Ab ZT
.~EA^ AR ~F^ Z| Q] ZT
\b flZ AAH
PT dAW \b h flZ p A AAH [WB

.A AL AAnL ANZT
iFL Ap ^
AQ Zp {q ,iqF Z Ug iFL Ap K Z|
: ,iFL b
flZ AnL A A ` flAp : \b flZ AnL >
.iFL p

.kF w^ JAQ ZTCE BE A_T >
.flZ xeL Z l} iqE ] >
A_ \BE dAW ^
A_ \ wLX \p p _AE L^ GIk

:O \WBK GF_K
T A^ \v O y AE\kg wLX \p >
.Z_ vB \s ~jA \qb m ZO
.AE AEAL A }EA^ h\ Mg\qK >
(AO }q AT ) G G\K ZqE Ab ZT >
,iIAE A Ap O A }EA^ AE Ap \Q >
. Ap ,`\LZ Ap
(A W }LK ) _ AEAL A }EA^ h\ Mg\qK >
(ZQ ) ~EA_ ^
Q AwK O fl\aAF AQ fl AL fl\Lw dAW

.vW AEAL ZT fl\
Aq Ue A ^
\ Q PT Aq Ue A p GIk k
flZ]A kF dAW T\Q Ap \Q
AZqE .AqAE N \ GIk \kL Z| , Z
38
GIkAW .. \WBK
q [ wLX AdUw Avb GIk \kL

ZF h\ A AAI [W ZqE .A `w ~EA_
A_) k ZLE xb \QCE feXL GIk
Aq xb ZF N (Body Mass Index BMI) _ L \a
Ze G} AT p
Lb Z} LT \ ZE
.F xb A_ xbE A L kF ZO
GIk flA] M|K

,flZ Z A W GIk flA] K hw
ZAE A AUK O wLX AUK GIk Gk A flAqv
[ ,flZ A _ A\Q AhqE GkL [
, flZ 21 fi\Q GkL [ iFL UK
-copy kF AbL^ p p \ GkK A h hw
hw Hysteroscopy WZ T\ AbL^ laparos
ZU LT \b flZ xe K
`w [ \b flZ yAO fl\Lw W vZeAE
ALAE eXbL SA\F \WBL LT [ ..q M|K
Z A W GIk flA hw Qq SA\F
. flZ
GIk Q] H |q K x
?UQA
GÂ GIk AW ZqFv ,Z\v AW |q fi[
p ALp d _ UK }O AE Cv
Ap\ A_| }E p xLXK dAW |p A ..E AL_ a
p q fUv UK \Q p x|LK v \W Ue
\dAp GIk GkLK A AW |p E ,xd
q [ }qL Ik AwK M| O flZZp
GR [ ..A pALQ _w wLX WZ
K LT Aq GIk r fl] |p A| p Q] Z
:VAe iqE fi[..Ek R
:Zv flZq GIk r A} Zp Q] ZQK hw

q }\j p A|AwK Q] H AwL >
VAe Aq AQ\L^ _ qR Q] Q >
Z Z}v .PZ ]Q \[L^ \j ,GIk A\
ZqE fiAg\ GIk H |q ^ZE zq wLX A^Z
.A} W \ Aq %40 p Z] AE \[K L A}
39
\hUK GR [ ,Aj \e| GIk r hK [ M|

}\kE Ap EAQ L LT ALEALE wLX A_wL^ ^
: Z \hUL ..flZ fl]\
GIkAW .. \WBK
GIk r hK [ M| O ZXL^ >

A_wL^ \O p EAQ
fXbL p fl\N A} p ]\L
.q
>
>
,dA Z}Lp AX p ^ a GIk \ >

}K GIk `v ,A AvAK ,Z}q A Ak_E
Ik LT zq A E pALQ \w L_
.fl E d _w
} A p \L_ ]\L L GR GIk r A| Zp >
w [ d Zp oT A Cv
A A v v GIk
:_E A_wL^ GR A
Ik Ake ZE \W fl\ \a flAp >
q \Lw v \TAE A_T Zp GR ,flZ}q
.ATke fi[ Q]
.La\ \m ke dAwL fi[ EAL
>
: AUv g A w Zp \L^ MnT Cv

A p Qq S\F }_ GIk ZpA_ A_wL^ 1
A g v Zp A \[K , GIk fiZe} A
G kqK ,\b j M| Akp AUL^
Z GR .EAq^ g v p _ Aq
,Z d q AR T \ep A w
.\L^ O flZZp A} Z}w^
wLX AAe Aq Z| \F rRK AU 2
,EAb AT R GLA
L LT q KAq qQ\ GIk r \W Zp G\K 3
SAL Aq fi[ VUe v\q \ Ah^
.FK\L
AEAQ KAnT A ZK fl\[ q rA 4
.KA_wL^
feXL GIkAv ,GIk \b \Z}L \LT flAp\ >
A | \s Zp j Q \WBK p
\kE \n fi[ Aq ALUK , ZQ dA AAb A AT
[ , j GIk A Fp b A ,ARE wLX dAW
>
>
>
>
40
GIkAW .. \WBK
de Ap |q G_ Av\q \Z}LAE Q AZp

.\Z}L
\s \W _ flAq q ]\E A Ap \qK AT >
vAX p \ fl\L_ ^ LT Aq GIk
..GIk H H d fl] A h LT KA_wL^
[ Qq S\F v\b }_ E
O \q A ZQ
:AA
Q] ZT A\[ Z| wLX A_wL^ p EAQ 1
[W T AT BE [ {q ,AL ZqE A}Lp GIk
Z| ,q xd A } [ a E v GIk
PUE Ij W A AF\| fXa Q] ALU
.GIk E A| [ fXbL A \a A _
A Q] r Qq SA\F [K | qEAL qQ\ 2
\O p LU \WBK p Cv a AFv .GIk fiZ\
AR fl\N q K Z| }|Z dAwL
F_AE Z} `w p dAwL fi[ K ,q
Q] ZBL }_ \nK A ,Q]
Q] Z Z|
Ov .TAR q \dAp \ep
T\ T\ p ZqE A \N q M|K AnE q [W
.q
.q ]\ Q] H |q ~_K 3
wLX AL|LA ]\ W dA \Q _K 4
SAL d qEAL O ,]\ Q] AQAT p 5
.BE Q] AsE qEAL GIk AsE AUL
>
>
>
>
>
41
!!wL \O ZXL^
..x| \O wL AeK U
: flAp\ GR \t
GIkAW .. \WBK
: v\q GR ]\ GIk flA Zp >

AeK Zp
.QAw Aj \ ZT Zp AeK A|
A_wL^ p \ GIk \s _ ZQ
.Qq S\F v\b }_ ZpA_A
?AeK M| G_ A
Ek AqL EAL T AeK F| | | \hUK GR >
GIk }EA_ ALa\ \hUK >
|\E E ÂE l}v ` AAK _w x\qK GR AeK Zp >
p ] \eqE , GIk fi\ [ fXbLAE ,
O x
A_wL^ p \ AFÂ M| [ BE ZBL GR AeK F| >
\ A M| Akp L T fiZZUK L \W M| AeK
.GÂ
.q \pBE AZZUK Z v q a Q Zp >
}_E AeK b Z flZBL \s M >
.GIk ZpA_ Qq S\F
>
>
>
>
q AR {qK Z| AnT
..}q \WBK AF^ p GL fl\}E A Z}E qK >
:qR^ [
ZU A A \O 1
\dAq q p GIk B_K qR^ 2
. Aa q AR GF_ L^
GÂ GIk AW p flZ| \O qR^ 3
>
>
>
| [ eeXL A wLX flA AR B >

AR v ..flZpA} fi[ p AFj Gk [b .. A eeXK \O
h A \ eeXL A ,
O jAF Gj
q Z}L E ]KA\ \ eeXL \W
` eeXL ZR [ ,\F QZE feXL GkL r\_
\W ZF \ Ah E h A l}v
GR [ ..vW h A \mA eeXL
\WBK p Z} `w p AFj q L_ q|LK
\W ,\F QZE AR [ eeXL Av ,}q
A \W p qE AL \n | L_
.Gk \w `w LT
42
!? GÂ GIk \bL_K \qK x

\bL_K q A AE\v AQ Aq iqE
:GÂ GIk
fld kq ,KA_wL^ L^ p \ Aq [ GIk ZQ >
.q wLX T\ W ZU^ Ap Ug
.}K A AL^ d\w kq GIk A >
:q fXbL Ug kW flA] W GIk rh >
fXbL Aq Ug q kW rg }q \WBK q Qq `^
p B_K GR q fXbL wLX T\ W GIk Ap AT E ,q
...GF_
flZU \s A} flk ,fi\K Z `wE LK wLX A] MnT >
.V
q `ÂE _ A A VFd \bq ZT \} AZE Z| A A Z GR >
A_ Zd Ov ..|N q AUE p ZLqK q fXbL
..}q \WBK q rFLK GR q `^
flZUL AE ZL
\k BE kFK\ wLX q VhLL^ Z H [ AL K\| ZqE
hL q ZQ ALAE ..}q \WBK p fXbL wLX GA^
e v AQ AQ ZXL^CE iFL qEAL ZE iFL kb }T
O
..GÂ GIk \bL_K [Zp Cv F W hw [ (A_)
:q fXbL flZ >
Ap weE ,q fXbL flZU q z ZT rh rkL_ A s
GR _w M| ..\O p rHA^ 8 - 6 p fXbL AdUv \Q Z]K GR
A ..wLX Qq \k bv AR ZZUL z ZT GIk rh
.GÂ GIk \bL_K [Zp Cv }q w }q Vg GF^ Q ZE \ Aj
43
\WBK AF^
fl\ Zp }q
...hE ALU k_F fleE A T\ AAK VhK
FeX hF fl\R N ...Av flA| AE AU}K N
FeX hF AZqE... fiZQ \tK T\
A W Cv ALAE . .
wj L T\ W A zQ MUFd
:AF^ fi[ AL AqK .}q \WBK GF_ fi\ ~F^
A %28.................................iFL Zp -1
A %22.............Av }E }qL AF^ -2
A %11.....................T\AE }qL AF^ -3
A %3................T\ ~qE }qL AF^ -4
A %6............................. `\LZ -5
A %28.........................GF_ R }p -6
A %32.....................Q\AE }qL AF^-7
(Q] GF^ \O ZQL Z| oT)
iFL Zp AF^
W wLX Q_w Aq _^ A iFL
iI W AhF Ak_FK ,_
ZqE [ iI W fl\O qE \NBL iFL AZqE
AX flZt A _ wLX Zt A\wK A
_ [ Y ]\ ZTCE AZE \NBLK Y A}E
A iI W ZU W Bv [ .`NFAE
.iFL Zp iI p \NK
?iFL ZT r|K
AUK O iFL ZT r|K AW \j flZp ZQK
F W e v AQAE xb A
ZT r|K flZ_ .(AdUw AE A \q^)
: T iFL
44
\b flZ AnL 1
>
\WBK AF^
fl\ Zp }q
p \b flZ j LW Z] flZ AnL {q

flZ G_UK ,flZ^ F_AE flZ j l^L p A 3-2
Cv .AL flZ ] ZE LT Z ] \b
(A LT `) fl\I QZ {q nL \b flZ MA
{q \b flZ AnL s\AE oT .iFL ZT
ZBL GR ,iFL TA b ZQK fl\I QZE
Z \_Q\F F_ A}E iFL ZT
]K , nL \b Z %9 T iFL ZU
._ \F A F_
Z \p 2
>
H fl\Lw xeL q \pBE Z_ iqE \qbK Z|

: \p fi[ ,
. H fl\Lw xeL F Z A} iqE ] @
.IA ZT dAW kF w^BE BE qb @
!_ fl\T QZ AI ^\ 3
>
iFL ZqE 1 - 1/2 ZqE _ fl\T Q rwK\K

,iI \wd _ \_Q\F \v R
F| A}^ ZqE AFd _ fl\T Q A}Fv p
v\q A ,feX AI ^\ AZK \\_ flAt
ApAwK F| fl\ Q ]K [ iFL
AO xe j fl\ Q AwK \L_ . .fl\aAF
Zp {q Z| fl\ Q AwK Zp Cv [ .\b flZ
dA \b AdUw AE \q^ .iFL ZT
.AE kFK\ flZZq Ab }\k fi[ Ue
:iFL Zp AF^ p \qL AqK
flZ A
fl\T Q
_
37.2
36.7
36.1
Q AX
T\ ~qE

45
\b flZ
hF h T\ iFL ZT
iI W
T\ fiARKCE U} hF fl\R
iI `K 1
>
Zp GF_K AbL AF^ \O iI `K \FLq

`K f A ..}q \WBK ALAE iFL
A wLX _ A\ ZZq EAbL \tK BE iI
yA_ \tL \eUK .._ Ahp ZZq p \NBL
: _ \p \tK NN MUK iI `K A
. \WBK \b flZAE \tK -1
`) wLX _ ~jAE \qb flA _ \p -2
(A rRE K fl\hAE
ZAE wLX AF_ Z ZXL^ AqE kFK\ \tL -3
\_ ZXL^ AqE kFK\ [ ,vW \_
,_ dAW p _ \AE jAFK _AE
.Z ltg AwK [
Ap AOw ALa AFIk A A fi[ O oT
pR H fl] Awd flZq ~N AFK Q AnT Z}v ,1935
: Awe fi[ ,hI AW bE g\
| \b flZ ZT Zp
ZUK B ANZT \ Zp
\WBK ,\O rHA^ 5
\s _ }q
flZqL ~jA \qb qIk
ZT lFK\ . _
Q qLR Awe fi[
Q iI `K XhK
fl\te A \O Zp
Z}LAE , VhK .hIAE
fi[ ,z_ W q
Awe A\s Awe
AT \O kFK\
^ 1
A q a nE
, iI fl\td flZqL
VhK A .Z A G_ \tK [ GTAe Z| [
\p Awe fi[ ZQLK fl\hAE ` A h
\tL Awe fK .A fi[ O fXbL
:A wLX
\WBK AF^
fl\ Zp }q
:iI `K
EAbL \tK
_ A\
_ Ahp p \N
T\
iF `K
`
46
\WBK AF^
fl\ Zp }q
:iI `LE kFK\ \p Awe -1

(fXbL \p Awe fi[ ZQLK fl\hAE `)
\b flZ ZUK nL \s K O \b flZ AE\kg (iI `K AT % 90 - 50) rHA^ 5 ZqLK j \Lw
(iI `K AT % 75 - 55) }q \WBK \L AQ fl\bF QAE AFb GT \p fi[ ..A iqE AwK \p iI `K Q qAb \p fi[ Q rFkAE {q ..{Z \qb zZ
[ y \tL \W \p r \p fi[ Q lFK\ tF E
k_ \[^ A eXbK [ iI AW bE AQ lFK\
.A}
|[ }k dAW) Q O _ wLX ~jA Z]L bE \qb m `K AT % 90 - 60) fl\_ MUK ZO T T ZO H (b
(iI
\a rwK\ _ .l}v A %60 - 40 T ZU A : _ j p A\QAE _ _}E \a [ A_T .25 p _ L
\L 167 j \Q 60 _ A Ov ,A qE\ ALAE _
215 = (167 x 167) 60 :A _ L \a A_T
(A\QAE) _
= _ L \a >
(\LAE) _ j x (\LAE) _ j
:y \tL 2
>
\tK F\ flZZp y \tLE iI `K lFK\

K A \W p \N q L_
\tL fi[ xbL A ..wLX flZZq \tL
[ rQ\ ,iI `K AT l}v %44 p Z]K F_
\v L [ ,A} fl]Q | O flZZp AF^ LW
B fl\tL q z Aqv p _ W A
n L A| Cv _w M| ..
O }| 30
AwK \Lv q [W ]L Z p [W
K AbL \Lb [ .Â| \ AwX
AÂ| Z ,iI `K fXbL y \tL
47
\O ZT ZU Z| . A qEAL A h A Z}K Z v\q

: y \tL
:iI `LE kFK\ y \tL >
(fXbL \tL fi[ ZUK fl\hAE `)
F_AE dAW LH Hormone F_ AwK >
. FSH
.SHBG F_ AwX >
Testosterone \_L_L O A iqE F_ AwK >
.Androstenadione A^Z
.Prolactin F F_ AwK >
._ \v G_ \tK >
\WBK AF^
fl\ Zp }q
_AE iI `K |p 3
>
\E }qL AE\kg iAF `K H AFK Q wLX AUE VhK

ZQ .|Ak \XL^ A\_ _ ZXL^ Ap p _ _
p _ A\ iI p _p }\kE \N _ \v flA Ah
GF_E _ \ \v rwK\ iI `K AT ZQ Z} ..Ee
pAv f} N GF^ Q Aq iqE VQ\ ..A fi[E \ pAv |
lFK\ [ ) \_ \ Z A| iqE ZQ Z| [ _ \
EAe iI `K AT [ {q ..(_ \ pAv f}E Ah
.\_ g\ r \Lb flZpA| Z \_ \E
?\_ \ iI `K AT Zp :
flZ fleE jA_FE EAQ :
?iI `K AT Zp _ \ flA Ap A :
p Z G^\K p qK _ \ F_ flA , Z}v Eqd :
`q q jA_FE _ f}E \I Z EA} Zp Cv
.Z L^ r
?\_ \E EAd g\p \O iI `K AT :
\E EAd (ZU A `) ALT flA p A A^Z ZK :
\ flZZp z_ Ap G_E \L_ \v A}k ZF ,\_
\ A A ,flZt fi[ "A " Z| A\F flZs _
.AzqE ^ ZqE EAd \OK [ .._ f} \_ F_ AwK
48
\WBK AF^
fl\ Zp }q
:fXbL
v AQAE fUw p AÂ^ A fi[ O fXbK ZLq

Ultrasound Scan F W e
fUw `w \OE Transvaginal
_ iI `K g\ dAW kF
fleE iI \n ,fle g } A
fl\td A (fl\bp T) ZZq ZQK PUE q
,iI \j p \L 8 - 2 H AÂ} \L
iqE QE r lFK\ .fleAE Vg A
F_ A| fXbL ]q ,A\ ~EA_ \p
.(A %44 T ) ZAE A Zp
..AT AQAT G_T iI `K AT p xLX

flZ AE\kg T \eUK \p MA q xLX
d b MA p Fs\ ZE \b
.\L AQ b MA
1
>
iFL ZF Z|
iwW \RE
v ,_ E ] AE q r p GR A
fl\ Ab iI ZF A | \s Zp
L \aE d iwW \RE iFL PT \W
iw [s "R" AFKCE Ve [ .25 | _
_ iwW p R\ [ q nT r
kq A _ _ iwXK [t n iqE)
flZpA_ wzq \s gA\ r ( f}E jAW A_T
Ee ]\ \O E .. ]LX Z \T p _
A^ ZXL^ p rLK Z}L Aq flZpA_
} GHA Awj O A QK Z}L AeW flZpA_
`K AT NN p _ L \a \R
28 \a [E d \O hw ,iI
.q ZE F| |
iFL lbK 2
>
[WBE ( _ E ] ZqE ) flAp iFL Zp p ZF

Z dAwK) iFL lbL Clomiphene \|
VR Cv .(flZpA_ AeW A^ AE ZXL^ fl\Lv
P dA } AFj B A A FAtv , d
A^ AE Z dAwK) iFL p iI lbL
fUwAE iFL N AhF qEAL (flZpA_ AeW
. F W e v AQ ARE
49
d iFL lbK AR Zp AT 3
>
A iqE .pAkd V}L vAgCE GIk Ve Z|

fi[ p GtL iI p \Q \ ALU \W
} GHA Awj }\j ZXL^ \ GkL Z| ..b
\W GF^ ZQ q \W \k VRK \R
. \WBL
\WBK AF^
fl\ Zp }q
Ovarian Drilling iI

Operative Laparoscopy T\ An kÊ q fi[ LK
ZXL^CE iI QA Vk_AE AULv p A L
fi[ F_AE \[K GR .Laser ] Diathermy \
:q
Ap AT\Q \Q p HZ q fi[E } GR >
Z| iI Z] ..iI dAW A_ \mA
. p [ \ iIAE flQ AhF Zp }LE }
.A\LE Ve l}v flZT fl\ q fi[ eK >
AT iI `L A p iI \FLq >
T
q \Q ZqE a 6 W q fi[ SAL \nK >
ZqE \O F_ fi[ iwXK ,%70 - 60 eK Z| AR F_E
. _
~F^ A GRL_ [ iI lbK iI Z Z| >
ZU A ZqE A GRL_ O iFL Akb
.iI `K AT %20 T
ZXL^ p ]L iI wLX q A^Z M >
Akb ZXL^ IA AN GRLE }AE iFL Akb
!!iI Z]
AhF Zp } Z|
iF `L AnAE fld
50
\WBK AF^
fl\ Zp }q
\O iI Z] lbL }AE iFL

.(flZpA_ AeW A^ AE dAwL) wj
iI q AwpAh ZT A h q A^Z M >
ZU A AE A|AeL ZT ALT
kF VLv ~\j p A ^ T\Q p AwpAh
.An AT | K A|AeL ZT F_ A An W
j\X AeL^ _K ~F^ A p A MA :nT
iI `K q Ovarian Wedge Resection iI ]
p j fl\Lv [ AFj x|K ,kF VLwE q fi[ \RK
]Q AeL^
Ov ,fl\O AAb q fi[ \Q
, fl\I QZ iIAE flQ AhF Zp f} iI
| T dAW AE A|AeL q fi[ GF_K [
. Z_ \O Z }q p SL A Av
!!! wL :\_
wL
F_ }K
p ZAE \_
qIk L_
_ \ pAv iI `K H |p Q \n
Metformin wL eeXL AFj ZXL_ , _AE
ZpA_ ALAE _AE _ pAv flA] \_ ZT
T\ p fi\NBK } ALAE _AE _ \v f} p
Z \_ F_ }K p wL q .wLX iFL
Z [ ZXL^ oT ,k qIk L_ p
dAW Z Zq _UK , f} A nq
A . lth AwX [ ,Z \_
\W AUE Z Z} ,Z ltg AwK yAq
ALT AwX [ flZ nK wL
, GTAe \_ \E EAd G_ [ AQ G_
iqE AqK .iI `K QE kFK\ Ab A
\qbK Z| A ..A^ , }AE A_T ZXL^ Zp A
v [ ZXL^ ZE Zp dAW \W \pBE Z_ iqE
.\aAF v\a MUK GIk flAbL^ iqE fi[WBE Ve
iIAE ` QE iI `K |p
p Â| ] PUE iIAE ` K flZ^ Zp ZU Z|
p ` {Z ÀE iqF v\q ,(^5) \L 50
A . .A} [ p \F AwpAh FTAe Z| [ ,iI
p A A} Z] flQ A A| Cv iI `K
A A vLW Av [ . (10 T) flZZp K \L 8

\q GF_ iIAE ` Q iI `K H A [Q
.AH |p v AwpAh
51
( \F) F A 2
>
,Y A}E flQ AX flZt \F \w

AN Z LF_ rwK\K [ ,ZO F \v p _
F_ AwK .fl ZqE pAg\ T\ ZqL^
: rg\ AT \s flZ_ MA Prolactin \F
fl\aAF fleE iFL p \F F_ AwK \N >
A \v p \aAF \NBL A wLX \kE
A p A h ,iI W AhF p _
.iI A\w
PN T Galactorrhea ZO \v iqE \W >
ZAE \F F_ A}E Ve [ ,l}v A
.l}v \v \W Zp ` A rQ
.ApAk} \b flZ AE\kg >
:O fl\O p [ F_ AwK GF_ rQ\
AX flZt wm \kg >
\F F_ AwK iqE [W : >
.AL Z Z ltg Aq O
. [ F_ AwK (F|\ flQ) |Z flZt _ >
F_ AwK AT :AX flZt \td >
qk} qa qE GIk Ve^ ,fl\I Q \F
\eK qE Ve Z| \ p CT Scan
A RT ZZUL MRI _jAt y\AE
` ZT v Ap] p .
A fi[ nq ,\q qAE A Aj\^
QA ZE AE fl\I pAwE A AqK
.T\Q p \Q
AX flZt \}AE ZT \td >
A\v Z] AX flZt p \N
ALUK A fi[ O ,\F
. T\ h\
F_ AwK iF `K >
rwK\ Z}v AU %30 T v L\F
AT qIk F_ xqg p Z]K QZ \F \
.iI `K
[ l_E AwK O AE A_T GF_ Z| >
.Z p [W LT
\WBK AF^
fl\ Zp }q
_jAt \AE fld

AX flZtAE
52
\WBK AF^
fl\ Zp }q
\ A| A GR
F| \F
AwK p fXbK
\
F_ AwK Aq AFF^ AFj ZR A iqE >

ZQ fl\td Q GF_ \O Z}Lq ,\F
fl\ ,AvAbL A xb A^ rkL_K AX flZtAE
nq A Aj\^ M_ flZT v Ap] p v \W
.T\Q QA ZE AE q GRL_K A fi[
ZTBE \F F_ AwK AFj Aq
Bromocriptine E\\F : AZe fl\vL
dAwK) Cabergoline Q\F Quinagolide ZQA
iqE \ ALU Z| ,(flZpA_ AeW A^ AE Z
.iFL Akb vAg A
?qwK\ \F F_ MA qv GR A
F_E F_ AwK MFN Cv ,\W fl\ UL flApCE GIk Ve^

qE Ve Z| \ p CT Scan qk} qa p GIk Gk_v fl\I
.|Z. flZt A A| [ MRI _jAt y\AE \eK
?A k_E A pAwK qwK\ \F F_ MA qv GR A
AE A_T \RE \F \ rwK\ Z| \W fl\ UL \K GR

.Z p [W \Q
F_ iw [WBK h\ T ZT qv GR A
?\F
dAW AN [W ZqE Aq Ue ApAFK v Z [W A} GR

LT MFO . \a NO z Ahp K \a W
. AN [W z p \g
?AX flZt Q ZT q AIK A
,\a 3 \ p CT Scan qk} qa qE RT qEAL p GR A

. AN \W fl\ Z [W flApCE GIk Ve_v RT \F oT A Cv
. AN [W z p \g LT MFO
iI wm e| 3
>
}E A ,A GR wm iI {q [
\W qE..AE W Gp v iFL p fl\N \W q
A \wK A k Z K AX flZt Cv
flZp A .A L iI GRL_ AhF
:iI wm bw e} [ K AF^
53
\F iAF bv (
jAb p iI x|L [ fl\ ^ \q
_) \b flZ x|K ALAE A \v iFL
\F ZU Z| .50 45 ^ H A (B _E BkW
\F iAF bwE A fi[ _K ,40 ^ F| ^
AwKCE A fi[ O fXbK .Premature Menopause
Stimulating Hormone (FSH) e F F_
Luteinising Hormone (LH) F_ [ Follicle
Q\L^ \ f}) iFL L_ iwX A ..ZAE
L_ MqwK A (kbL R d iI fi\w [
Vg) lb iI \OK T iFL kb A\
A .(iI AX flZt H _q |q fi[ fiA ^\
scan F W e v AQ ARE xb
.T\ hI RT \td p Z Transvaginal Ultrasound
Z}Lq ,} Q p \q \s A fi[ O GF_
A_Q \q \s A GF_ _ AF^ g
oT .ALwm iAF bv A iI flAh
Q\L^ A [WK GR A fi[ O
A f} _ \NBL LT hqL \_Q\F
M|K p \NK N p A iqE ZQK A ..A
^ Zp flZ x|K ZT [ ,q p hI x|K
AX flZt F \
A fw
AX flZt
`NF
\WBK AF^
fl\ Zp }q
iAI bv fXbK
:\F
A\ AUK -1
A_E xb -2
F
_q |q VgK ^
AX flZt \v H
KA\ iI
Q\L^
iFL kb A\
iI
iI A\ fl\w AW
K e
hF AE
54
\WBK AF^
fl\ Zp }q
A fi[ [ ..AKAE Zp b `w ZU Z}v fl\F

[ A fi[ [ Aq GIk rh GR [AE
\k \e| ARL q }\j }K Zp p Ge Aq
. v F| d
A iI A} \ (
Resistan Ovary Syndrome
kb A AhI GRL_ A fi[ O
\ Zp p hI LT s\AE \q \s GF_ iFL
A EARL^ p KZ| iI \L_ Z| .AhF
}\j ZQK LT ,A F_ iFL kb
K A .jAb iI \L_ [ M|L v\q
. weE GIk qQ\E Ue
\\ \ (
Turner' Syndrome
.A^\AE R Z A \
LU iI ALU AhF Zp A f}
.Zq Fa Cv [ .AhE p iI
A pAqa q iI \qK (
h\ QLK GR
]\ ZT flAbL^
[W F| Ee
pAqa p
A
iI wm AT e| A pAqa q
A M| .iI ALU [ AhF Zp dAW
zQ\Ly AQN AZRLE QAE owLT VFd
p ALUK ) h\ MA Ve [ ,dAW
ZT QLK Awj AZp ` Q]L (A pAqa
LT AQO fi[ O AZ \vLK ZpA_ AeW ]\
Zp p iI PT ZqE) Q ZqE AwLT A
(Q VFeK LT qAE ] {E AU}K N AhF \I
AK ZqE ,A pAqa q h\ \qLK F|
.F| AE owLT QAE UK rk_K CE Awb
Aa AhF ZRK A G\| M| LT \q
G\} VFe^ [ AhF ZRK yA \W AUE
ALAE ,AU}K ZE AhFAE AwLT QAq
p ALUK ) Q]L \s h\ VFe^
h\ \qLK F| AhFAE AwLT (A pAqa
.A pAqa q
.\q \s GF_ }F A iqE (

55
AX flZt A f} 4
>
Z| Y A}E r}K AX flZt \wK A fi[ O

AZqE iI W AhF p _ A A A
(FSH) e F A fi[ , iFL
Hormone (LH) Follicle Stimulating Hormone
h\ BK A iI \w ALAE .Luteinising
: A fi[ O GF_ rQ\ .\a fl
A F (Y ]Q ) `NF \v Zp >
,}W Gp GF_ A A FAs ,(GnRH) _ \NAL
.\a fl h\ BK ALAE
(Prolactin \F) F A >
[ fl ZqE AT x] R AX flZt W ZU Z| >
wm p \N Z| A AX flZt [t Z f}
,flZt fi[ A\wK A f} ALAE ,flZt fi[
.AN A }p h\ fi[ a K ALAE
.AE Q AX flZt AeL^ >
AX flZt A f} p _ A fi GR
.}T fleE flQ QA AAE iFL lbLE
.(flZpA_ AeW A^ AE Z dAwK)
!! _ AwX >
\b flZ Ak} q L_ p _ f}
,\b flZ rk}K q A `.A f}
Body Mass Index _ L \aE _ A A_UE G_U
Z}v 19 p \a [ iwX Cv.(AF [ T\a ~EA_)
:T\ p _ A f} \N ..\b flZ rk}K
\WBK AF^
fl\ Zp }q
: T\ -1
RKA A F_ }K T\ K W iFL \NBL
p fi ZLq [ T\ kF Abt } p iFL p
.AU}K ZqE hF \t ALT } A ..A fi[
:yAO T\ -2
flA A fi[ O q .iFL ZU
j A Cv : AO [WB .20 p \a [E e _
_ L \a A \Q 47 A \L 16 h\
_ L \a 1835 = (16 x 16)/ 47 = A F_AE
GR \Q 512 = 256 x 20 = A GR 20
AAn \b flZ qK LT \Q 42 A Z]
_ L \a k L_ \W fl\ A fi .qIk
.25 20 H A
56
\WBK AF^
fl\ Zp }q
>
_ Cv ,iFL e| _ AwX A
Z]K Z| _ GF_ ..b `w Ah K Z|
p fl\aAF fleE \N [ _ _ AQAT
\ A A \W A\ ZZq p iI
W ALT K _ {q .iFL e|
.KAwL G_E Z_ iqF ZU iFLAE
!! wzq gA\
>
\b flZ Ak} K wzq gA\ \q

\,(iI lbK p _ A \v W R)
gA\ A {q ,Aq gA\ ` wzq gA\ A
O q L_ p _AE Ap F_E Z L_ }K
fi[ \ A flAp ,AF f| k AvA_ \Q ,AF
.AgA\ fi[ O Av\LU b
r FT A} ZqE A fl\Lv
>
ZqE r FT ZXL^ F| AZp ~EA^ Ee rQ\K

yAq A %15 - 10 T ,AZXL^ x|
[ (a 3 p Z]K ) M| iqF iFL \kg
Zp \L_ A %5 | ,q RLU
.iFL lbK RLU [ j fl\Lw iFL
Luteal Phase Insufficiency \wd _ e| 5

>
\wd _
AhF eT
hF \W
K AhE
57
hF \W ZqE L [ ] \wd _
\_Q\F \v p _ ,e
AkE \hUK Â^ fleE ZpA_ [ Progesterone
[ ,T\ Ad Zp U} hF AF}L^ T\
W MIOLE _ A A}E p ovAU
AO ] flAp \w . fl\bq rHA^
Z fiL_ } ZU Cv ,\b flZ
A iqE .] flZ ZF m fleE
,\_Q\F A Z} \wd _ \w
ZAE [ L_ A}E A fi[ fXbK
[ O ZU A flAp .flZ AO xe W
AeW A^ ZXL^ iI lbK Zp e}
\_Q\F AFj xe A A FAs.ZpA_
.q Human Chrionic Gonadotophin (hCG) }T
\WBK .. _
flA H |q T rQ Aq \WBK }q Aq AR eeXL An ]\LK
A pAwK Z flZUL AAE A flZqE M\Q ^ \m Z}v .. \WBK (_) _
_ p A| L x \n )27 p _ p \WBK G_E \I
AwX _ flA ZQ AEA M\Q \W ^ .(iI `K
Z}v :iI `K AT gE _ \NBK \n .iFL kb A _ EARL^
ALUK Z| E ,iFL kb \| GRL_K Z| A fi[ O BE flZZp A^ MUg
AQALUK iFL kb } Zp flA
() k
fi[ \m A .iI lbK L LT h\
.A fi[ O AQ G_ AwK A^Z
:AE Z_ p _ \NBK fK
iFL xqg >
^ iFL Akb _ EARL^ AwX >
} \|
AQ F_ flA >
GTAeK Ue Ab F_ flA >
:
U GTAe Z ltg AwK
U GTAe \_ \
fl\F fl
(R)
flAE flZZp Ab
>
>
>
>
?_ Ab Aq Q\
,\W p ZE \O T Z_ Z AwX flZZq A^Z MLFN
. iFL kb } [ \| iI EARL^ F_ MqwK Z}v _w M|
?A rQ Zp p _ \NBK
,_ yAq T iqE iI p W K _ p iqF \Lq Z|
ZpA_K iI p p \NK wLX \W WZK ZQK E jA_F fi[E ` g A \
ZpA_K _ {q [ . .iI p p WZL fi[ J_ \NBL p \I ZT _
} Z}v _ fXL K PUE \WBK GF_K fl\O p \NBK flA \I ZT
F_AE A ..l_E p p ZE ZU Z| ALAE q K LX LT
\WBK _ A GF_K ALAE \WBL \W AFF_ Z ZQK v _ yAq T
.A A \qLK Ue Ab Z]K A _ MA
58
Av A}E }qL AF^

T A j .T\AE hI eK A Av A|
qK flZZp Z ZQK iI TA flA| A .^10
iI AQ\W Zp hF A}L iI Vk^ V_ p
ZQ }| \qa kÊ T\ fiARK flA} W Aqv
A Cv [ , A EA}K LT Q ~ÂK \ULK
ZqE hF }FK [ A Av flA| AeW
d F \R Av flA| \FLqK .A F\}K A 5 flZ AU}K
: \N Aqv \F A ,T\ iI H
.iI hF \W Zp hF A}L >
.T\ hF } >
.flA}AE A\ AN [t AE hF Z >
.hF EA}K LT flA} W A } >
T T\ fi[ \tL_K) T\ FeX hF } >
.(F^
A\ W FeX hF lU A \K >
. [ T\ A }v \tL [ Av flA|
\WBK }q AF^ %22 T Av | Ab OK
ZT Zp A FF^ K Ab .fl\ Zp
\WBK AF^
fl\ Zp }q
Av flA| hF W ^
hF
Z
Av flA|
AAE jAU hF
Av flA| W
T
hF
60
hF \T rLv flA} Z_K AEAK fi[ R .AEAL

\tK Z| A}eL GF_K ,flA} W A
K K Z| ,iI F_AE (hF l}LK ) Z rg
GF_K Z| A . flA} W hF WZ
AT A}eL
WZ R_ p \NK Z| E Av flA| Z_ AEAL
.Z AL ZU A O ALwm AZ}wK flA}
\WBK AF^
fl\ Zp }q
:AF^ fi[ ZT R AEAL ZUK

R ZU \ AL .] A AL
T Z A .AZ A AE\ \O
bK ALCE AEAe Z_ %70
Z_ flZT fl\ AL ..\p
%50 flk ]K ,A %10 Av A|
AEAL) .\ O ALCE flZ_ MFd
.(F AEAL p xLXK
_ Zq p RKA AEAL
: r ^ G ZXL^ AwpAh ZT
,}q Aq^ ^ fi[ ZXL_ [ {q
nq ,A pa r GA^ \O G E
ZT .AqL^ p x|L ZqE UK Z_
Ve [ ,AEAL ^ fi[ ZXL^ AwpAh
AEAL ZT b Zp L v GIk qQ\E
.\W ^ AqL^ v Ah [W
.fl ZqE rHA^ 6 fl\Lv AEAL ZT : Aw T
\ U A^ ] ,fl\ Q AwK \p
AE A_T vAgAE T\ x] A ,F
A fi[ O Ve [ .kF w^ }k dAW
.KAbL^ ZqE v Ah [W GIk QLAE
ZUK ,AQ AwpAh ZTB AEAL ZUK Z| : AQ
.\b \s AQ AT dAW Ab \O
ZU A _ W \W }k AEAL AbL
.flZ] ARw ZT dAW Z flZ] AL
dAW T\ Aq AwpAh ZUK AEAL
.Z flZ] AeL^
h\ LAd W AEAL R A|AeL ZUK Z|
fi[ .AW AL Q s\AE g\ \p BE \qbK Z|
A|AeL Q An W GIk xbL Z}v ZQ k}
p Z A Q Zp s\AE Av A| T dAW AE
. AKA W h\ GIk b|A AN
>
Q :Av flA} ^
A}L rK A|AeL
hFAE A
A|AeL
>
>
>
>
>
>
>
61
:O A|AeL GF_K Z| \W AF^ A

"Z}Lq n" T\ Aq R A|AeL ZUK Z|
vAgCE b Z}qK \ }}T !!!}q AqK A A
O .}q MFF^ Â^ b GHA Z_ b
Resection iI ] j\X AeL^ : Aq fi[
AeL^ Ap , T\ rg VUeK Ap , Ovarian Wedge
\NK ,fl\ EeW p nq \NK )
T\ xRL p ZqL AA AT Ap
A LT ^ AeL^ [ {q (\I RT
ZBLAE Ve [ A Z| A|AeL ZT
F| fl\ EeW p J^ bE \NK
.T\
LE Ia R_ : Endometriosis `\LZ
, dAW T\ AW flQ T\ kFK
fi[ AwX Zp ,iI A R_ fi[ GRL_K
p ]Q ] [ T\ kF Abt XE) A
A A A}\j R_ fi[ ZRK (flZ fld
.Av | T dAW W A|AeL GF_
>
\WBK AF^
fl\ Zp }q
>
^ kEAn fld
kE An kE An fld
A|AeL Vg
62
\WBK AF^
fl\ Zp }q
VgK tFeAE qa
Av A| AwL
.AF [ \W A fi[ \q^

tFd qa qE A Av A| AT v\q
Laparoscopy eXbK kE An qE Hysterosalpingogram
, A|AeL fXbL O ^ \FLq [ Diagnostic
.ewLAE AdUw AE }\k \q^
"_L" }|Z T\ \QCE A Av | Z_ p L
An ~\j p kF VLv ~\j p ^ A|AeL v
MA Aq fi[ O eK . Operative Laparoscopy
Q MA ,(^ 34 ZqLK ) _ fl\td h\
[ q V}L \W }\k .Ap \s A|AeL
}\j p ] ewLAE \q^ .GHA AwjBE _
.flZpA_ AeW A^ AE
:T\AE AAeK Zp Av flA| Z_
[ ] p l}v Av flA| Z_ \eL} Z|
Z_ ZQ T T\AE Av flA| eLK
%20 T ZU A ,Av flA| ]Q }E
A^Z MLFN Z} .Av | Z_ AT
\bE) EF ] [ "_K" yA q
T\ ZE (flA} ]Q }E ^
p O \j flZp ZXL^CE kF VLv hL}K
ZXL^CE Hysteroscopy T\ An ~\j
T\ T\ ~p W \K dAW \jA_|
Aa Z} .flZ_ flA} AAW L N
F_E \k fi[ AR OZ q A^Z
eLK [ ] p Av flA| Z_ \eL| %70 p Z]K
qE \ Ee qQ Md [ ,T\AE Av flA|
}E ^ \bE) T\AE AAeK Zp Av flA| Z_ AT
_ q V}L T\ ZqE (flA} ]Q
ZXL^CE EF ] [ _K AU ZqE GHA Awj
.dA \jA_}
>
T\AE }qL AF^

:T\ AbK 1
>
ZqE A ZULK EF d fl\ T L

A bE AUK [ L T\ AbK SLK ,T\ AL
flZZp d A .z T\ W T\ K fl\Lv W
y\| T\ O AbL fi[ Ap \nK
K Z| .A j ]QAT T\AE zNBE ZT ~qE
\O GF_K A ,}q \WBK T\ AbK
.\L AQ A
63
v AQ ARE xbAE A fi[ O Q b L

L , Transvaginal Utrasound Scanning F ~\j p e
vAgAE Hysterosalpingogram tFeAE qa qE fXbL
Hystroscopy T\ ~p W eXbK T An \Q
T\AE B A iqE v q F_AE A . Diagnostic
T\ T\ An kÊ q j ]QAT
VLv ~\j p T\ \Q GUL_ , Operative Hystroscopy
T dAW AE A|AeL ZUK kF
.q AwpAh ZTB Av |
\WBK AF^
fl\ Zp }q
Fibroid or Leiomyoma 2
>
tF \q qAE yAj\^ M_ flZT

v Z^ N flZ_v qAb A ,A ~}
LK R fl\td fi[ nq . AZ qE ^
fi[ RT ] ,T\ hp BbK b \ A
flZqL K A A FAs ,Q\L^ Q
}
Aq r A|AeL
`\LZ
iF
W AE xK
T\ xRK
T\
AE L
hp W xK
T\
Abt MUK xK
T\ kF
Vk_ MUK xK
T\ QA
64
\WBK AF^
fl\ Zp }q
Vk_ MUK xK
:T\ QA
\WBK GF_K
MA
ZQ fl\I
WZE xK
:T\ hp
\WBK GF_K
MA
fl\I
Abt MUK xK
:T\ kF
\WBK GF_K
65
: T\ AA F_AE _}K .T\
:T\ QA Vk_ MUK (xK)

\p GF_K A vZeAE fi[ O xbLK A A FAs
A PUE ZQ fl\I ART Md Ud Ab
h\ bK A AO dAW F\} Ahp p lthK
.F fl\I A \W Zp s\AE FL \L_ A[
ALUK \WBK p fi[ GF_K A p
AE A|AeL q GF_K E T\Q p
A .}q q GF_K ALAE Av | T dAW
v kU Ahp p \N fl\I ART fi[ Md
.A T\Q AAeL^ A fi[
:T\ hp WZE (xK)

\WBK A nq A [ GF_K
, \WBK ZE UK [ O Z Z_ nqv
Ap weE .T\ xRK p \N RT RT d
AN fi[ RT ] r|LAv Q K
iqE ALUK , F_AE iqE GF_K Z|
Q \N .T\Q ALUK l}v A_
.fl ZqE fi[ cK A A FAs . z Ud p
:T\ kF Abt MUK (xK)

[ ,T\ xRL W r| A fi[ O
,T\ kF Abt W U} hF "At" r v
GF_K . r G AB fi[ qK \W fleE
b L ,\b flZ flA A [
p e v AQ ARE xbAE A fi[ O Q
W eXbK T An qE fXbL L , F ~\j
An kÊ L hw q F_AE A .T\ ~p
.T\ T\
}K A LHRH analogues O iqE A
AX flZt r p fi[ qK , fi[ RT
F_ }K ALAE iI lbK A \v
cK [ p ZpA_ [ ZAE Q\L^
nq qw j q [ \FLq .ART }
q x| ZqE A }EA^ p A A RT rQ\ A
AwpAh \a (L^) 6 \O \L_ GR [
F| q [ O rw ,j fl\Lw ZXL^ ZqE ZUK
:AL AF^ \I RT A T\
\v } ,l_E q qR RT \teK >

A A ) AE T\ AeL^ AT
( ZQ \I
q AN fl}w Z } RT \teK >
Ek kF ULv \te RT \teK >
. \XL^
T\ ALU
: q
T\ xRK p \N 1
\I RT A 2
>
>
T\ rg 3
>
RL Z_ %20 T ,A A FAs T\ RL
, T\ rg A qIj A vLW [ \FLq ,x T\
ZAE A iqE GL B) \WBK A }p [ GF_
,(!!EAL p \N v ,\_ ZAE \W GL
~EA_ Z}Lq A Z}v .T\Q p ALU ALAE
GF^ xbL dAW) }q GF_ x T\ fiARK
A T\ RL Aq iqE \RK MA [ (}q \W
T\ fiARK rFkAE [ ,}q p Aq fi[ Mbv
AK BE F| A Ve A . \WBK d GF_ `
.A p fiZQ MFO A A ZqE AkE p Q]
x T\ Q
\WBK GF_
T\ xRK W A|AeL 4
>
R A iqE \WBK ZU Z|
A T\ kF bsAE ZZa AT AL
hF rk_K ALAE Abt [ \Z
ZUK A A FAs .Abt [ At U}
MU p AwpAh ZTB A fi[
p ZqE dAW (xnL qE fiA_)
W A|AeL K L AQ
A|AeL
qE A fi[ fXbK .T\ xRK
T\ ~p W eXbK T An
q F_AE A . Diagnostic Hystroscopy
T\ An kÊ L
L N Operative Hystroscopy T\
.T\ kF Abt p ZpA_ LT Q\L^ [W
]QAT
W xK ]QAT A|AeL ^
At qK T\ xRK
ZT T\ ~p
:Ee dAW A \v T\ ~p \w
.T\ F A\F qd rK 1
A Z}Lq A ]X \v fi[ qK 2
.T\ ~p Ad ZqE pA^ 72 fl\Lw flA rkL_K
;\b flZ fl\Lw G_T p \v fi[ K \tL 3
A QZ Q] flZZa \v fi[ K \b flZ v
>
>
>
66
fi[ ^ ]K Q\L^ \NBK MUK flZ Z}LE , A qd rK

\NBK MUK AZqE , A qd _K V_L iFL Zp AK eK E \v
\W wm T\ ~p A\w \v ..\W fl\ \v Q] ]K \L_Q\F
eK p qK \v fi[ Q]
"}" r\_Av ..flZpAe A
T\
[ \LW rkL_ A fi[
A| T\ d ] A_
Awj Aqv q .hF d Av
hv AW }\k fi[ ZXL_K GHA
ient method }\kE \q AE A
AU
T\ ~p
.fl\w `w p ZLqK sperm grad
T\ ~qE }qL AF^

Sperm antibodies T\ ~p \vCE flAh A_Q Q @
A Aqg p qK flAh A_Q p T\ ~qE flQ \v LUK Z|
ZRK .q A^Z ZT Aa A \WBK AT %2 | ZU A ,A\ZK
. A Zg flAh A_Q p _w A_ LU flAa
AqL^CE A L A fi[ p A . "A ZqE AFLW"E A fi[ O p xb
A M| ,A nq q [ O ZQ Zp oT ,\a 6 flZ \[ |
ZE A AW L PUE dAW \kE { A^ ]RK r pAkd V}K qE Ve
_ \R AeW L flQ\ RAE }\k fi[ BK A .flAh A_Q
p A AK xLX [ AAE A \F flAh A_Q (Q] ] ^)
.\R } p SKA zAE A \F
T\ ~p \v f} @
~p }EA^ Ap R T\ ~p ] AL R T\ ~p \v W ZU Z|
[ O bv IK ,T\ ~p \v flA] ~EA_ ZXL_ Q\L^ A .T\
.iFL p
W ZU Q\L^ [W A ,flQ\ SAL d q
.pAkd V}L A fi[ O q
!!??A AN T\ ~p rg @
A p MFO ..qIj rg A x A RL Z| ,F ]Q p T\ ~p ZQ
...T\ A qeE A AN F W T\ ~p rg H |p
_L fl\aAF A ZqE AkE A\m p Q] }L_K BE iqF Ve A p \tL_
l}v ZL hp E A s\v ` F A AF^ flZq v[| ZqE A_ T\ ~p Q
F p A_ A AL ZqE [ ,\[ hq GpL_ A AN
..p\_ Ap A p LU A_ A ..qg A A T\ ~q A }d
A qeE AkE A\m p }L_ MA ^ A ZqE Q] rg H |p v [
.T\
67
Endometriosis `\LZ
(T\ AkE AFL - T\ ZtL)
AW flQ T\ kFK LE EAb R_ Q
A T\ kFK K R_ fi[ H NAL rQ\ ,T\
Cv \q A ,iI A\w A AFRL_K
A Z A fi[ F_ iwXK \b A
flZ p AQ\W T\ kF R_ Ug
A A_w YwLK ACv T\ AW flQ K ,\b
ZT AZE K \v GF_K Z| A A }\j ZRK
dAW ZAE A Â K Z| A , W A|AeL
. Chocolate cysts Kb ABE _K iIAE
A ,ZZUL Q p \ [ GF_ LT \q \s
Q p ZqE ALUd MFOK Ag\Lv A\n \R \q
~p ] ZE) i \W A\n fi[ .}
p dAW xRK ] Av A| W (T\
_ Z_ \ [ Ge A flAp .T\ xW hI
^ ZQ VhK fl\W p W , 40- 30
F ZqE ^ ZU `\LZ ZT OL_
[ Q oT v _ [ ZqE A .flZ x|K ^ LT
\I ZT iFL A\ iwXK _ [ ZqE \
%50 - 20 T \ [ \bL ....R_ K UhK [
ZQ T , }q \WBK yAq Z_
T ZQ AH , BE LbK %59 - 39 Z
.a Zp ` Z_ % 18 - 15
\WBK AF^
fl\ Zp }q
`\LZ cqL
iI AE
iFL AN
\p
\ ZT \q }q \WBK Z| >
A %30 T
.Q] A AN W DE qb >
.\b flZ AE\kg >
A AE A_T ZF : \b flZ AN AE qb >
] Z| flZ ] W \L_K \b flZ ZE F| }
flZ p xLXK fi[ oT .flZ ]E
.Aq
.\b flZ j kF w^BE dAW AE qb >
ZU ,flZ ZT AN FL \FL AN Z \n Z| >
}|Z Aq ZQ AO ZQ `\LZ \m
.}
68
\WBK AF^
fl\ Zp }q
`\LZ q}F fld

eXbK An W
fXbL
\p `\LZ Q H AFK A `
\p flZ_ bK Z}v ,h\ A bK
. kF An \QCE \ GIk xbL _w M|
`\LZ Q b L \W A iqE
Zp A\ ~EA_ \p QE GIk v\q W
A iIAE Q `\LZ A ..h\
\ Endometrioma A\LZAE _
F ~\j p e v AQ ARE xbAE
A fXbL L Transvaginal Ultrasound Scanning
Diagnostic Laparoscopy eXbL kF An qE
W [ (Ik AdUw AE \n)
p \qL Ah An W L A , `\LZ
_}K G_T AQ qE _}K \ flZT
kF An \FLq [ ,Ee \ q
fXbL ] \RT Diagnostic Laparoscopy eXbL
flZT H |p ZQK \ [ G\t .`\LZ
._w \ flZT \ \pBE A_T
? }q \WBLE `\LZ |p A >
`\LZ |p
\WBLE
AE A|AeL GF_ >
fl\h \v>
Q AhFAE
69
q AdK G_T AQ qE `\LZ _}

GF_L ,AnAE AeXbK Ee \
ZT qE\ OAO QZ dAW `\LZ
q A Av A| T dAW AE A|AeL
\T [ iI AQ\W ZqE hF A}L
\WBK A AjA}L ZqE Av flA| W hF
\ yAO QZ F_AE A .}q
T fl\aAF fleE }q GF_K A iqF Z}Lq v
flZp AF^ \WBK }q GF_K A \W Z}Lq
AQ\W ZqE hFAE kU I A \tK O
h T\ hF d [ iI
Aq \W q AUE Z Z} ,fl\W
\ ZXL^CE `\LZ yAO QZ
ALT G_ rv\ An W ]AE
KAQ rRE `\LZ H |p Q VQ\ A Aq
\W AF^ p PUF GR .}q \WBK H
yAO QZ }q GF^ rQ\ F| \WBL
\WBK GF_ iI `\LZ Ad .\
.AhF PT iIAE WZ I A \tLE
? AE `\LZ ZT A A
WZE iI QA Vk_ p
Uterosacral ligaments T\ kE p >
T\ QA Vk_ p >
Av | >
AO >
} }|Z Aq >
]Q ]Q p >
>
\WBK AF^
fl\ Zp }q
:AL ~A} p q ZLq

fl\I QZ "cqLK" GRL_K `\LZ R_ >
AFj ZQ [ , Q\L^ dAW A
_ flZ x|K ^ ZqE K UhK `\LZ R_
QZ ZAE A F_ }K fl\Lw fi[ ) B _E BkW
fleE j fl\Lw A Ap F_ Q [ ,(fl\I
ZLq AE qAv [ ... ( fl\Lv W ZU [A) fl\L_
.iFL A flAh [W ,\Lw flAAU p
A A l}v ZXL^CE q rw >
ABE v\q) iIAE fl\I A Â Z| `\LZ
O p Ah} T\ A \ ALU ,(Kb
flA lwa ,] ZXL^CE \ AE A R_ fi[
e v AQ AQ flZpA_E ` W flQ A_
}K [W vAgAE F ~\j p
hv \W AW \O \FLq ..Q\L^
p \N \WBK AqK A F_AE AW
,AhF iI LU p \N ALAE iI R_ }E
. \W Ik AUE KZ A
ABE v\q) iIAE fl\td A Â `\LZ >
Zp oT Cv iI lbLE q ZF ,( Kb
kF An W A ` p GR iI EARL^
F ~\j p e v AQ AQ flZpA_E lwbAE
. Transvaginal Ultrasound Scanning
yAO QZ Aq \W q AUE M >
An W ]AE \ ZXL^CE `\LZ
.Aq ALT G_ rv\
A A l}v ZXL^CE q rw >
fi[ G[K Av ,AE A|AeL Z| `\LZ
_ q V}L \Q A FAs \ ALU ,A|AeL
. GHA Awj
:`\LZ Uh
A\ Q Zp @
iFL
Ap F_ Q @
A\ fl\L_
A Ah @
iFL
70
\WBK AF^
fl\ Zp }q
A|AeL
A
Kb
`\LZ r}E
iI \NBK VgK ^
`\LZAE
b MA Cv , h\ b G_T p q xLX >

\WBK }p b Q ZE Â^ h\
xh Z| ,j \Lw wLX [WBE AFj nq Ve
A .A AQAT G_T p T\ iqF
q L \WBK }p b MA
Z_ A A Cv ;Av A| AT p AL^
p \NK A|AeL ZQ A Ug EF
kF An W fl\I QZ Av A|
Diagnostic Laparoscopy eXbL
Awj _ q V}K p A q
A TLw EF MA A ,GHA
Ve Av \q A\bq flZ_ ^
}AE hI lbK qE AFj nq
flZt lb NA Q
pAkd V}L r LHRH Agonists AX
L ZU Cv Qp O
.GHA Awj _ q V}L
q ZXL^ ZqE \W fl\ \ \n Z| >
.A %40 - 30 T (T\ AE q )
(\L_ Jk \a MUK) AE q
:A `\LZ q flZp ZQK
Ap Z| p LUK r FT 1
q [ \FLq ,\_Q\F Q\L^
}\j oT ,`\LZ q MZXL^
ZQK ) Ak} ZE dL fleE K GR AZXL^
K p wLX }\k fi[ ,(F A ZXL_K A
.(flZ A 7 flZ F [WK ) r ZXL_
p v\q q ]\ nq \b AE ZR
: AF^ }\k fi[ ZXL^ p ZqLE `\LZ
q AZXL^ \Lw r A AT ZXL_ F >
A [A A Aq Z} p LUK `\LZ
.}\k fi[ ZXL^ ZE Zp Q
.a 6 p } [ dL AqL^ IA \p >
>
Danazol A 2
\[ K NA pAkd
Q\L^ Zg [ q ,\^L_L
Ug Z| [ ,\_Q\F Zg [
600 ]\LE qL_ A A FAs .`\LZ R_
.(\b flZ x|LK LT k ]\L ) A \R
>
71
AEE A_T O IA \p K Z [ b
_ \qb ,z fl\bF qQ , fl\bF AwQ , X_
.(%1 T fleE ZU Z| A ) e ns [
\WBK AF^
fl\ Zp }q
\I ZT Danazol A Fb Gestrinone \L_Q 3

.A pF^ \ [W Zp A
>
eL fleE \_Q\F ZXL^ \_Q\F 4

.\b flZ x|LK PUE
>
Q) ÂL A F NA 5
Gonadotophin Releasing Hormone Agonists (GnRHa) (cK
\v AX flZt rE q ,AAT Q p ZT
F NA s\AE ) iI kb A
\v } AZqE fi[W A F\}K pA^ 48 W flZt lb
Q\L^ F_ }K p , (
\p IA g\p .fl\I QZ ZAE \_Q\F
BkW _ flZ x|K ^ ZqE ZU [A A f}
QZ ZAE A F_ }K fl\Lw fi[ ) B _E
[ , F AwQ , X_ AE : \p fi[ (fl\I
[ a 6 W %5 Z}E AnqAE _A L_ AwX
,\a 6 p q [ A ZXL_ fl\Lw kK GR
.q x| ZqE ~EA_ L_ AnqAE _A L_ rQ\
>
T\ q
:T\ q Z
,`\LZ R_ \ZL \ ] ZXL^
>
,hI Av A| T A|AeL
>
K LT A q : hI T\ AeL^ >
T\ fi[ AFj B , A A `\LZ R_
]Rp M| `w Awj \W Zp Z\K h\ MA
h\ a MA A ,AQp p \W Qq \k
.q [ O A qFj A v \WBK }q
kF VLv p W L T\ q oT
q fi[E } GR , Operative Laparoscopy An W
A_ \mA Ap AT\Q \Q p A Ap A FZK HZ
eeXL AbL_ ]\ q fi[ \RK
AT\Q AAp \q v .\mA AT\Q v\q
fi[ O eeXL ]\ Ap GZK ALUK `\LZ
.Aq
72
\WBK AF^
fl\ Zp }q
GF_ R \WBK
ZqE LT R n \WBK }q GF_ A {q
F_ Z}K .(AdUw AE qQ ) Â^ AdUw AK
H \L AE GF_ R }q Aq
GIj xLXK F_ fi[ ~ .%30 - 10
rQ\ ..\W \WBK q ]\ \W
Zp rQ\ LW [ GF_
dAW Â^ GIj A\FLq AdUw
Zp GF^ xbLK AdUw Zp
AdUw A \FLq !!! A ZqL ZT
A ,q }\j ZZUL Â^ A Â^
GF_ v\q ZpA_K v flZpA_ AdUw
p ZqE AZZUK ZqE q kW \tK A
.Â^ AdUw
: Â^ Ap p GF_ [ p ZLq

flZ_ ^ 1
>
ZT Zp z^ Zp 2
\b ALT K fl\te _ v
A ,qIk A %20 T
N p ZT Zp z^ Zp A ]
]K qIk \b ALT Cv ^
^ G_T GF_ R \WBK p xLX [ ... %5 p
| _ A
Ov , ZT Zp z^ Zp h\
v z^ 5 | ZT Zp z^ Zp ^ 34
N ,\a (L^) 6 p Z]K fl\Lw iFL AkbE q ZF
V}L vAgAE iFL qEAL r }AE iFL Akb
,\O p AU rE O q [ \L_ ,pAkd
Awj _ q V}L A Bv q [ bv A Cv
ZT Zp z^ Zp ^ 36 34 H _ A A .GHA
r }AE iFL AkbE q ZF z^ 5 |
rE O pAkd V}L vAgAE iFL qEAL
q V}L A h A Bv q [ bv A Cv ,AU
Cv fl\te _ flAaZR .GHA Awj _
Z| AdUw p ZqE p ZE fiZT AnL
z^ 3 W p ZE A A}K UK A xe T
flZ_ ^ A ^ [ AFKCE Ve ,fXbL
N p Z] ZT Zp z^ Zp A 34 ^ v
.^
>
R \WBK
GF_
GF_ Q Zp {q
AdUw E
xbLK Â^
GF_
fl\N q
Q] ^
73
\WBK AdUv
fl\ Zp }q
Â^ AdUw
:Â^ Z AdUw fi[ \Q GIk q_

\WBK }q GF^ v\q >
A r L q Qp kW ZZUK >
zq AdUw vA \Q GIk q_ }k ZF
k ZZUK F| \WBK }q Q GF_ p |
AdUw \I Zq Q ,h\ Qq
p \s AdUw fi[ \Q VFe ,(!!! A ZqL)
V_ bE VhK ZqE dAW M| qh A A x
[ Q] ^ q AR p \NBK q \O bAE
Zp [ {q , A Es\ \ qIkE ` M| rhK Cv
rQ AdUw \Q zq A AdUv \Q
:AL AF^ A\Q p AR [ A eeXK AFj \O
! Â^ AdUw
.A pa AbL \WBK }q AF^ \O Q VgL_K A -1

.q Ee q \O xbK A -2
,A Qq k ZZUK p fl\aAF }\kE \NK A -3
A GF_ v\q rFkAE ZpA_K flZpA_ AdUw Cv _w M|
.Â^ AdUwAE AZZUK ZqE Â^ bE q kW \tK
A Â^ \FLq A UK {q [ ,GF_ AbL^ | \O A -4
.GF_ p xb | flQ AUL \O A
AT fi GR wLX AUL AdUw \bE ZF F|
.Â^ AdUw A q A\[^ AL AeUv A_K A
iFL AdUv
\_Q\F F_ A|
Z T v \ q | v \ q A d U w \ O U L [ \ F L q
[ F_ rwK\K iFL AT \q ..iFL
\W ZqE iIAE L [ ,\wd _ fi\v \n
iFL ZT Z UL [ A fi GR .hF
flA ,iFL | AdUw \O , %100 F_E
(A_) e v AQ ARE iFL qEALE |Z fi[
.(AF [ \W \W AdUw p fi^ [) F W
:flZ AnL G_T q M|K Z p [W L
74
\WBK AdUv
fl\ Zp }q
nL flZ
ZQK fl\I QZE {q \b flZ AnL s\AE
iFL ZT ZBL GR ,iFL TA b
%9 T Z \_Q\F F_ A}E
A F_ fi[ rwK\K iFL ZU nL \b Z
ZqE rEA_ Z [ F_ A}K ._ Z}K
[ ,\b flZ ZE F| rEA_ A h iFL
28 nL flZ MA (7-28) 21 UL [
MA A ,(AL flZ flZ H fl\Lw)
(7-35) 28 UL 35 nL flZ
flZ ZT ZE nTE UL | ZBL L ,flZ
.AL
nL \s flZ
Gk A AFAtv , 42 28 H A nL \s flZ MA
21 ZLE F^ fl\ [ F_ A| GIk
A .AL flZ ZT ZE nTE | ZBL
qEALE 28 | \Lv nL \s flZ MA
F W (A_) e v AQ ARE iFL
. p AE UL p L ALAE
iFL ZT ZBL UL [ ZXL^ e oT
ZT ZBL iFL Akb ZXL^ AT
. F W e v AQ ARE A iFL
:T\ kF Abt p [W
.AF [ "\W AdUw" MUK \n

75
A fUv
FSH e lb F_ UK @
\a hv FSH e lb A| \FLq
p ZAE [ F_ AwKCv ,iI wm }L \q
,iIAE AhF Zp AwX p fl\I QZ Z q L_
Akb iI EARL^ lbK Eqd Z p Z ALAE
flZT 25 v A F_ MqwK A ,wLX iFL
GR A fi GR .\F iAF bv [ {q \L/
AO flZ q M|K [ A|
[ , ZqE F_ rwK\K qIk , À
flZ G_UK) flZ ÀW ZqE A| ZqK
[ A| ]K A fi GR .(Z ]
GIk A b A _ Z}K AT
.hI wm feXL
\WBK AdUv
fl\ Zp }q
LH F_ UK @
AT iI `K AT [ F_ rwK\K Z|
flZ q M|K [ A| GR ,\L AQ
flZT p [W L [ , À AO
. LH [ FSH e lb A}
Prolactin \F UK @
A Zp AwK AÂ^ UK [ F_ A| \FLq

fl\aAF \N [ [ F_ AwK AqK A ZQ
,ZO F \v p _ [ .iFL p
ZqE pAg\ T\ ZqL^ AN Z LF_ rwK\K [
\W \s [ F_ AwK Z| .fl
,l}v A PN T Galactorrhea ZO \v iqE
A rQ ZAE \F F_ A}E Ve [
.l}v \v \W Zp `
\W A A| @
, \W A F_ A| A iqE \ GkL Z|
ZE F| GIk ^ p h\ EAQ ZqE \ [ VhL
Z}v .(h\ GIk fUv) z fUw ZqE ,fUw
PAO Q\L^ F_ A| GIk Gk
.AhF AhI ]X \a ZTC flZ À
oT A ZAE \^L_L F_ A| Gk Z|
,xO bE A dAW Ap A \s \qb m
fUw W a |Z flZt A F_ Gk Z|
.nL \s \b flZ MA |Z flZtAE W Q
76
\WBK AdUv
fl\ Zp }q
v AQ
e
`R
(e v AQ AQ) A_AE xb
F W
Â^ ]A\ ZT F W A_AE xb \FLq
ZqE L Z| AT fUv \FLq v , }q AT fXbL
: fi[ GF_ .F W A_AE xb
AT fXbL dAW hI AT p }| fld kq >
.iI `K
dAW ,T\AE Q p Ug fld kq >
Z ZZUK A ,AZQK A ZZUL
.(7 AF qQ) }q \WBK
F_AE T\ kF Abt \tK p Ug fld kq >
.A
T\ e [ Z ~vZK AT v\q W >
.hI
p F W A_ \Q ] A @
?kF W A\Q
p LÂ| | Vg fleAE F W A_ AL >
\| GF_ ,kF p A_ \Q p RKA K
[ kF p A_ XE ÂL Ahp A
. flA Zp dAW ÂL Ahp p A ZqE Fq
\a GkL A AO kF p A_ \Q ALU >
ALU T ,A_ \Q F| A 8 T h\
.fUw \Q F| _ \a F W A_ \Q
.h\ iqE kF p A_ \Q AN AO L GF_ >
fleE .h\ F W A_ \Q GF_ >
.F xb \Q GR fXbL }L | A Ap
\Q F| fl\I AE ^ \a GR A @
?kF p A_
A_ W iI fld
F W
77
A_ W T\ fld
F W
AE ^ \a
AO p q fl\I
p ZpA_K _AE
e AQ A}L
, Ahp
AQ K xOK [
\O fle qR A
`wE ` ,A Tg
\QCE A g
.F W A_
T\ Av A| AT p xb AdUv
A FF^ K Ab .fl\ Zp \WBK }q AF^ %22 T Av | Ab OK
, ZQ A %50 T .WZ ÂL A AEAL ZT Zp
\Q GR [ ,AEAL fi[ ZUE T A , flA] h\ GIk b|A W
.Av A| AT p xb dA AdUw
A^ p H hwL L , T\ Av A| AT p xb AZT ZXL_ AFLW N ZQK
}\k AAW eeXL ]\ xLXK , AKA W h\ Lb|A AN GIk fiZR A
: A_K ZQ .A qQ \[^ [ ,Av flA| AT ZBL
?Q p ALwm AK A q TLw Av A| ZBL

flA| \s AK ZT hFAv ,hF A AW }LK EF \R M_ Av flA|
A}L iI Vk^ V_ p Av flA} QA \k flZZp Z qK ,\ p
\ULK ZQ }| \qa kÊ T\ fiARK flA} W Aqv iI AQ\W Zp hF
\v Cv AU}K hF A}L ZqE _w M| . A EA}K LT Q ~ÂK
\UK \tL GÂ lU A [ [t AE U} hF ]K Av flA| A\wK
Abt W z At LT iI AQ\W [ hF T \qAv ..U} hF
LT hF ALUK Av flA| AW iI hF \W wv ,A 6 eK T\ kF
M A Ap F_ ALUK A T flA ZQ | F_ AU}K
~F^ A VhL [ .. ^\AE Vg A , ZqE AKAQAT AAK x| `q ,M\I
A ..A Ek wm AK TLw Av AKA| K
.AT A|AeL GF_E iI p flZqE TLw Av flA| K
Ap F_
M\I hwX F_
M hwX F_
M\I Ap F_
M Ap F_
ZqE A_}
hF V}K
T\
AL
U} hE
iI
hwX F_

hE
qE T\
AW
yAO T\
AW
T\
F| th
T\AE AÂt
Z| th
MQ\W
lU t
iFL
T\AE AÂt
78
\WBK AdUv
fl\ Zp }q
(HSG) GHA T\ p tFeAE qa 1

>
A\eK tFeE T\ }T p fUw [ fl\v ZLqK

fi[E (T\ ~p W ) T\ xRK }T L [ ,qaAE
`w ,kF xRK A Av A| }LK flA
fUw [ AwL_ , x-ray ` qaBE \eL L M|
:p Aq v\q
p Q RT PT T\ xRK >
T\AE }W AbK Q >
. TLw ALA PT Av A| ^ >
.A Ek wm AK Av A| fUw [ Z
?GHA T\ p tFeAE qa \Q L x
]RL @
\Q F| pA^ 12 flZ [s AK p AL >

K LT At Aq W Ah qa
.A Tg \O fle
A AK \b flZ LK ZqE qa p L >
] flZ G_UK) flZ xeL F|
ZBL GR nL \s flZ MA Cv ,(Z
qa \Q F| T AFLW \QCE T Q Zp
T\ dAW Aqa z \qL LT
. \kg ZT Zq [ ,
.qa v\tE fUw p \R >
Q a A A qa fi[ \RK >
.FAE AE AT AL
}\k @
.(A_ fUv) F fUv qE GIk }^

.T\ ~p \ FAE An rg
. \v F xnK
.tFe }UE dAW T\ ~qE dAW EF rg
.F An ZqE d flZp [WK tFe }UK
.\W fld [WK ~A| flZq A\m p }L_ h\ }FK
>
>
>
>
>
>
\W }\k p tFeAE qa ] A @
? An T\ Av A| AT p xb
.T\Q p \Q tFeAE qa ALUK
.A nq Ap \ZXK tFeAE qa ALUK
.EF Z_ A tFeAE qa VgK
.bL_AE A}F tFeAE qa ALUK
79
>
>
>
>
?tFeAE qa p A @
.flAT BE qb (%40 T ) GF_K Z| >

EFAE Z_ A EFAE tFe \ Zp {q >
M| f}K ZU Z| ,(T\AE EF A}L }k dAW)
EFAE tFe \ r ALAE tFe R EFAE
.EF Z_CE jA fXbL
p\ , s\ \s \ qa iI \qK >
.g A \qL
p flZ }| fleE A Aq tFeAE qa kqK >
W rK Av A| T AE A|AeL Q
.EF W hF
A Ek wm AK Av A| fUw [ Z >
.TLw A l}v Z E
\O T\ W A|AeL Q fUw [ fXb >
.Hysteroscopy T\ An AeXb ,A
Ahp }E AT p Aq fUw [ kq >
_ T\ ZtL O \WBK }q GF_K Z|
.`\LZAE
\WBK AdUv
fl\ Zp }q
Laparoscopy kF An 2
? kF An A @
>
\AE kF GIk AW xbL_ p An

GF^ A A A v\q fl\F An ^Zp W fl\aAF
}T L An \Q AN ... \WBL }q AE q
ULw AE\_K T\ ~p W A| flA
.Av A| ^ ZBL AE Av A} QA
A j ULv ULv E fl\I AULv An ALU
fl\O AT .An ^Zp WZK LT \L^ 1 - 1/2 p Z]
A An ~\j p GF_ T\ \Q GIk rkL_ Z|
.Av flA| hF W rK A|AeL A
Laparoscopy kFAn ] A @
An eeXL q ]\ nq \FLq >

. wLX Ahp Av A| AT AbL^ O }\k
Z dAW Av A| fUv An AqL^ >
.hF A}L p _ flA} QA \kAE flQ
Ahp AT p A Aq An [ kq >
:O \WBK }q GF_K Z|
A|AeL > `\LZAE _ T\ ZtL >
>
iI `K >
80
\WBK AdUv
fl\ Zp }q
An }
ZQ
A|AeL
81
ALvAO A|AeL Q p A Aq An [ kq >

) }| A|AeL ZQK Z}v ...AL ZQ yA p ALAE
AL _ (Av flA| hF W rK
Z}v `q p ,flZQ SALE q [ B _w M|
A FAs A AL }}T ZQ ZQK PUE wO A|AeL ZQK
q [ O SALv [ \e| M| W \W fl\ qK A
M| qh Z| `q p E k L_ p M_
34 \O _ A dAW q AR Ap [
.GHA Awj }\j ZXL^ hv A , ^
. s\ \s \ \FLq [ qa iI \qL >
tFeAE qa \Q h\ ALUK A | Zp >
^ An MFN dAW eXbL An \Q ZqE
tFe \K s\AE Av A| dAW WZ Ahp
.AhqF AL}\k \FLqK A .An \Q AN AW
? q \Q M| \tL_ @
An AT }| 30 \O q \tL_K A nq
T\Q \Q ZE l}v fXbL An AqL^ AbL^
\tL_Lv wLX Qq AT\ \Q AT A ,Qp
A| h\ ALUK .xe pA^ - pA^ T q
.ZT bL_AE
\WBK AdUv
fl\ Zp }q
? q fi[ QALUK [ \ZXL A @

.Ap \ZXK q fi[ ALUK
F| AAXK GQ AjAT A @
? q
}EA_ xeL ZqE a \bK BK >
.q \Q
: p \ZXL GIk \ >
fl\Lw A[W Z| yK \ p
.}EA_
. Â_T Zp A
.(ZQ ) }EA^ p A Mg\qK Ab p
>
>
>
? kF An p \Q L x @
p GIk ALU A ,fl\_ w^ (^ 1 T) ULv p L

L ZqE ,kF JAQ p(^ 1/2 T) ULv ULv
ZQ rv\ E\ Z_ AN As (}| fl\E kÊ) AW
N , }k AbL^ GIk rkL_ Aq p kF
ULw AE\_K T\ ~p W A| flA }T L
A ...Av flA| ^ ZBL AE Av flA} QA
ALUK ) W fl\s p At [ \W L q
\[AE \Z .AULw (AeL _ ZqE A AL
.kF ZRE \[K AbK \LK AULw fi[
? MI A[ ZqE Ek AjAT A @
.q ZqE F^ _w }\K >

.q F^ W q Q\ >
Zp [T [W ,q AN "" A [W >
.fl\_ w^ dAW xbL
.\ p \ K flE qhK >
\ ,(Ab) \_ xL p Zp iqFE \qbK Z| >
GIk Awe^ A_AE } ,An ZqE ZQ qIj
.bL_ Q\W F|
\L^ ,pA^48 \O flZ `wE \L_ GR >
. Q 38 p fl\ Q MqwK v GIkAE eK
82
\WBK AdUv
fl\ Zp }q
? Laparoscopy An p A @
.Ap \ZXK ALUK p A >

An W T\ \Q p ZL GIj ALUK A >
.A|AeL \ GkK dAW
.tFeAE qa \Q wK p A An wK >
An tFeAE qa H GIk ALX x @

?Av A| fUw Laparoscopy
eeXL \F AE Md AdL A B^)

(1998 :flZUL - ZE ZL A_ AFj AE
\FLq T\ An An AA\ flZZq ]
Ap weE Av A| fUw O ^ \FLq An ZXL^
: A dAW weE A h
:O A|AeL Q A r|L A @
. AT AL g\ AXAK ZT
Z flZ] AT AL A ZT
.AARw
.AE kFAE Ap \Q K
A AN ZT
kF w^BE Q
: AF^ ZT GIk b A @
`\LZAE _ T\ ZtL
A|AeL

iI `K
ZT Z| {q A ) AO (}q) \WBK AT @
.(F| A flZT fl\
F xb A_ xb W A VhL A >
.qIj \s A a Q
Q tFeAE qa \Q W VhK A >
.GHA ZTCE Z_
,^ O p Z]K fl\Lw \WBK }q fl\Lv MAj >
. \WBK GF^ \b A ZQ
AARL A GF_ ,^ 34 \O Q] ^ MA >
p p\_E ew L Z\ [ , M| Ap An
.q kW rg ALAE \WBK GF^
A E _vAL }\k \FLq GIk Cv Ap weE
}\k G_ ALX ,A ~|Z fXbL AL
A \m G_T (\W \Q ZqE AZT B Z| AE )
.Ap xb ZqE [ A g\ YAL [W ZqE
>
>
>
>
>
>
>
>
83
>
Hysteroscopy T\ An A
\WBK AdUv
fl\ Zp }q
A T\ xRK W GIk ZQ ~| An
.T\ xRLE ~qL \WBL }q GF^ A A
qIk ULw \ v AULv ~|Z An [ ALU
AT fXbK T\ An [ ZpA_ .T\ ~q
ZpA_ A ,T\ xRLE ]QAT Q O T\ } AbL
Q T\ xRK p \NK fXbK
rkL_ A fi[ nq .T\ xRK W A|AeL
.An ~\j p GF_ T\ \Q GIk
? T\ An ] A @
T\ AT AbL^ O }\k T\ An \FLq >

Aq An [ kq An AqL^ >
:O \WBK GF_L Z| A T\ AT p A
]QAT Q O T\ } AbL
A|AeL
T\ xRK p \NK
T\ kF AbtAE Z
.T\AE AAeK Av flA| Z_
.An `w ~\j p GF_ fXL >
>
>
>
>
>
? q \Q M| \tL_ @
An
A ,fXbL Zp }| 30 \O q \tL_K
pA^ T q \tL_Lv T\Q p \Q \ kK
.bL_AE A| h\ ALUK .xe pA^ >
? q fi[ QALUK [ \ZXL A @
hwK Z_ nq MA qg \ZXLE p
.flkL \ZXL AqL^ Zp dAW Ap \ZXL
]QAT
? q F| AAXK GQ AjAT A @
.An \Q F| ApA^ 6 fl\Lw a \bK BK >

: p \ZXL GIk \ >
.}EA_ fl\Lw A[W Z| yK \ p
. Â_T Zp A
.(ZQ ) }EA^ p A Mg\qK Ab p
>
>
>
? T\ An p \Q L x @
A|AeL
W \ An kF ^ AULv p L
.AULv ALU ALAE T\ ~p
84
\WBK AdUv
fl\ Zp }q
? MI A[ ZqE Ek AjAT A @
.A flZp ZqE A ZU XE q AjAT ZQK >

.| A Z A} iqE ] Z| >
(HyCoSy) ^ A }\j 3
Hysterosalpingo Contrast Sonography
>
ZXL^CE Av A| ^ p xb \k ZT fi[
[ fl\v ZLqK .F W e v AQ AQ
v AQ AÂq GF_K flAE T\ }T p fUw
W e v AQ ARE Aq xbAv ,e
XwL flA} A K A Av A| \n F
T\ xRK }T L [ ,( EF W ZZd A^ ) rRL
,Av A| }LK flA fi[E (T\ ~p W )
[E e v AQ A Âq GF_K flA fi[
.Av A|
:AE Av A| ^ p xb }\k fi[ ]LK
e v AQ AQ ZXL^CE xb ALUL^ h\
.F W (A_)
gA ^ ` W OZ Ik AUE Z
.\W flALq A^ p xLXK }\k fi[ SAL
.tFeAE qa xb A A Aqa h\ \qLK
.Ap \ZXK }\k fi[ \Q ALU
.QA flAq }\k fi[ ZXL^
>
>
>
>
Av flA|
T\ xRK
T\ ~p
zq flA }T A
>
?(HyCoSy) ^ A p A @
Z_ A EFAE flA \ Zp {q
,(T\AE EF A}L }k dAW) EFAE
flA R EFAE M| f}K ZU Z|
T\ ~q QA ULw EFAE A\ r ALAE
.EF Z_CE jA fXbL
F Q p Aq }\k fi[ ZXL^ kq
W rK AE A|AeL
A_ AQ `R
.EF W hF
wm AK Av A| fUw [ Z
. ALTLw A l}v Z E A Ek
}E AT p Aq fUw [ kq
\WBK }q GF_K Z| Ahp
.`\LZAE _ T\ ZtL O
.GIk AW GZK }\k fi[ ZXL^ ALU
fl\k_} AE
T\ ~q WZ ULw
>
>
Yw }T
fl\k_} AE
>
>
>
85
Q\ A_ AdUv
.Q\ }q AE Q\ A_ AdUw \q^
\W AdUw >
\W iFL AdUv >
!_ fl\T QZ AI ^\ 1
\WBK AdUv
fl\ Zp }q
>
37.4
37.3
37.2
37.1
37.0
36.9
36.8
36.7
36.6
36.5
36.4
36.3
36.1
36.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5
R iFL ZqE 1 - 1/2 ZqE _ fl\T Q rwK\K

p , iI \wd _ \_Q\F \v
F| A}^ ZqE AFd _ fl\T Q A}Fv
v\q A ,feX AI ^\ AZK \\_ flAt
fl\aAF ApAwK F| fl\ Q ]K [ iFL
xe j fl\ Q AwK \L_ .^\ Vg A
:}\k fi[ Ue oT .\b flZ AO
fl\| _E flZZb |ZAE ]L AW fl\T ] \a GR
H\t Z ^ ZQ ,fl\ Q k_F \tL
.\t [ AW fl\T ]
A}^ ZqE AFd _ fl\T Q A| GR
.\\_ flAt F| fl\aAF
.A ~A| 3 flZ wAE ] rg GR
.a \a F| fl\T Q A| GR
.A^ w _s F| fl\T Q A| GR
>
>
>
>
>
86
\WBK AdUv
fl\ Zp }q
p ALp
v\q }\k fi[
iFL ZT
:O v\q flZZp Ab }\k fi[

Eqe Ek |ZAE fl\ Q fl\| flZ_ rk_K A FAs >
.Aq \L\LAE AK\|
A p j \Lw AFd fl\ Q A| GF_ Z| >
Q \tL \L_ AnL A R flZ_ Z ~}
. fl\
_AE A AL ZT O \W GF^ fl\ Q rwK\K Z| >
.h\ A bK \W \p m ZE
}\kAE fl\ Q rwK\K A | \s Zp >
p ARw AwK ZE ARZK fl\ rwK\K Z| E q|L
.iFL ZT r|K
Z_ iqE Zp \_Q\F \v GTAe Z| >
Zp fl\ Q AwK Zp {q [ ,fl\ Q AwK
.iFL ZT
ZT v\q }\k fi[ p ALp VhL ~F^ A
\_Q\F A| hw ,Zp iFL
iqE ~ ..A }EA^ A\ A flZ AO ] xeL
: AF^ }\k fi[ Fk Z| AFj
.ZAE UK \Q GkLK wL | }\k fi[ >
GF_ } A iqE fXbK ZpA_K Z| A >
.\b flZ AO ] \e
|
A Z}Lq fl\Lw L Q] A GIk \nK A >
. L
MU r^L p 2
>
\F A AT ZQ
\Q
" MU r^K "
iFL AbL^
!!!
87
MUK AL^ T\ p [W AZ| ZXL_K }\k fi[ MA

Q ANZU \tL \ ^\
ZQ .iFL ZqE iI fi\w [ \_Q\F
: AF^ q fi[ \Q \F A A M|
Ap \ZXK p \Q pZL_ A E p \Q p >
A Ap gAqL^ T vW bL_ W
.flZq N \O \tL_ UK \Q \RE
W NZT Ae Z| AQ EAOE q fi[ K Z| >
.q fi[ \Q fl
!!}q GF_ Z| A T\AE AEAL q GF_K Z| >
!!q fi[ A wL \F A ZQ >
e v AQ ARE iFL qEAL 3

(A_)
>
\WBK AdUv
fl\ Zp }q
T hF p LUK e K
20 T flZ A 2- 1
L hF ~kK AZqE ,flZ xeL
RT [ qEAL .\wd _
ZT Zp r}K \tL [ e
ARE AdUw _^ qE iFL
. Folliculometry (A_) e v AQ
GIk Z\ AZp }\k fi[ ZXL_K A flAp
.q AN iFL r|K v\q
Av A| p xb \W AdUw
!!! GHA Yw @
AN AtE Av A| Yw A dAW AQ ZXL_ A Z| A
\O A E ,ALAT p xb E\ Z_
fi[ .flZ_ } VLv Aqv \N }\k fi[ BE Z}Lq
: AF^ ZE Ap ZLq ZF }\k
lth p AwK p ZLqK v fXbL }| \s A >
At \_K Cv [ ,Av | Z_ fXbL AAE
\s p Akp {q (A Gs ZU [ \ )
.^ \s fXbK UUd
:GHA Yw
ZE }\j
ZXL_K GR
A\g
,A EF ZT Z_ H }\k fi[ \wK >

Z_Cv ,q kW p \N Lv\q GR [ Aq
) GHA T\Q A T ]\LK q kW {q EF
T ,GHA Awj _ q V}L (fl\te _
bK q kW {q l}v EF ZT Z_
.pAkd V}L
EF Z_ A p Aq }\k fi[ kqK >
.q kW p \N Lv\q GR [ Aq
.flZ_ GHA VLwK }\k fi[ A p MFO >
flZZp \g fl\kW AwpAh }\k fi[ ZXL^ K Z| >
!! K Z|
.}\k fi[ ZXL_ ZT Zq [
88
\WBK AdUv
fl\ Zp }q
Av flA|
Z
hE
iI
\wd _
A
Abt
T\ kF
T\ ~p
Post Coital Test A ZqE A fUv

fUw [ fl\w @
p fUw [ \Q fl\v ZLqK

\v ] flZ A Z}LE
flA p q [ Q\L^
~p \v Q A_
A qd _L T\
T\ (A L PT) F
eK ,Av | ALAE
AK \v fi[
fl\Lw `w ) flZ xeL
hF \W A ZU
p [W [ ..(iI
A ZqE T\ ~qE Q A_
qAE A
.AZp [
fUw \Q \a @
.12-10 flZ xeL fUw L GR >

\Q F| 3 - 2 flZ A p AL Q] Gk >
.fUw
xLX) A ZqE pA^ 24 - 2 T ZqE GIk h GR >
pA^ ZqE R iqF Gk Z| T v R Aq ZZUK AFj
O M| \ Aq Ue n AdK Cv A
.(!!! pA^ 24 9 H A fUw
.A ZqE F p GR >
fUw p @
rg N fUw v\s A\m p }L_K ,h\ hT ZqE

~p \v p \NK LT A AqL^ ZE F An
.^\ MUK ZK \v fi[ p [WK N , T\
fUw [ @
Â^ AdUw ZT fUw [ AFj iqE Z}Lq

kqK A }q \WBK AT rQ Ap GR
Z| A , A r T\ ~p \v ~vK p Z
T\ ~p A\w \vAE flAh A_Q Q p xb
iqE ...AL| Awqg A Zg
A eUv fUw [ Z}Lq ,AL [ x ,AFj
: AF^ AÂ^
89
v [ fUw \Q }\k Â| ZTK ZQ >

K Z}v wLX Ee ]\ H fUw SAL p ALp
LW \W ]\ Zp HAR ]\ZT Zp I^ R
.]\ AZXL_ \Aq
\WBK AdUv
fl\ Zp }q
V}K A Q\ kb A qIk >

[ ,T\ T\ ~p AW ZqE A q\^ ZqeL^ hF
ZqE pA^ 24 - 2) fUw Zp ZL^ AAv
A Q\ wqh A (A
.AL^ flZAv v [ V}L \Q
T\
T\ ~p
~p \v ~vK Zp {qK UL [ I_ R >

: AF^ A r T\
ZQ dAW fUw M|K BkW A AE 1
RE lFK\ q M|K p \AE zq A H AwK
.q
\ ) Ap bE \W GF_ iFL ZU 2
UL p A K flZ fi[ W (NZT [
bE \N A Awqg Q\L^ L_ _v
A r T\ ~p \v ~vK p Â^
. Â^ b Q Zp
ZE UL R p \N A Zp AwX 3
. A r T\ ~p \v ~vK b Q
>
>
>
Â U p A _w AFp fUw [ b >

!! Jj yA p qIj Fs A Q] |q
p }\kE \N^ fUw [ \Q A p MFO >
.A Qq k ZZUK p fl\aAF
90
A_T.
GEA Awj U \WBK p ]\
AR flZpA_ flkL AQL ~FkK

AU ~|Z }L AFkL @
( E ) Z ~vZK A}E T\ iF }K @
(\R }U - GEA Awj ) QAX AeW q @
EeX p dK A ZT p ]R e
A_ ÀX AE A} Q p A}EAE V_
www.ganinivf.com
U \WBK AF^ eeXK Ap @

pAkd V}K @
GEA Awj @
\R }U @
fl[ \ flAp @
13
fl\A} - c - Aq A\^ \E
5242321 / 5260069
ZpA_ AeW A^
Ap Qp Zp|
GHA AwjBE _ q V}L AR Bv ,p\_E \L^CE ZRL A I_ ZZQ q [ >
] wk flE Edwards & Steptoe LFL^ b yAk\F Aq \a MUK K
ZXL^CE \v flA Ze}E q\^ fleE q [ ZRL YAL [ [ .1978 Ap \E
.ZpA_ AeW AÊ AR _K flZZQ \j A^
AhF A "G\}K" E \v flA p wLX ZpA_ AeW A^ qK >
. AE hF V}K ZBLAE AT iqE
1000 - 400 p LUK w iT \| [WBK q_K flZ^ p GR >
z EAd A| AT [ A , NO \a W A h \Q\
- 4000) \R 5-4 p\ ]K p , A NZT AbL \O Jeq A AbLE
fi[ ZTBE Gd Z| AAwj ZT A \e [WBK flZ_ MA (\Q\ 5000
.AbL
xLXK Qp AW flZp ZQK Z| E A `w q flZT ^ ZQK Z| Z >
:p Qq GA^ fi[ H AW ZLq ,AT AL F_AE Q flZp
fl\te _ v , q }\j ZZUK j p q Aq [ \FLq :Q] ^ 1
flZpA_ AeW A^ ZXL^ ZL "A QK k_F" Qq \k A
A Q] e Zg ` M| Ap
d AkL_ Z}E A AU GIk
LUL _ Z}LE , M| \e| Z
ZXL_K A flAp \k \e| Ap
d A LT Z}L A QK
.fl]Q fl\Lv
p ALp
O v : \WBK GF^ 2
flZ_ Av A| MA l}v iFL lbK
d A I ^
Zp \WBK GF^ A [ .AhF
. p q ZLq Q\
>
>
~EA_ q \WBK ^ Zp 3
>
AzQ qhE ARLK v ,ZpA_ AeW GA^ H A wL xLXK :A wL 4

.AQL A ZXL^ Qq GA^ \O Az iFL lbK \|
>
]\ TAL AQL G_T p AFj ]\ Qq GA^ xLXK :TAL AQL 5

.GIk
>
92
.q ZE F| A FÂ q Qp kW GIk rh >

A A \tL_K z fld Qq k fi[ [WBK
\j ZT ZXL^ fl\Lw fi[ W L .rHA^ 5 4 H
hL ,q { SA\E G_T p ZpA_ AeW A^
q FkL A [ q AL|K [W SA\F [
.wLX AdUv \Q fl\Lw fi[ W
Aq AQ] q q T\ d Zp GR >
q GIk Aqg Qq k p A A
:AL A} PT
.ZXL_L^ }\k 1
>
. }\k bw AR flZU {] SA\F 2

>
:AL A} F_AE dAW ZXL_ 3

AZXL^ }\j b T p ZpA_L^ x Ap }\j
IA AN
AnwT
?KAbL^ ZqE KAbL^ ZE ZF ZXL_ ZE A ZQK
bL_ A[ GIkAE AeK GR L
fi[ N
>
A[W M|K
L ZT F_
>
>
>
>
>
>
>
>
>
: }qL wLX AL|L 4

bw Z| E , q ]Q Zp | p \Q Â^ bE ZLq }\j AR a
.GIk F| flZU Zp AFK AQ] q
>
..\L^ ..A @
Aw Aq [ ..\w Z A p _ ..qAE Q] A p
Qq ^ [ GF_ \p ` " Zp \ \L .. A AK Q]
GIk q .."flZ}q eeXL Ik fi[ v .. Z\ A \q GIkAv
^ GF_ Q] Zp .. q }\k fi[ Z \q [ feXL
Z \q ..\L^ Zq ALAE GIk E Ve qw AE }O Zq N xqg
F_AE _ A p ZLqK \WBL p AR À} \q GR ,\L^
q Zq flZU z fl\Lw fi\K ZqE q AR F_ :k_F }\kE Z \L
Zp z] fl\Lw fi[ Ah} ZqE q }\j bv AR p AE tF .\
flZU z] fl\Lw W q p \L^ {q [ .\ q Zp ZqE ZT
.bw \L^ fi[ Zq ...\ q Zq
\Fe @
S] v ,Ap \FqK A p Gqe \I A _w A Fp UL Q] a

Z Z}Lp ..\OE \O E ..A AEA_T ~} k
flZpA_ AZ flQ AQLAE PZ q AkL^ gA } _ W Z
VFeL^ Q]L nq }q \WBK [ AL M^ { LT E A
.A }p ` \WBK AqK AUF^ ~A CE fl]Q fl\Lv ZqE b
93
iFL lbK
Cv [ ,q Â^ A ZT iFL lbK \FLq
q T\ _w M| , AbL A^ \k \O
Zp AO q [ q_ .A fl\I F_
iFL lbL \j flZp ZQK . \v ]K LT AhF
: ZXL^ p ZLqK
ZpA_ AeW A^
(\|) 1
>
.\| p flAFp ,iFL lbL A ZXL^ \O >

iFL kb A \v flA p Z [ q >
.%50 F_E AX flZt
:AL A q [ e >
iFL Zp A MFO A
iI `K AT
\b flZ Ak} AT
GF_ R \WBK AT
ZXL^ x|K ZqE \WBK AT
. FT
A L_ A iwX A q [ rw >
e F iI lbL AX flZt A\wK
.(LH) , (FSH)
>
>
>
>
>
,A %75 - 70 Zp iFL d q [ VR >

%35-30 q a 6 fl\Lv W \L F_ eK >
qEAL QA ZE A nq ZXL^ >
.(A_) e v AQ ARE iFL
94
ZpA_ AeW A^
A A FAs ,\a 12 - 6 p kK fl\Lw ZXL^ Zp hw >

.A %80 T a rE O W ZU
.% 10 T AqL^ Zp L ZT F_ rwK\K >
[W flZ ZE 13 iFL ZU A flAp >
iFL ZU AFAtv À [W A ,PAO AO
.ALq p A flZq flZ \WBK Z| A 17 16
I_ \NBL IA \p
At ~q Z| A T\ kF Abt ^ } 1
.Abt [E z
~q Z| A T\ ~qE flQ \v fAeW \t 2
.T\ ~p W A qeE
\T AEE A_T Z| 3
\ \tLE A_T Z| 4
.iIAE A K Z}v Ap Ap\RE fi[W K 5
>
>
>
>
>
(\|) A_AK 2
>
AE q }\k `wE Z [ q
(}T) FSH e lb 3
>
.iFL lbK fl| Aqv \O fi[ \FLqK >

p A[W [ ,flZq W fi[ fLK >
_AE }FK A }T fld p [WBK \| fld
.pA^ 24 p kK fl\Lw
p LUK AQ flZp wLX Z A\a MRL >
, A} A ] PUE FSH e lb
: y A_L Z| p LU Av
} ZXL_K
\a MUK
GIk
A_ ZXL^CE
A ,(LH) ,(FSH) e F
LT [ ,iI lbK p _
e F } p ]\K p PAO AO
. Follicle Stimulating Hormone (FSH)
OZ AQL MpAkL^ gA qE p W
ZE } fleE k p LUK OZT AL
AQ AL Ap ZLq [) qIk Ae p ALp
.( O
\I Zp iI lbK [ ZXL^ >
.AhF
95
Z] lbL K Z| A \UE fi[ ZXL^ GR >

,(q V}LAE A ] ewLAE \qL^) iI
AQ ZXL^CE A fi[ hI EARL^ qEAL GR [
A , F W dAW (A_) e v AQ
L_ p fiZ} rwK [ Q\L^ UK vAg
Z]lbL ZT LT flA] F EAOE q
.flkW b [ iI
GIk \aAF \a MUK fi[ ZXL^ GR >
v AQ AQ ZXL^CE iI lbL LqEAL feXL
.F W (A_) e
FRL_ qhFv } p fi[ Z_ EARL^ xLXK >
Z}K A .Ap Ap\ \W iqF ALU ,fl\te Ap\
.q p Ap\Q Z_ ALUK \q
ZpA_ AeW A^
Z_ ALUK
:v \F p\Q
_ Z}K >
flA >
vAgAE A\wE A iFL lbL fi[ ZXL_K >

r iFL lbK O flZZp Qp S\E [ ,
.GHA Awj _ q V}L pAkd V}L
A bw A iFL lbL fi[ ZXL_K >
.iI `K AT dAW iFL lbK
.%70 q a 6 fl\Lv W \L F_ eK >
.%30 T fi[ AqL^ Zp L ZT F_ rwK\K >
ÂL A F Xh -4
}| 90 Ae AX flZt Cv AO AF A A
[ R ,ÂL A F Ap ]\K AF\}K
MF}L^ ,iFL kb A AX flZt \wK
\v x| lFO [v M| j `w AX flZt
[ YhK Xh fi[ Cv [ .iFL kb A
AX flZt \wK LT }| 90 _
fi[E iFL AR F_ eK .iFL kb A
fl ALT ,fl %81 T }\k
.qIk G_ EA} G_ fi[ %20 T
Xh G_LK
Apa
ZXL^
Z}qL
.AX flZt _ AT }\k fi[ ZXL_K >

AFj H AZXL^ Apa }\k fi[ G_LK >
AE\| fl\w jA_E s\AE \W \kAE A}AE eeXL
fi[ ZXL^ \QCE dA Z}qL \n ,_ qIk
.ATAR \O Z}qK | \W \j Q _w M| }\k
96
ZpA_ AeW A^
Prolactin \F F_ AwK p 5
>
,Prolactin \F F_ rwK\ A iqE >

A wLX \kE iFL p \NBL AwK [
.AhF p _ A \v p \aAF \NBL
AUg A) wLX AdUw AUL p GR q F| >
F_ A| UK rQ\K , ( \WBK AF^ AE
:AL AF^ ZAE \F
oT \F AwK AF^ v\q
flZ [ F_ AwK AF^ iqE
.Ap F_E rwK\ [ ..flZtAE
\v QE [ F_ AwK r|L Z|
\F F_ A| GR s\AE ,ZO
. F_ AwK Z v\q A ZBL ZAE
ZAE \F F_ iwW q AR qEAL
>
>
>
: ZTBE \F F_ AwK AFj Aq >

Bromocriptine E\\F 1
>
F_ AwK q MZXL^
Ap\Q flZp p [W GR .Ap pAv MFN \F
F| ARZK A fi[W ZF hw ZT
O IA \p GRL l^ [W [
.ft iqE
qv } } Fs\AE A_T
Quinagolide ZQA 2
>
E\\F A}p pAv `w MLFN OZ

[W [ LpAv fl\Lv kE ZQA AL .. Bromocriptine
.| IA g\p Cv [ ,A flZT fl\ \|
\q , fi[ [W |ZE GIk Aa AFK GR

.A RZK Z p\Q ]K Ap
>
Cabergoline Q\F 3
>
Bromocriptine E\\F A}p pAv `w Z [ MFN

LpAv fl\Lv kE Cabergoline Q\F AL ..hv
.| IA g\p Cv [ ,A pF^ \ [W [
97
pAkd V}L
_UL LAq ZqE A_ }T pAkd V}L

.AhF AeW GÂ M|L T\ W eAeW
A "G\}K" E \v flA }\k fi[ ZK
.AhF
ZpA_ AeW A^
: pAkd V}L An Z @
fl]A AhF Zp flA] iI lbLE \v flA
.pAkd V}L A [w Qq flZ W AeW
>
ARE AhF qEALE ,AeW O M|L v\q

.F ~\j p (A_) e v AQ
>
.AeW O M|L A }T
>
}\kE LAqE A_ Awd fAeW _UK

[ ,A jAb A \O AW p LbK dAW
Ga A Ab T } A fXL
p AE Aq fi[ \j flZp ZQK.(A Z) flAh A_Q
. A_ fAeW
>
FAE ZQLK AF^ q }\k fi[ GRLK

. ZT rK T\ ~p
>
A }T
T\ W
A_
LAq ZqE
_UL
eAeW
98
ZpA_ AeW A^
?pAkd V}L Qq flZ W L [ A @

: A L pF^ T pAkd V}L Qq flZ \tL_K
} vAgAE ZXL_ A AFAs : iFL lbK 1
AO ZLE (AF [ qQ) iFL kb
lbK \E xW iFL lbK An A A FAs .. flZ
wj" AT iFL lbL \W AÂE A iFL
.Ek } Zp dAW , \R AeW "GHA
>
p (A_) e v AQ ARE AhF qEAL 2

p LUK ) eT 3 - 2 eK LT F ~\j
K [ R , 17 p Z] RT (AhF
.AeW fi]AQ iI \ iFL fl]AQ AhF
>
iFL }T [W L ,GÂ R AhF eK AZp 3

\W L .iI Q\W [ AhF L LT
.} [W pA^ 38 36 T ZqE iI AhF
>
.fi\hUK L ]AE A A_ p e ZqE 4

>
fl\k_| kÊ T\ W (LAq ZqE) A_ }T L 5

flZqE F| iFL r|L M| L } Cv rFkAE ,dAW
\O } [WB A FAs ,Ap \ZXK } ALU ,ApA^
\ F An G\K A_ xb p A L ~A| 10
ZXL^ ) dAW Ê fl\k_| \\K N T\ ~p
L AZqE .. T\ xRL WZK LT T\ ~p ULwE (ZT
.xRL [ W }
>
.} L ZqE }| 30 flZ \\_ ]L GIk Gk A A FAs 6

>
T\ j p T\ Gqd RK }EA_ T\ ZqE 7

.R AnL A 14 fl\Lw \L_K
>
:pAkd V}L ZXL^ A\vK GQ \b @

.qIj (N ) | p flZT Av flA| Q
.AhF PT qIj fleE q p A| AhI
>
>
\Lb "}q" A_ Awd fAeW K

A VFeK A_ Aq ,flAL K
.hF V}K p flZ| \O
>
99
:T\AE pAkd V}L A ZXL_ A @

p ZqE Vg GF^ ZE) GF_ R \WBK AT
.(Â^ AdUw
.yAO QZ Endometriosis `\LZ AT
.iFL xqg AT
A ]\K } B : A_ fAeW xqg AT
ZXL^ GF_ ..AL\T }K ,fl\I M_ QZ
T A ]\K AwX Zp }\k fi[
%7 T T\ A e qIk
V}L Cv [ .. A ZqE FAE flQ A
.m QZ F_ fi[ rv\ pAkd
A flZ| p \N A T\ ~p \v \kg AT
.T\ qe T\ ~p kXK p
A_ j Q\ A rkL_ _ xqh AT
.F W
?}\k fi[ AR \v A @
fi[ O AR \v ]K LT OZ Ik AUE Z
N A_AE AhF qEAL iFL lbK GR }\k
eK A , GÂ M|L T\ Aq A_ }T
T flZT Qq flZ %20 15 F_
.^ 35 | fl\ \p A Qp 3 W %40
q \W \dAq T\AE A_ }T K
Z| PUE bE }L^ AR \v Cv iI lbK dAW
. \W Ik AUE KZ A ,ZQ \s
?pAkd V}L A \R \ Zp A @
\L F_AE _ A p ZLq \WBL p AR
fl\Lw fi\K ZqE q AR F_ :k_F }\kE Z
AR p tF .\ q Zq flZU z
ZT Zp z] fl\Lw fi[ Ah} ZqE q }\j bv
T\AE pAkd V}L F_AE .\ q Zp ZqE
GIk Ve A flAp AZqE , \ (3) O ZXL_ A flAqv
.GHA AwjBE \q q AeW q ULE
rv\ Z| [ \W \ (3) N qE V_ Z| AT iqE
AeW AR F_ F_ fi[ eK
| AR F_
.\ OE flAp eeXL Ve [ q
ZpA_ AeW A^
>
>
>
>
>
>
100
ZpA_ AeW A^
? T\AE pAkd V}L IA AN A @

GF_ l_E \Q K ZT T\AE pAkd V}L >
ZXL^CE iFL lbK GR \v flA] ,AwpAh
iI Z] lbL ZT ALT flA {q A ,}
\qL^) ,%1 p NZT ZqL ,flkW b A
.(q V}LAE A ] ewLAE
ZT ALT flA } ZXL^CE iFL lbK >
K NN ZT F_ T ,%10 T eK L
.%1 eK
ZqE q fl At GIk Gk Z| :q fl At >
: AF^ ZT [W \L^
flkW Z] Ab [ a dAW iI Z] lbL 1
.A_AE iFL qEAL GR NZT GRL.h\ Ud p
>
,fl\aAF } F| V}L fl]AQ AhE qE \O Q 2

e}AE A \ .K \O ZT ALT flA {q A
\L^ h\ Aq xUe AF A AL|AK
AUe Aq AFIj s\AE iFL kb } [W
Zq Av V}L flZqL_ AhF Zp \L^ ZqE
K (8) yAN MT Z| A A\L^ R A ,E _
. A pF^ 12 \O \L_ [
>
iFL qEAL VhL [ iI A EARL^ Zp 3

\W fl\ ZF Qq flZ At GkL A ,A_AE
.A FkLK A G_T p ]\K Ap\RE } Zp flA]E
>
AU AW fl\k_|
101
(q) _ AW AeW
"GHA wj"
wLX ZE T\ p \L_ Jk \a
\WBK p \Q UK k} ] \RT "GHA wj" E \q q AeW \FLq
LFL^ yAk\F Aq \a MUK q AeW p ZqE 1978 Ap ] wk Z [
kq A fl\I q\^ kXE Ee qE _ q [ Z}L YAL [ [ .
.b fi[ Aq \F Z}E
qIk
fl\w @
GHA Awj }\j
T\
Av flA|
iI
V}L
AhF A}L
iFL
q T\
z A_
AA_
Q Q
T\
fl\k_} kÊ
H \w VgK ^
GHA Awj
qIk
AhF
d fl\w MA
\q q AeW
kXK "GHA wj" E
A}E Z_ Q ]QAT
fi[ O , Av
hF A} L A
. AE
AR q Z}LAE
Awj" }\j L}}T [
Ak r_K "GHA
A
}\k fi[ A ZXL_K
[ eeXL LT
Jj \a \FLq AR
\F L_ p \L_
ZE T\ p
\W A^ wLX
,AeW flZpA_
\WBK p Z
AeWAE A ^
(GHA wj) QA
\W flZpA_ AÂE
AeW A [)
(_ W hF
A j p flZpA_ ZE
~}UL wLX A^
. Z
102
:Â^ \dAp (5) _W p "GHA wj" E \q q AeW ZLq

.AhF \I Zp lbK A LT ,iFL p AX flZt fl\k^ A} 1
.AeW FÂ Sh Q eK LT iIAE AhF lbK 2
._ AW AhF GU^ 3
.qAE ]AE dA AAE AhF V}K 4
.T\ W ( AE hF V}K MK ) Q } 5
>
>
>
>
>
?"GHA wj" A ZXL_ A A @

.Av A| Z_ AT >
.}EA^ T\ R Av A| Q Zp AT >
.GHA T\Q A eK GHA T\Q A Mbv A >
. T\AE pAkd V}L AU (3) N A VRK A >
GF_ R \WBK AT >
.iFL lbL flALq A^ A rwK iFL Zp AT >
,fl\I M_ QZ A ]\K } B : A_ fAeW xqg AT >
.AL\T }K
.] Q] Z flAh A_Q Q AT >
hv "GHA wj" E \q q AeW Aq GIk A \ A >
.SAL PT h\ Qq AW
?"GHA wj" ZXL^ A A A @

.T\ AeL^ A K A >
.T\ _Q p A}E r ,T\ kF Abt AeL^ A K A >
.T\ W _ \ AqK A >
.h\ flAT p flkW A b A >
O ,B _E BkW _ "flZ Ak} ^" T\ flZ_ A MW A >
.iIAE AhE ZQK A fi[
.\R } ALUK A >
?"GHA wj" AR \v A @
:q fi[ ..q }\k fi[ AR p \NK p flZp ZQK
fl\ ^ >
\WBK ^ Zp >
\WBK GF^ >
A}EA^ flZ_ MT ~F^ >
Ap e K AhF Zp >
.q AeW ZXL^CE ~EA^ T ZT >
fLX GIk AqLE Q] ]L >
."GHA wj" \Q L [ ]\ >
103
Qq ]\ Aq l^L ) eK F_ Cv A p
flZT Qq flZ % 39 %35 T (wLX
,^ 34 | fl\ ^ A Qp 5 ZqE %62 T
^ 37- 35 H A fl\ ^ A %30 T F_ iwXK
a ..\OBv ^ 38 fl\ ^ A % 20-17 T
Awj dAW flZpA_ AeW A^ ZXL^CE G_
\O eK Ap G_E MqwK Z| \R } GHA
.]\ iqFE ^ 34 | fl\ ^ A %50
ZpA_ AeW A^
\R } "GHA wj" AR \v @
?q E L [ ]\ p ZLq
Aq ZE flQ ]\ AR G_ fl\W \A}L Aa
]QAT ZqLL ]\ iqF G_ l^L AwK Z}L
,%40 wK AR G_ \W ]\ M}}T _w M| ,%60
~F^ A VhL .. %20 p F_ K ZqLK \W ]\
:
G_E AwK \I p kK ZQ >
wLX ]\ H AR G_E AwK ZQ >
Z}L Aq rRE Q AwL [ >
.AR G_ p \NBL q L^ [ ]\ AW GR >
wLX ]\ H AR G_ AwK ZQ A @
?}\k `w ZXL^ s\AE
\v AR G_ AwK B
G_ AwK rQ\ ..vZd \R
S {FK A p flZp ]\ iqFE
T\ rQ AL |ZAE ]L ZZQ
Awj }\j ZXL^CE dA Qq
lbK Ak v ..\R } GHA
SA\F Â^ ]Q
O iFL
n K\E AWCE L ,Qq
,Z_ LWCE xLXK lbL dAW
AhF p flQ n fi[ K
z p flQ fiZE [
ZRE At EA| \O ALAE
Cv A_ }L F_AE A .T\
OZ \Aq ZXL^CE UL |
p flA| dAW ZXL^ UL
A\s _ A ev
hv A ZXL^ AK
104
ZpA_ AeW A^
hv flQ d AhF AeW p flZ} PT

A \R Aq fiZbK [ \I kL [ .Q
kL ALA| AeK PT QA AeW
A wLX A T\ W flZqL Q AQAT Q p
AAeT AUE fiZK A [ .. Q flQ _UK
.wLX
AeW ZXL^ h\ _ e| Z A @
? "GHA wj" E \q q
Z ZZUK \WBK p eeXL ]\ xLXK
}K AR \v Cv A }EA^ A\ A ,h\ _ e|
AR [ eeXL \O \FLq [ ,^ 40 ^ ZqE
\q q AeW ZXL^ h\ _ e| Z
lFK\ [ \[L GR ..^ 45 ^ "GHA wj" E
xLX rFkAE [ AhF ]X iI UE A}N AjAFK
.\W flZ^
\O "GHA wj" ZXL^ p SKA @

?} AbLAE EAd g\p
AE ZU Z| \q GR _ [ p GR F|
%2 | }W AbK (WZK ZE ZT [ ) A}L
ZXL^ p SKA zAv , :_ [ p EAQ .Z
EAd g\p \O ` "GHA wj" E \q q AeW
flZqL wLX AeT KZ A ,} AbLAE
AbLAE EAd F_ LW Zp Z A Aq fl\O AU
"GHA wj" E \q q AeW ZXL^ Zp }
. A}L AT p \R }
AeW A \R \ Zp A @
?"GHA wj" E \q q
\L F_AE _ A p ZLq \WBL p AR
fl\Lw fi\K ZqE q AR F_ :k_F }\kE Z
AR p tF .\ q Zq flZU z
ZT Zp z] fl\Lw fi[ Ah} ZqE q }\j bv
A flAqv q AeW F_AE .\ q Zp ZqE
\L^ A Zp a ..\ (5) ` ZXL_
A , ZT \ 5 \F Zq }\k fi[ ZXL^
5 p }\k fi[ ZXL^ \eL} A IAs } Z\
ZLq A h a .}\k bv AR p \
.q A K [ ]\ p
105
?"GHA wj" E \q q AeW ewL qw k A @

,treatment cycle Qp fl fld p \R } "GHA wj" E \q q AeW L
A pa \O Qq An A fi\[^ A Qq flZ AK Qp n \j flZp ZQK
:AL k Qq flZ LK [ ZXL^
AhF \I Zp lbL _ K 1
>
Sh T\ LT AhF \I Zp \L^ lbL _ K T\ fi[ Z

\L_K AZqE flZU fl\Lw AhF \I Zp qIk flZ ZU A ZE , A
:\j flZqE [W [ LHRH-a [WBE L ,l}v flZT hE
qw j }AE >
AL |ZE GIk A\[ AL|L AFK q [ O oT :x ~\j p AbLÂE >
.AL |ZE GIk A\[ AL|L AFK q [ O A h oT Z MUK } >
iIAE AhF lbK 2

>
p LUK } ZXL^CE iIAE AhF lbK L

[ ZXL^ ,FSH e lb
Zp GIk ZU .AhF \I Zp iI lbK
Z] lbL ZU LT ZXL_K GR } p
.} fi[ O ZXL^ IA AN ZT iI
AhF qEAL 3
>
kb } hI EARL^ qEAL GR
e v AQ AQ ZXL^CE iFL
Ultrasound Scan F W (A_)
: qEAL fi[ Z ,Transvaginal
AW K e qEAL >
. GÂ R eK LT AhF
ZT iI Z] lbL ZT GRK >
.iFL kb } ZXL^ IA AN
.AhF GU^ M|K ZZUK >
106
_ AW AhF GU^ 4
>
GU^ L GÂ R AhF d Zp

: _ AW AhF
LT HCG iFL }T [WK AhF GU^ F| >
.AhF A T\ LK
e v AQ AQ ZXL^CE AhF GU^ L >
AW lwa AQ flZpA_E F W (A_)
Ap ZX \NBK MUK GU_ [ \Q L >
An ZXL^ A A GIk B Z| >
.AhF lwb ^ T\ kF
.AhF GU^ \Q F| ApA^ 6 p }K fl\Lw \b Zp GR >
.ApA^ 4-3 ]\AE A}F ALUK k_E p AhF lwa p >
.EU_ AhF ZqE q ZqE GIk tF^ >
qAE (]AE dA) AAE AhF V}K 5

>
Aq A_ Ah N ,dAW }\kE fi\hUK L ]AE A A_ p e ZqE

A flA \n A A \vL Ah \LK AhF
. Aa V}L ZBL AhF fUwK A F\}K pA^ 20 - 18 ZqE ,( A AhF)
.AhF %80 - 60 V}L ZU flAp
T\ W Q } 6
>
A iqE v ..A \m G_T \W AT \W ]\ Q } M|K ZZUK xLX

A_} ZE Z| U} hF K PUE pA^ 48 T ZqE T\ W Q } L
d A A_} AT PAO LT AnL L A iqE .. AW 4 N W
À Q } L flZUL A dAW ]\ iqE ..A Z}K \O T\
[ AnL K qwK\ G_v [ _ W A qIj ZU A NA ) A_
L AT iqE ,T\ W Q 4 - 3 } L A flAp .. (A GÂ
Q } L .. ZT \v flA] _ Z}L flZ_ MA dAW Q \F Zp }
L Q } ALU ,}| dAW Â| Awd dAW EF ZXL^CE T\ W
.Ap ZX \NBK MUK
AnL T\ 7
>
fi[ \tL_K ,Zp AFN GÂ M|L LT T\ W Q } K fl\Lw

^ fl\Lw fi[ W h\ A[wK q dAW Ue A M_ .A 16 T fl\Lw
hF At flZpA_ q [ GIk Z .. GIk we^ [ q [W
p LUK flAp q L , MIOK [ T\ kF Abt U}
iqE Ve [ M| v , T\ p AFj xLX .hCG \_Q\F
xLXK Aq \AE \W Ve ,M| j \\_AE A}F {q [ T\ iqFE AFj
.. T\AE Ue p AFj Zp AR G_
107
Qq flZ W iFL lbK GR A @

?"GHA wj" E \q q AeW
ZpA_ AeW A^
flZp d iFL lbK SAL q A^Z MLFN

, flZT hE Q \OE hv Q flZp ALAE AhE
lbK eeXL Qq ]\ nq MUFd [
SAL d q AeW Qq Z AhF
.flZ_ Z qIk iFL b A K LT hv
?h\ AE ]LK GR AqL A @

.A \T A[K GIk AqL ZQ AL^ >
: F_AE dAW M|L AqE AL >
.Qq SA\F wLX \dAq M|K 1
.ZU q M|K v q [W M|K 2
.AL |ZE q M|K L AhF lwa oT 3
.iFL qEAL Zp 4
. F_AE Vg \s A p GIk ^ >
GR (]\w `) QO AE AwLTAE AL >
iqF Q 25 | fl\T Q fi[ owUK
AQ 8 p }K fl\T QZ \W ALUK T
.Aqw Z}wK xL AFe^
>
>
>
>
T GHA Awj AR G_ GF_ A @

? % 80 - 60 V}L F_ s\AE %40 - 30
p Z]K qIk T F_ A fi GR
V}L F_ s\AE .qIk \b flZ %25-20
Qq flZ W F_ Cv EU_ AhF %80-60
ZLq A T\ kF Abt Q At p ZqE ZLqK
:A p flZp p
Q] ^ A \v AwK \q v :Q] ^ >
.^ 35 |
T\ W } Q Zp >
.Q rQ\K Zp T\ kF Abt ^ >
AhF Zp AwL^ iI lbK GF_L

?B _E _ flZ x|K \| ALAE hIAE
AhF Zp AwL^ iI lbK GF_L v ,rAa BkW [
ZXL_ } \|AE lbL [ A ^ ,hIAE
] W K AhF \q GR .A AT
A AF\}K A 50 A \tL_ l}v \b flZ
AhE flZp K qIk \b flZ W A }EA^ A\
108
ZpA_ AeW A^
:iI lbK GF_L
Zp AwL^ >
AhF
flZ x|K ZT >
\F ^
ZpA_K .flZZp AF^ A \L_ A W

T\ ML AhF p }
\NZ lbK ZE M\K A T\ ZqL_K
Zp AhF Zp AqQ gE [ RL ..MUg
iIAE flQ AhF Zp [Zqv MF flZ ZT
AhF Zp s\AE hE (x AqE) 400000 T
400 p Z] A fl\ flAT W h RT eK
\L_K T\ WZK AhF Zp \w ..hE
.hI lbL Qq Z W AZXL^ L
?}AE iFL lbL IA AN A @

IA AN ]\LK ,IAQ AN ZE p A `
:k} }AE iFL lbL
.iI Z] lbL 2
.\O K 1
>
>
\O K 1
>
ALAE ,T\ W Q 3 - 2 } p q Lb
} AT v :\O K ZT ALT flA
A, %20 T K ZT ALT Cv zzQ
M_ A) ZQ wqhv K 3 T ZT ALT
rg AT A .(EAbL K ZT UL_
T K ZT ALT Cv T\ W Q 3
GR .%6 T v K 3 T ZT ALT A ,%30
\O ZT p \NK p flZp ZQK fi A
:O wj
.Q flQ >
\WBK GF^ > ~EA^ T ZT >
fl\ ^ >
,K "GHA wj" E \q q AeW Z GR \O Z}Lq
AT nq \K A ) [ O AwpAh iqE ZT \O A fi GR
:(AwpAh ZE L T
GTAe Z ltg AwK >
:fl\F fl >
j l^L uF . A Â^ bE wk Ud p \NK Ab fl\F fl \FLqK
AT A pF^ 37 fl\Lv l^L iwX ,ApF^ 42-38 ZT wj AT fl\Lv
.Awj 4 AT A pF^ 32 Q 3 AT A pF^ 34 L
:z | >
Ue Ab wk | Av Â^ bE wk Ud p K Zp wk \N
uF .q\^ fleE fl\ Z}w _ fl\T p Aw p flZ} dAW wk flAT p \NK
\Q 2,5 wk l^L iwX , \Q 3,5 ZT wj AT wk l^L
.Awj 3 AT \Q 1,8 L AT
\^F Z > |A_ K >
dAw \n > fl ZqE F| x] >
.`wL h \kg GF_ A kF AwL A >
109
:iI Z] lbL 2
>
A k_F fleE ,iFL lbL IA AN

,q AN k Z p iI Ab flA v ^ T
h\ KAwL AQZE iI RT flA A
]LXK (%1 |) A ZQ | ZU Z| ,\W
.AZK GR Ud b b A _ _ R_
: A fi GR
b iI Z] lbL Cv A nq >
.A | h\ Ud p }}T flkW
}W p ZT \v Z] iI Z] lbL >
.Q
AQ \v Z] iI Z] lbL >
\I Zp Q r | EAd g\p Z_ \O >
`K AT [ .iI lbL R AhF
fi[ Ap ~FkK Z_ [ {q iI
[ ZU E iI Z] lbL A ZU^ Awe
.Z_ }
ZpA_ AeW A^
:AQ N iI Z] lbL
k_F QZ 1
>
h\ \qbK ,A % 10 - 5 T QZ fi[ ZUK

A_T r kF w^ }k }OE [ } l_E E
iqE A_T [ GTAe Z| ,}k fi[ l_E AwLCE
[ ,\[K Ud flkW QZ fi[ bK .w
Ve A A FAs [ GIk E ^ AW p ALUK
\O rg [ \L_ A nq ._ \a flA]E
A T ZT dAW fl\Lw kK Z| ..F^
.iI Ab Z]K
k^L QZ 2
>
,kF w^ AE qb [ AwLAE A_T ] A

ApAE A_T r } } AE Ah QZ fi[ ]LK
GR A .`wL Eqe iqFE h\ \qbK Z| ,ZZb
A}| AeUv h\ fUw^ fiZE [ v GIk E
AkK Zp A ZBL wLX AdUw iqE \R^
flA T\ A fi[ p A^ .e} QZ
WZ GIk Gk Z| ,A\F _ \a
.} A_ OL q iqE [W bL_
110
ZpA_ AeW A^
e} QZ 3
>
xe | ZUK v QZ fi[ \ e A A
\ }}T Ud flkW T\ fi[ bK ,(%05) A
T kF dAW _ R_ ZAE flQ _
.M| \^ AZK GR Ud Ab GF_ A G} \
\a MUK bL_ L A fi[ O p a
Aq A fi[ O p A^ .feXL GIk
p q Lb ,feXL GIk \a MUK fl\L_ Ik
weE wLX AUL p [ wLX AU [W
A fi[ \L_K .AQp ALAE A kK p |
.rHA^ NN F^
?ANZT v GIk tFK GR \p A

AwL [ R Q r m fleE kF AwL >
A^ } AOtAE A_T >
F AwX >
`wL Eqd >
?iI Z] lbL ZT GRK x

:AL VAe AFKCE iI Z] lbL ZT GRK
\q [ v , \WBK AR feXL GIk \a MUK q L
ALp } Zp ZZUK [ ,iI Z] lbL Z g\p \O
.iI Ab qEAL A h
>
.AhF qEAL ZE iFL kb }T [W GR
>
(A_) e v AQ AQ ZXL^CE fUwAE AhF qEAL LK

.ZAE Q\L^ F_ A| A iqE \ ALU Z| ,F W
>
[W \L^ ZqE q fl At GIk Gk Z| :q fl At

| rg A kK GRK L [E ,h\ Ud p flkW b \L^
.flkW \O flkW
>
111
?qIk A T\ Q AQ L L
z K ALAE AE hF V}K L ZqE Q] ÂL A W A qIj ZUA
5 H \LK flZ (AeW L PT T\AE iI eK flA} ) Av flA| W }F
ZT T\ kF Abt W z (W ) At T\ ZFL T\ WZK F| A 6
..A qIj ZU A [ ..
?T\ ZRE Ât F| K T\ W z a A

flZT W :
AW 4 T :
AW 8 T :
A fl\I pR :
ZE Z| A Xg Zp :

AO
PAO
rE\
A_ À
:_ pR A_}
L^ T\ ZQ W At p _ : pR
z K : yAO pR A b ZqE A
!?Q } G_T p AR G_ \tLK

G_T p xLXK AR ~}UK G_ p wLX AUE Av
:AL Q p Q }
AR G_ p
}
%25
AO LT
%43
PAO
%69
A_/À
?g [ MOUE A^Z \W ZT A
q 2003 ^ \W Zd AAeT \W Av
} GHA Awj Ap rQ \n Ee \
:AL ZQ (p 81000) 2001 Ap W A\Q K \R
.PAO MK _ K W Q } Ap %76 1
A_ /À A} K p 19000 T 2
.%9 l^LE PAO p 6 / 5 G_ 3
.wLX \q T\ p flQ G_ AwK 4
G_ Z| E ,A rQ 6 / 5 Q } GÂ 5
.PAO Q }
>
>
>
>
>
?} p AE G_ \tLK A
: G_ AwK AF^ flZp A
qwAE kK Z| K A_ À }K Q >
}K ) Q \L_K T ,At fl]AQ T\
.At T\ eL (PAO AO
112
.PAO AO Q Ap A_ À Q \O T\AE flQ I >

,rE\ A ZLE m fleE AhF} fi[ }K ,Q \kK Z| AgAF} T\AE ZQ >
.Q \j } A
.qIk T\ ZU A : k_F fleE >
?\R } GHA Awj AU flAp Q AQ L L

AO LT dAW AAhT Q p Aw L _ AW AhF AeW L ZqE
T\ F| NN flZ T\ WZ z A oT ..T\ ApAQ L AZqE PAO
.LT LpAv p \N Z| A T\ AkE W Ât
?A 6 - 5 fl\Lw _ AW Q p A}E L A
hF q fi[ ._ AW A AkK Q p \NK flZZp fl\O p A
[t } g Q fl\ \tK Ap flZZa Â_UE ]L z
Awj q flZ| T ZK p AR kU I p r k_F fleE kU
ALAE flQ AhF flQ A h q .A_ _Q W ZU A flAAU GHA
.AL [ A} Aq_ flZZp p A ..QA q UK AKZ|
?A 6 - 5 fl\Lw _ AW Q A}E p A
kL p flA| Q M_
6- 5 fl\Lw _ AW A}F
AUE Av [ ,A
rk_K Q 2/3 T
\n _ AW flA
GR [ .wLX flZZp
kK ZT \[
T\ PAO Q
} L {q [v Z}L
ZU A T\ Q
.A % 10 7 T
Q } GÂ
A_ À
?A rQ
Q } GÂ
rQ A_ À
G_ d [ ,A
L flZU \Aq ZQK Ap T
AE FÂ A AW
.Ap
113
\R }
I n t r a C y t o p l a s m i c S p e r m I n j e c t i o n (I C S I )
ZpA_ AeW A^
wj" E \q q AeW p \R } xLX

V}L p ZLq "GHA wj" v : hF AeW "GHA
,_ AW qAE L [ A hF qIk
W }UE hF V}K L \R }
|Z As flZpA_E AW ^\ MUK hF
F_AFv [ .AR [ eeXL Ap AFj kÊ
} p ~Fk .A F_AE Ik \Q xLXK v flZ_
."GHA wj" E \q q AeW fiA\ A \R
: AF^ Q Zp }\k fi[ O B A flAp
] A_AE A Zp | >
(p A) _ A Zp | >
V}K p _ ] p LUK A F_ | >
. A \E AhF
q AeW \Q ZqE AhF qIk V}L ZT bv >
.}EA^ AU GHA wj
Awj" ZE \R } ZXL^ B >
AhF V}K Zp GRL AhF V}K ZBL "GHA
.GHA Awj }\j ZXL^ Zp ZU [
flAh A_Q Ap ]\K Q >
.GHA wj q AeW \Q W AhF Zp | >
Q] ^ Z}K >
114
GHA Awj \R } H LW Fb Q
:(GHA AwjBE A ] qQ Z] v\q) Fb Q @
AhF \I Zp lbL _ K
iIAE AhF lbK
AhF qEAL
_ AW AhF GU^
T\ W Q }
AnL T\
1
2
3
4
5
6
>
>
>
>
>
>
:LW Q @
wj" }\j v :qAE (]AE dA) AAE AhF V}K \w

L LT AW ~Fj hE p ^ T x A T \K L "GHA
} }\j ..A qIj AZQ A fi[ ZT \LWCE hF AeW
.hF W }T ZT T AW L \R
?hF \hK AE hF }T p @
..AhF %95 T AE hF }T \h
.A} R A I^ \NBLK AhF %95
?hF AeW AE hF }T Z @
ZU ...AEAeW ZBK AE hF }T {q
.AhF % 80 - 70 T AeW
\O \R } ZXL^ p SKA @
?} AbLAE EAd g\p
[ ,1992 ^ fl\ \R } ZXL^ Z}

A \O \O \R } ZXL^ LT
F_ flA q AUE AFj ZR .wLX Aq
kÊ T K [ Awj Z } AbLAE EAd
.\R }
? \R } AR \v A @
AeW AR \v p }K \R } AR \v
T\ d yA r|L ..."GHA wj" E \q q
.. A %95 \O T\ Q }
?GHA wjv Ap Z]K \R } \Q A wL @

Ap %20 UE Z]K \R } \Q A wL Cv ,q
rQ\ ..."GHA wj" E \q q AeW \Q AT
115
O As A ^\ ZXL^ flA] fi[ GF_

L |Z As ZXL_ A wL [
.flZT fl\ AZXL^
ZpA_ AeW A^
? AE AhF }T \Q A @
Aq AqL A_ _Q AW \F hF
_ [ :\R) AW ^\ MUK L GR
gE hF PUE dAW Awd (\R
AQK ^\ [ ZXL_ ..Ap flAg \NK ZE
:A v q \Q F_AE A ..|Z Ap OZT
K ] q ] flZpA_E hF lUK A >
.A_w hF p \N A
A p LU [ ~Fk A ZT GU^ >
A_T AW wLX GA^BE A\hUK K ZqE
.}|Z fl\E W AZT GU^ L .Ahv
(\UL \s AqQ ) hF MIOK L GR :hF MIOK >
ZQ \td ] l_E lwbE L .hF }T A LT
.(\ \qa ZT ^ ) At }| lwa fl\E kÊ AZQ
W p LU }AE dA fl\E AW >
L ZqE ,hF W rv L AZqE hF
K Z| [E ,hF AW fl\E GU_K ZBL
.\R }
hF Sh
hF QA t
EL_ s
(hF WZ t)
hF MFOK fl\E
\UL AqL
A}T AN
LUK }|Z } fl\E

p AW
hFAE kU A
116
G_ MqwK
\R } ^ 12 ZqE
!"GHA Awj" ^ 25
GEA wj \E ]
Awj Aq
fl\bp \E 2002 Ap Aq wLT

}\j ZXL^ wj ^
ZXL^ a v .. \R }
Z A Av Z| }\k fi[
.. \WBK Aq E
}\k fi[ ZXL^ ZE [ ~
flZZp AqE Gk feXL [ xg
ZXL^ AbL Zp vZL_ K
.q }\k fi[
Aq p yA AqE fi[
A ^ A flZ |
.AK e A_
\R } ZXL^ Av A h
\O p R A p ,AEAeW n hF H |q Ab p GtL
LT \R } MFN A . ! AR A A Ab p GtL \R } ZXL^ AK
AU) AAE ^\ Gp QE AA}Lp AQp A Z}Lq A A
ZE wLX AAeT W MFN Z| E ..Ab E M_ Awj (\Lv L
p ^ 12 \ ZqE ..\R } ZXL^ R AbL F_ flA wLX Aq
? \WBK AT q ZZ AbL p Aq q x|K }\k fi[ ZXL^ ZE
\bq p Aq nq Z}Lq E) gA p fl\bq W Aq AQ Aq Z
flA p fi[ W Z A E ..\R } A UK flZZQ }\j AbL (A}
a ..}\k fi[ ZXL^ AR G_ flA \W qE .. d }\k fi[ flZ|
A\n v .%50 p Z] ZqE AR G_ flA qwAE ~}UK Z}v ..flQ AR G_ flA A
l^L) flZUL A 1994 ^ flZT AU F_AE wj fl AR F_ l^L
Ap W %37,8 eL F_ fi[ MqwK T ,%21 AAZQ (300 \O ]\ rQ
!!! %60 wK G_ qwAE Md Z}L ]\ iqE ZQ ..(AeT \W) 2001
} GHA Awj dAW flZpA_ AeW A^ ZXL^CE G_ AwK a
1999 _E A \W \\}L Aa Z}v ..vZd \R \v B \R
| KAQ Ap MA A) ]\ 107 %40 \O Z F_ ZqK ]\ Zp
MqwK ]\ fi[ F_ .. ]\ 83 A 1997 ^ ]\ fi[ ZqE AA| .. (^ 35
]\ Zq F_AE A .kL [ O ZQ fl]Q fl\Lv l}v AL^ W A F\}K PO Z}E
,1997 ^ ]\ 23 Zq [ A T ,1999 ^ W ]\ 39 Av %50 ]QAT ZqK
117
AE ZK G_ fi[ ..]\ fi[ Zp %69 flA] F_

AwK rQ\ ..]\ fi[ ZU \I kK A a
T\ rQ AL |ZAE ]L ZZQ S {FK G_ fi[
AAR ..\R } GHA Awj Qq
:rFkAE \e ` \[ I^ p AL T F_AE
iFL lbK AR @
AUE Z Z} ..iFL lbK d \j flZp ZQK

E ,\W \j iFL lbK hv \k iqE Ik
Ap weE iFL lbK p \eU A M| Z
ALAE [ AhF p flQ d p ]\ A Z}E
ZRE At EA| \O fiZE [ z p flQ
AFj Z a Av .. \L^ T\
A Q Q d AR [ eeXL
\j PZ q AK A h .hv ATAR F_ \q
\k rkL_K Z_ Zp dAW iFL lbL flZZQ
.. AhF A Zp d iFL lbL Ap
N ^Z OZ AQL ZXL^ W vAgAE
Z| fi[ VK }\kE iFL lbK A\ rzeK
.pAw AFO \F
G_ fi[ rv\ ZT \ep p ZLq AR G_ AwK
AH A pAwLK }|Z q fl\I pR A E
p iFL lbL OZ \k ZLqLv .. AR AE eL
a Av ..Z_ r eK q }\j p ]\L Zp
GF^ PT \W p xLXK dAW F\K flZ^
wLX q fi\s WZ A\ G_ \WBK
VFd ..fl\aAF \s fl\aAF fleE iFL p \NK
AR A q^ wLX A O }L eeXL
iI `K AT Ov .. lbL \k hv
hv bE A }K \h VFd ZQ qAb A
Akp E q Zq O f}E _ K
ALAUE |p A h\ Z}LqK Z| dAW
}\kE \N E .. _AE _ pAv Z]K
.. AR G_ p ALAE flb AhF flQ p \WBE
`\LZ ^CE \q T\ ZtL AT [
q QZE `\LZ Q Ik AUE MUgBv
LU p ovAU LT q }\kE LAq ALU iIAE
Z}E Ap ovAU GR fl\W[ AhF iI
.flZRL \s A A
ZpA_ AeW A^
xbK dAW \eK }\j

AhF flQ Z p
118
ZpA_ AeW A^
A
Zp MA [ g\ p \R } AK
AE ZQ A AK E , A flZ
A ZXL^CE A_AE AT
flZp q\^ kXE \_ AR [ Z}L ..eAE flQ
fi[ ,AR G_E AwK AR AARK
: AARK
OZ \Aq ZXL_K PUE A_ UK | :
\Aq AE \tK `^ rg [ \Q\ Aq AZE
.1999 ^ [ Aq Ue n AZXL^CE VeK
}K OZ \Aq ZK
A }}T
Ab v ,AeW p AKZ|
A }EA_ \Aq flZZq
flZ} }} rg `qK
AhF AeW A
T .. d
O ZXL_K OZ \Aq
q p xb dAW A sAFd
F_E AAE flQ
p \Aq fi[ }K A ,Ap
SAL .. A \T
\Aq fi[ ZXL^ fl\aAF
VRK MA flZZp AT }L
AeW Zq GHA Awj A
AeW VR T AhF
T ALX [ \R
AW A hwL GF_ .. hF W } ZT
.GHA Awj V}L bq \L ZE
A ev p flA| dAW ZXL^ :A yAN
A ZXL^ AK A fl\I F_E _ \s p _
Q ALAE [ AhF AeW p flA}
. \L^ T\ ZRE AeL p flA|
p xb flZZp \j AFL^ p q AUE ZE :A OAN
[ , A ^\ G\L ^
.^ wj d A \O ZXL^ p A h
119
T\ AW AeW q
ZpA_ AeW A^
AR G_ rv AR [ r\_ q Z}L A^
q AUE MvAg AO I^ qv AE AL_ QZ
\N A Q AhF p T Aq M| x|LK
AhF r AqL ZXL_ GA^kK A Ap
AR G_ rv kL [ ..Q A
:kL fi[ iqE p ]\L A ..m }\kE
T\ W Q AQAT v\q p wLX A^Z ] 1
Ap O A wLX A AZQ ,wLX A
L^ _W H A \LK T\ AkE AÂt F| fl\Lw
GHA Awj Aq flZ| flA ,AEAeW ZqE A
_ AW Q A}E
LT j fl\Lw
GU^ ZqE A_ À
AQ ALAE ..AhF
fl\Lw T\ Q
A F}L_ qIk
[ O Q T\
..qIk ZU
A^Z MUg
À Q AQ
\v flA A_
.. dAW \bE
p A}E \^ W
fi[ _ AW Q
GkL ^ ` fl\Lw
F_AE ^ dAW A j\a
TAL Q PT flZ_
F_AE [ PAO
[ ,GHA Awj q
Ap dAW \a ALU
A U .. Z}qL |Z
p XL ` \e
fl\Lv [ AZE Z}v :G\
\s ARL MA A 6 - 5 fl\Lw Q p A}E E\RK
~}UK p }EA_ fl\Lw W Z AqkL^ qRb
L_ p MqwK Z| qwAE G_ E ZQ qRb SAL
.A_ À T\ Q } R %48
>
120
ZpA_ AeW A^
cqK \ I p wLX A^Z MUg 2

hF AeW p fl\ LW \NBK p hF A
dAW AE^\ ZXL^CE K ..SKA z flQ
..AhF WZ G\L p fl\ LW \NBK MUg
Aw e fl]Q AW p fl\W ]\L K A
._ AW AhF Q AN fl\ p
>
q W }K p flZZp A^ MUg A 3
\tK A .. G_ Q flQ p \N q QZ
Ap Q W VFdBv GHA Awj q V
PUE q QZ W ltg \tK K E A}
\t fi[ WZE \_L LT kU \t p ltg
.GHA Awj q v\tE Q
>
fl\O AqE \R } GHA Awj G_ AwK

Zp} MEO BE Z}Lq A A \O \I Z \s
\k G_ AW A ..b|A AR LUK Ik
\WBK p Zp
Ov ,wLX Qq AW A^
fleE ZXL_K }\k MA GHA Z_ GF_E
flQ A|AeL }|Z AT\ ZXL^ A}K
Q r %30 p Z]K }\k fi[ O SAL \q A
G_ | r ~EA_ }} , wO \s A|AeL
AT\ MA ZpA_ AeW A^ \k v\q AR
T\ AnAE TLw AqAE MA ^ }|Z
AwK AR G_ AwKCE A M| ..qAE ZQ
AW VFd .. }|Z GHA AT\ A wL
GHA Awj }\j ZXL^ d \^ ZQ
Ap ZQ VFd ALwK MhwX AQ AbL r
..T\ ZE
W z AQATCE ALv\q flA]E A h PZ q AK
A l}v ` Av | Z wLX fi T\
\K AL A h hI T\ H d F
W z AW Zp G_T fl\tL z wLX AQAT
H A 6 - 5 \tL_K T\ W ,fi Z}K T\
fi[ O AFLp rh GIk {q A .. T\ iI
flZ| A h G_ AwK Ag ...A }K AN q
T G_E AwLT r Q Zp }K eeXL AFj
.L flkW } ZT wj LT Ap
121
Gamete Intra Fallopian Transfer (GIFT) Mw
AZp AhF A G\}K p Mw fl\v }K

q AeW FbK ,AeW flZqL_ K
lbK dAW AKkW \I ZT "GHA wj" E \q
:AL k} p xLXK AhF
iFL qEAL [ iFL lbK `w Mw \Q ALU >
K AZp AhF lbK ZqE ,GHA AwjBE A
A A) _ A AFU_ fi]AQ
kF An p \RK ("GHA wj"
An kÊ A AhF GU_K
.Ap ZX \NBK MUK
A_ p e L An p \Q F| >
dAW }\kE A_ \hU ,
A_ Ah q AN ,eAeW _UL
rgK N ,EU_ AhF Aq
,Av flA| W A AhF
ZT K Mw \Q Zp ]L_ [
A ZQ A AK ^ | p Av |
.T\ fiARK \ q
AeW F_AE Mw } Z\ AZp p\ GR
:"GHA wj" E \q q
ZpA_ AeW A^
Mw VgK ^
AhF p LU ~Fj
A
^ | p Av | ZT K Mw \Q Zp GR >
.q AeW \b [ ZQ \Lb A AK
\Q W hF AeWCE A ] AK ZBL L >
} GHA wj }\j ^ _ AW AeW
,hF AeW p Aq Mw kq ,\R
.Mw A _ A Fp \FLq A
fl\td AULv p {q A kE An p Mw \Q ]L_ >
.q fi[ O GHA wj \Q ]L_ ,kF ZQ
.q AeW p Mw AR F_ xLXK >
Q Aq \I kK ,gA } p W, ZT >
.Mw hv q AeW SAL qQ
\WBK p eeXL ]\ nq hwK }EA_ AF^
\kK ZqE LT Mw \Q p q AeW \Q U
AT ZE T\ W fi\Q AAE VFd [ Mw
.kF An q
122
A|AeL v GHA T\Q >

| Z_ p L .fl\ Zp \WBK }q AF^ %22 T Av | Ab OK
An ~\j p kF VLv ~\j p A|AeL v "_L" }|Z T\ \QCE A Av
p ] ewLAE A \q^ .GHA AwjBE _ [ q V}L \QCE
. }\j
T\ ^
>
L_ h\ qK PUE \WBK }q GF_ p T\ \Q q_

\O rw q A qIj ZU BE T\ ^ AL ..qIk Ee
iI lbK AwpAh flZ_ \q ^ [ ZXL^ A ,T \O [ fl
p A T\ \Q AE^ A ..wj \O [ iI Z] lbL dAW
:AE T\ An AL T\ An ~\j p kF VLv ~\j
.q \Q ZqE \W fl\ A|AeL Q F_ AwX >
bL_ A}F ALUK T ApA^ flZq q \Q ZqE bL_AE A}F h\ ALUK >
.kF VLv ZqE A flZq
.T\ H^ H SAL xLXK >
AwjBE _ [ q V}L \Q p }q p T\ ^ ZXL^ hw

:AL A GHA
.^ 34 | flZ_ ^ A >
. k_E Av A| T flQ A|AeL MA >
.Hydrosalpinx Av A}E ZK ZQ >
.A ` flA} ]Q p e} Av flA| Z_ A >
.AW ` flA} AW p fle} flQ q MA >
.}q \WBL \W AF^ ZQK >
:AL A GHA AwjBE \q q V}L \Q hw
j p Ap fl\ ^ Bv A}EA^ A\ Av ...\OBv ^ 34 flZ_ ^ A >
q VR Cv \OBv ^ 34 _ A Cv p , d AR
Z}L q V}L AR G_ AwX _w M| ( \a 12 flZ AnL {qA ) T\
.\q
.T\ \Q \n \vLK >
.}q \WBL \W AF^ ZQ >
.F| A T\ AW T ZT >
.`\LZ Q O A A| A Av flA| xK GF^ A >
fAeW A Gp A B ] TA }q \WBL GF^ Q AeK >
. A_
.q T\ ^ ZXL^ ZqE \a 12 W ZU >
123
Q\ .. }q
Q\ ÂL A
F
YE\F
WZ GHA
AW AkFK
A K
10
F
Gh}
>
>
: Q\ ÂL A L
YE\F
e
AKAL^\F
e
>
>
>
>
Testicles e
A ,_ AW we ` W e ZQLK
,z L T\ \n d AA
ZQLL A [ eW \QAK T\ W
fl\ Q K GR e qK v ..T QH AF^ fl\R fi[ .ALq AA
Q 37 fl\ Q ALUK _ Ahp }E XE Q 35 T A cqK
QZE _ }E | fl\T Q \vLK PT we ` e \QAK [ ,
flQ Z }Fj Q Zp Z |\ [ ,_ AW fiQ L Ap : IF_
iwX lU [ e ZQK Z ..fl\ Q p nvAU Z flAp
: _ W AA}E \q fl\
. A Zp >
.F}L_ g\p \O e qR >
QA ULw
Gh}
\RT eW LK ,\q ^ 25 T k ^ 5 4 HA e ALq R

.. ( A K AAkFK ) ZQ j q GHA p A LUK flZZp
rRLK ..\^L_LAE \q \[ \ \wK A ZQK q\ GHA fi[ H A
.YE\F L e p q\ GHA fi[
YE\F
Epididymis YE\F
p flAFp ,YE\F L e p q\ GHA rRLK
qIk p k T v L Za L ZQ q EF
T e (fi\v K ) YE\F j ^25 p Z]
W . T vA_ fi[ rk} ,\L 5
A_ K \tK YE\F kF A qK T\ fi[
..\ p AKZ| flA p q AE AAE lU
.YE\F AW F| AeW p flA| A MA
. F YE\F
d GHA
e
WZ GHA
K AW AkFK
A
124
F
AKAL^\F flZs
F
Vas Deferens
F
hp EF
35 T Aj
A_T ^
,e p
F ZF
N YE\F A
Z MUK Zqe
e
ULv fiARK
xeL q
YE\F
WZ [Xw zN
MUK
e
}L A AO
e flA}E
we `
AZqE ,
.Gh} flZpA| Zp F flA| VLw AKAL^\F W \

Seminal vesicles e
%50 T jAX A^ AKZt \wK ,AKAL^\F xW AO MUK ZQK AK\td AKZs A
. A_
AKAL^\F
PN T AKAL^\F \wK , F \R flA| ZE Zp AO ~p lUK bb RT flZs
.fl] LU A_ kq | ] A^ p flAFp AKAL^\F flAep . A_
Penis Gh}
Rw^ S_ p A LUK hp ]Q NN \[ hqAE \q Gh} L
10 T j flA A ,_ flAN AeL Zp fl]tE Z ~vZL R ZL EA|
WZ TA AOAE eL F \R Gh}AE ZQ .^ 17 T (AXK AT ) ^
.Gh} \E L LT
Aa PqFK A ,YAE Aq Ieq ]\ IK ALAE _ flAN ZUE AeL L
Z p Ieq Aa fiZE ^\ [ b FAE AeL ]\ Ieq
f}LK [} ZqE .. Gh} R_ GeK K ZAE LL r_LK ZL Gh}AE flQ
A Z .. AXK rg Gh} flp A A Z }K Z p
\O Z jAW A}Lp A E .. Ee p Â^ bE \N AeL AN Gh} j
.A AN AeL Zp Gh} j \e| rQ\ KAQ Zp \WBK GF^ BE
125
A_
Q\ ..}q
? A_ L A
:Â^ \ep A_ L
LK ..Q\ ÂL A : A >
hF AeW ALU ,fl\L_ fleE A
L ... ZU LT ZT p
[) [ A ,N flA \ U .. ~p
K .. \T p _ v (T ^
\q .. A_ RT %2 T A
T _ AW \td Ap
. _ AW \F hF
fi[ qK ..AKAL^\F e A\wK \v >
GÂ lU Ap A}E A lbK p \v
.ALqIj
{q A AN A_ \W Z GR >
A_ LU A iqFv , A p LU
.e Â^ Gp Q AT p
:wLX Ae A_ A BK @
e
%65
AKAL^\F
%35 - 30
F
%5 - 3
? A LK x
,T\ flZp ZqE A LK >
_ Y q ]Q \w BE ZFK
F \ Hypothalamus `NF
fiZE q [ LHRH \NAL A
A \v p AX flZt PT p
A lbK p _ A FSH & LH
[ A L eAE flQ
A K [WB .\^L_L fl[
.A 90 72 H \LK z fl\Lv
_ wLX fl[ \An H |p A fi GR >
_ AR p Q\ flZ| H \^L_L Ap
A_ fAeW a fleE A K Ap
hp \qb vAO Q\ QA \n Cv p..
[ !!Q\ EeW _ flZ} flAwAE |p fl\vA
!!Q\ EeW p AeL Q Gh} RT H |p v
A\
126
Q\ ..}q
:Q flZp \NAL A K fl\ p Q\ xLX

,z p (hF) fl\ Zp \NAL AW K L >
( A) fiZp \NAL AW K L [ Q\ `qE
.fl\L_ fleE
Q\ `qE ,fl (hF) flZT W fl\ Zp LK >
T) fl\L_ fleE A K L [
.(A 200
dAwL VgL fl\F fld

dA
[ n ,AhF q Zp AZ fl\ ZK AZp >

flZ x|K ^ eK LT AK [ \L_ f|AL Zq
A K L [ Q\ `qE ,AzqE A
.\q fl\WBL T\ LT fl\L_ fleE
fl\ Q\ Av[} A Zp
?flZT
Q\ Av[} A Zp AQ uF
. T 300 T flZT fl\
A Xh Zq [ [} A
hF AeW ALU T
?ZT T
\L ^\AE fld
zL q ZT VgK
(\Z \)
Z}Lq ,%100 } Q p _ [ p EAQ ZQK

: rQ\ \I Zq [ AT GF_
. fi[ T _T hF V} v :"hv A}F"
>
LW F A \O
QZv.. A_ F H g Q
\O A|) g K F g
} A_ T (N\
.(ALT p A owLUK LT)
>
fl Z} `w p fi[ M_
.}W p Z AhqE \ xqg AhqFv
>
\_Lv bp \T A \T
ALU hF A eK v [ ARK
...bq \AE hF AhqE e LT A
F AhqE Z}w ... A hF e v
qv
) \W Av flA| T\ [ T\ ~qE \W
.(\W iI fiARK
>
127
A AbqK z] fl\Lw A
?
Q\ ..}q
ÂL A W A 3 - 2 cq rkL_
.fl\
? \WBK AFF^ Q\ L
A_ Z p Q\ flZ| ZqE Q\ GF_E \WBK \q
A Z| p LU [ qIk ) qIk
OK .F p (hF AeW p flA} A
~F_ Q] Zp \WBK AF^ PN T AF^ fi[
..F| A ~F^ %20 T ,F| A
T ,fl\AE GF_ A %40 T oT
.A %30 - 20 T _ A q fl\ Q\
Q\AE AFF^ Q Zp q F_ MA Mh ^ flZp LT
AbL ZqE dAW gA \bq _ W wqg
LT At fl\I F_E q Z}K , (ICSI) \R V}L }\j
MFO [ AXa Z LT ZT AAE VFd
!! A Q Zp A_ UK
Q\ p Z}K
AbL ZqE \O
\R }U
!! \WBK Q\ Zp K AF^ A
_E AFpL_ , \WBL Q\ Zp flZZp AF^ ZQK
e A K T\ A^ p AwK A
:F p Ad LT
A LE }qL AF^
A dLE }qL AF^
A \T }K AF^
ZU A :Q\ EeW AwX Vg GF^ Q Zp
.A %40 - 30 T
>
>
>
>
: A LE }qL AF^
\O , A h LE }qL AF^
A Zp | A AF^ fi[ K .Apa AF^
xqh R hF AeW p AKZ| AwX
A fi[ Aa }W p Q AL\T
Ap AF^
A\AE }qL ]\ AF^
eAE AF^
>
>
>
128
Q\ ..}q
:Ap AF^
:e fl\T Q AwK 1
>
:O e fl\T Q AwK K p flZp ZQK

.A fl\L fleE WA^ AT [W
.AA pAd A p LUK WZ È `F
._ }d WZ È `F
Aq \vA fl\ Q A rwK\K ~jAAE q
[ QA \LF p G}L ZqL ApAd
A^ }A^ [ .qwK\ fl\T Q Q g\qL
flA_ flA| p GkL [ Ub A^ fl\Q
.j \Lw
>
>
>
>
: 2
>
, A K p Ah \N iqF
: fi[
AhE A p v\q Z ltg AwK iqE >
.Calcium Antagonist _A
^CE Ap v\q g T\} iqE >
Cimetidin Z^
Nitrofurantoin L\Lz >
, Salfasalazine Âw_A Aw_ >
Steroids A_Q AF gA\ iqE A[WB } >
!!! Anabolic
EeW p \NK Z| iqE

. A T
129
:g\ AF^ fl\ Q AwK

Z| g\ GF^ Q 38 p _ fl\T Q AwKCv
.a 3 eK Z| flZ A K p fl\aAF \N
flZ fl\ Q AwK GF^ G_T p \NBL [ xLX
. q fl\Lv ApAwK
Q\ ..}q
: AU \a WZL 3
>
\NBL a A wLX Ik AUE Z

A K p AU WZL Ah
ZqE - zZ TA p flp - Ve [ ,
Zp WZL Zp [ ,U AE\b AK
AR [ "cb" Aw [W
p l}v ` J_ \N fi[ b
.AEAeW flZ| ALT p E A Zp
:Aq Ue A 4
>
A K p \NBK ] \ iqE a A
,] bw ,\_ F \ : \[ I^ p ,
A iqE v G_Uv [ ` .|Z flZt AE\kg
AhAE Aq [ ~ AL O L| g\
,L| fl\Lw A ]\K | GF_ Z}v ,_FA
] A_ UK flAp Aq GIk Ve Z| [
. A_ fAeW qIj p \N M| Ap Q a
AAE }qL ]\ AF^

F \ \v L_ AwX K AF^ fi[
A\ \v L_ AwX [ LHRH \NAL A\
eAE flQ A lbK p _ A FSH & LH
\v Ah iwX A , A L
oT .y\ \v L_ AwX R \L^L_L
fAeW AwX nTE A fi[ O p \qL
. FSH & LH A\ \v L_ AwX [ A_
ZU A \F \ F_ AwK AF^ fi[
]\ AF^ Cv \O fiZ}Lq A XE Ap weE .. \O
%5 - 2 T bK A Z qAa \s YAE }qL
.wLX AAE AF^ fi[ O AqK .. A Zp AQ
GF_ A A
A\ f}
\WBK
130
eAE AF^
Q\ ..}q
ZQK
flZL \s fl
p _ A GRL_K AF^ fi[ O

L F A\ eAE flQ A K
nTE A fi[ O p \qL . A
\v L_ AwK r A_ fAeW AwX
:AF^ fi[ FSH & LH A
[ b :we ` e ] Zp O }W AF^ >
, \WBK GF_K fl[ \ %1 T GF_
ZT ] Zp AT %50 T \WBK ZU
.e AL ] Zp AT %90 T , e
ZqE AL ZT dAW eAE Mumps A AL >
.Ee Z}v A %25 T F T\
.(_) Z \ AL >
.OI A q >
.OI pAqa q >
.e >
ZL [ kF ALv O g\ AF^ e fl\T Q AwK >
.e
.Ag GF_ e T _ rRK A } \ >
. A g GF_K R AF^ >
Z
?AL A e A
ZQK
131
flZL fl
.e d fl XhK A}LT e >

T ZQLv Apa AF^ \O e \FLqK >
_w M| ..}qAE HAe AQ\ %40- 20
A }p GF_^ {q Z Q Z GR
eAE Zp [ (PN) 1/3 T Q\
\s p xLXK qIj A_ fAeW K
eXa [ AQ\ AQ \O E ,HAe
.flZpA_ ZE A qIj U Z QE
Q AwK A \j flZqE \WBK Z GF_K Z| >
.e wm p \NBK \NK e fl\T
A %60 T ..\_ TA ZQK A flAp >
.TAAE ZQK
. A \T ]\K Zp p e \NK Z| >
iqE ,z xbAE e fXbK L >
AQ ZXL^ \ ALU Z| k_F dAW A
. (EZ) e v AQ
iqE Ve T v e q flZp ZQK : q

\W \ ,e q T\ WZLAE AFj
M| ,T\ WZL flQ\ SAL MFOK q AUE
ZQ ^Z Ap L_ p Ij A^ A AT \RK A
fi[ SAL \K LT ..e q T\ WZL
T\ WZLAE eeXL AFj Ve , A^Z
gE AeXbK L B Z}L T\ Z MA
r A Q] Z ` _w M| z xbAE
k_E QZ MA A .^ 34 ZqL A^ [
flZpA_ AeW A^ ZT ZXL^CE Ve k^L
. A_ UK R G_T p AH A AW L
Q\ ..}q
: A dLE }qL AF^

Zp | Q Zp nTE A fi[ O p \qL
A \v qIj L_ r A_AE A
:AF^ fi[ .\L^L_L \ [ FSH & LH
.}W AF^ >
\ O _Q Zp AEAL K Z| AEAL >
._Q \s AEAL ,AZ _
~\kE F lE ZU Z}v : ~Lw q T\ Aq >
e [tK Z p lE rk| Z| A ,Bk
. Ag T\ AN
:AeL p Gh} flZ| Zp >
\ F_ AwK A GF_ [ K AF^ flZp ZQK
fi[ O ,AeL Zp AT %5 ZU A ,\F
fleE AAq F\\F O Z q Cv A
. ZQ g\
.Gh}AE }W AF^ Q >
:zN \ T ]\L A fi[ O p
A qd
T\ ~p W
L A q [ rw :T\ q
AT\ fi[ LK GR ..Z_ A ZZUK A
H^\ AT\ fi[ O eeXL kÊ
Q] K GR flAa AE ZR ..}|Z
}L A M| Q] LT _ fl\td
A ... q AR p \N ZE T\ AR
ZXL_K A hw ^ 35 \O Q] MA
(ICSI) \R }A ZpA_ AeW \W \k
ZTCE : AU GU^ A^ ZT ZXL^CE
LT YE\F A GU_ OZ \k
.e
132
Q\ ..}q
A \T }K AF^
flAh A_Q K Z}v pA A A
dAW A Aqv }K A
Q p flAh A_Q fi[ K GF^ \q .AL\T
K Z| q iqE ZQK Z}Lq ,ZZUL
I q eAE AL }EA_ AEAd O AQ
,A\F p pA A \qK \tK Z| wLX
AE ZR . "qIj \s" p "qIk" AFLp K Z| [
A flAh A_Q Q ZU Z| A flAa
..%18 F_E LT AwX {q AQ ,
fi[ O q \k hv \W Ik A^Z flAa
flAa _w M| ..\R } }\j ZXL^ A
.flQ\ R ~}UK q \W \k A^Z fi[
. LT R \U }K L AF^ nq MA
Q\ AT }K
Jk YAL
ZBL [ Jk YAL [WBE flAp A }K ZF
GF_ rQ\ A PT Q] |q
v ,A Ab A %5 T
A A AqL^C Ak_E GF_
flAg A p LU Z| [ vW
GIk B_ Z| . A KA| AT iqE
AZp \td A_ \W p
Gk A AO A_ ARK {q Z|
A_ \W ZqE M|K F UK GIk
GIk ZRL^ .\_ F \ AUK [
\Q dAW \te T\Q \Q p B_
F Ae %17 - 3 T v ALw T\Q
p GIk B__v [ .T\ AN
[ AA }EA_ g\ A
AUA Aw jAqK Ah ZXL_
\I \g \hK vW A cb
. A K p dAW
Jk fUw
_ j O fl\O \dAp Jk fUw b
G} A^ |Z flZt p xb \qb rK
Gqb ] AL GTAe Z}v ..\
133
ZO fUv Ah fUw b !YE\F K }W Gp

.Q\L^ \ F_ AwK AT A XhL Z| [
Ahp fUv .. kF fUwE GIk } AZqE
we ` [ Gh} fUv hL [ ew ÂL
eAE A Q Zp ZBL KLbE
fUv Ah ALQ eAE Q fUv [
.AKAL^\F
Q\ ..}q
Q\AE dA AFLW
A_ UK
p ZLq j p AFLW A_ UK\FLq
Zp GR [ , Q\ Zp GF_ A Ap ZZUL }k fleE
:AL flAp\ UL [ \Q
: A dAW UL \Q Zp GIk AqL A ]L 1

>
_W p Z]K p }K GR :UL F| Q] fl\aAq p AL flZ >

5 \O LT AQ \W [ z] fl\Lw MA UL \Q hw ..A
.fl\Lw K ZqE K Z| E ALT }K ALqIkE A A
.A Q] fl\aAqAE ` ,(\_ flAq) AL^ :q p e ^ >
|ZE fUw L LT q Q A UL \Q hw :q p e A >
GR .. pA_ p Z]K fl\Lv q _K GR A p .fAe xLXK ZE
Q 40 p Z]K Q 20 p }K PUE A}L AN fl\ Q p nvAU
._ F\| q K Ve [ ,
` ,q^ ULv }q AW Ê A q rRK GR :q rRK >
GF_ , r Q\ ^ ZXL_ [ (Condom) \[ Aq
ZQK) .ALAqv p \NK A L}K A p LU \[ Aq
A p LUK (Condom) \[ Aq H\t Z iqE
.( AAE fl\h
LU q ] dAW q rQ L flAp\ GR :q rQ >
. A Ap ]\K p
Z| A fi\s EAe A (\_ flAq) AL^ AN ZXL^ Zp >
.UL SAL p \NK
[W fl\ Q AwK FTAd \ fl\e| fl\LwE UL ~F^ >
\s R \m a 3 fl\Lv ZqE UL flAp A GR ÂL Ahp p \NK Z|
.UL qIj
134
Q\ ..}q
piqE VgK ^
A K
feXL q Zp UL \Q 2
>
}\j p ZZUK UL R p Aq AFj ZLq^

A F_ AwX AT ZQ
Ov .. q
AwX %15 p L p _
A^ QA {q A qIk AÂE AhF V}K F_
..\R AeW pAkd V}L O ZpA_ AeW
,q fi[ ZZUL dAW AFd ZXL^ UL [ GkL
A Ab
qFj T
A |
=
!!!! AZRK
135
AAE wLX p
,A feXK p p UL [ \Q p A}
Q Zqv .AK p AAE A Ap ZU
Q Z| A qIj L^ R {q Z| UL |Z fi[
\W }\k \W GF^ p xb AU Aq GIk
TA . . _\ GF_ AqK A UQA K Z| q
A Zp \I f}E zq A MA \W
\vL LT EeW ]\ UL p A hw
A V_ ZF ) flQ A ZRK yA
fl\F T\ A Zp f} [ Z| ,([E
A ZRK oT .ZqE A A Q Zq
.z_ ZZq e
Ap AnT
Q\W yAN 60-30 W \LOXL N
A^ A_ >
fi[ W UL Zp ) .}| 60 - 20 hs A^ UL
.(AK| ZT AKAL^\FAE W Q {q Z| fl\Lw
^\ AZXL_ feXL kÊ A UL L >
feXL kÊ UL iqF \ ..\KI kÊ L
O AkW iqE \KI ZXL_ S\FAE ZQK hv
q Z}L .| AZp BE AT Q Zp \}
q fi[ \O MAp fl\I kW AR [ kX
.z}L
A_ ]\K L : AT Q Zp AT >
. A p PUF centrifuge ]\ \k AQ ZXL^CE
TA ^ A iqE H A|AeL Q >
flAh A_Q Q {q Z| A TA A
. A \T }K p qK A_
\O A_ AhI Z A\ Zp A AT >
UK \Q ALU A AL Q {q Z| [ Cv ,
Ah hv [ A\LF v\q Â_T p]
.A\LF fi[ Aq
A ,qIk | A_ RT A iqE >
p xb A_ p ZqE E p p e \ GkL
, A_ ARK R FAE A iqE Q
.\_ \ AT iqE ZQ A
Q\ ..}q
UL R }K
,ewLAE A AL^ \dAp flZp A_ UK AL
Aq Ue n eeXL A AdK p A ZLq^
:A Ap eeXL ]\ nq Ap ZLq (1999)
qIk Z}
\L 2 A_ \O
8 - 7,2
20A_ \O
40 \O
A \ %50 \O
4-3
%15A_ \O
%75 \O
1 |
%40 |
flZT
dA
\L
R
hT flZT
h Q
\L/
A ]\K
. AQ Zq
\UL F_
\ AQ
4-1
\ Q
% a p ZE A F_
%
A F_
\L/
AhI Z A\ Zp
%
flAh A_Q AFLW
A_ UK }K ZQ
n AdK p AE qIk
1999 Aq Ue
136
Q\ ..}q
.\L 2 A_ \O : A_ 1
T 20 \O : A Zp 2
.\L
: A \T 3
:AL_ flZp A \T _}K
(A) A q\_ \ : rE\ L_
(B) A kF \ : PAO L_
(C) A M_ kF \ : AO L_
.\T ZQK : L_
\O (A) A q\_ \ MA qIj R \FLqK
L_ A \ K , A %25
. A \T %50 \O A q (A&B) PAO rE\
A qIj a GR : A a 4
.%15 \O
QE T \UL A AqRK Q 5
. A flAh A_Q
8 72 : g Q 6
\L 1 | :AhI Z A\ Zp 7
\L 02 | :\ Z A\ Zp 8
fAe rQ K GR A AK qIj R K
ZT q LW Q Zp ,fip fl[ Z
kq [ UL R p q ke ~k fAe
A ,ULAE Q Gq p Ug flAa GIk
R A\}K Z| q Ake iqE \qL_
:AUL
.qIj R : Normozoospermia >
. A_ AT ZQK :Azoospermia >
. A^ ZQ :Aspermia >
20 | A Zp :Oligozoospermia >
. A_ \L T
| q\_ A \T :Asthenozoospermia >
. A %50
A RE AbL F_ :Teratozoospermia >
.%85 p
| A Zp :Oligoasthenoteratozoospermia >
A_ \L T 20
A %50 | q\_ A \T
.%15 | qIk A a ,
T AT Q Zp : Necrozoopermia >
. A_AE
>
>
>
>
>
>
>
>
AU fld
ALsAFd ZqE
137
.hF Z A ZT \LW }}T fld

138
Q\ ..}q
A\ UK
GF_ a A\ UK p fLX GIk Gk Z|

W qIk p A_ fAeW LW
\WBK GF^ v\q Z^ A UK A
:A fi[ ..
FSH
LH
Pralactin \F
Testostrone \^L_L
Thyroid function tests |Z flZt A
>
>
>
>
>
N fAe UK
p [WBE L ,A^\ ULE A h UL [ _

flA fiZUK A_ N fAe Cv \q Av .Z
flA fi[ \qK ,A_ AW flQ flAE flQ N
fi[ ^ ,A^\AE _ AE N
.Q\ Zp N GF^ A A Ap v\q A^\
Post Coital Test A ZqE A fUv

\WBK }q AdUv :AO AF ewLAE fUw [ A\
."Â^ \s AdUw" p MUK fl\ Zp
e p [W
Gk Z}v , A_ AT Q Zp AT
Z| [ GF_ v\q e p [W fLX GIk
Ug fld kq Z| ^\ MUK q ^ .eAE
A h e p [W Z .eAE Q p
q [W L .\R } ZXL^CE q yA ^Z
MI i\ ALU Ap ZX \NBK MUK e
[W ZqE AR [ eeXL \O hw .bL_AE
Qp fl \Q Q] \hUK AT e p
A Zp ZQ A Cv ,\ } AK
A}T (A }EA^ fl]R) AhF GU^ L e R_
Z ZQ A \W A fi[ K AE\v AAE
K ZXL^ L LT ZRL yA \vLK GR A h !!]
A iqF A_L .A| Qp A
ZRK eXbK p p ZqE A Q] \hUK \W
A iqE A \ ?ZQ A A
A AT Zp eK ZRL \Q W ALT Z}wK
.ZqE A
139
W ZQ q\^ }\kE kL Q\AE dAW AF^ p SKA \WBK p a A

T p flZp flAp\ GR ,b fi[ T PqF A gA } _
:Z ~}UL LT flQ\ R d
p ]\L Zp GR ,wLX AUL \Q AN Q] ZT Zp GF_ AbL Zp >
%20 T \W \k ZBL GR E ,}q ZT GF_ p AZT
ZQK \W \k GF^ ZQ M| `w Q] ZTBE }q GF^ ZQ A
.Q] Zp \WBL A EAF^
QBK L , A_ UK p Q] Zp \WBL AUL LbK GR >
fXL Qq k ZZUK Zp {q , flZ_ ZBL L LT UL [
p J_ \NBL Z| }} GF_ d QBL E ,\e| M| b fi[
.q AR
AE q
q 1
>
FF^ Q\AE dAW AF^ p SKA \WBK AF^ %5 | Cv A}EA^ A\ A

Z| ..Aqv A Qp A\AE q l}v A fi[ .._AE \ AnAE W
KAwL AR AQZE GF_ \q \s Q\ }p p A\ AFj iqE ZXL_
A}p ZXL_ Z| A .\ xqg AT A | AT dAW
.\F \ flA AT F\\F
\W AE q 2
>
AAL BE iqF ..A iqE rwK Z| iqE AFj ZXL_

vW ]A wLX \dAq p LUK \| _F flZ_ Ah
bE \NK
qv ZK Z| \hK fi[ BE A \[ ..A iqE rwK Z|
A \Lw fi[ Cv \R }T ALUK A
Ov ,q kW p Â^
rv\K ,
O pAkd V}L }\j ZXL^ q }\j \tK
.AZXL^ Zp A fi[ T
T\ q
T\ ZXL_K A , A dK ~q A Q AT T\ AFj B
O q ZLq . . j \Lw Z A fi[ T\ q ]L .GF_ q
..\ GIk p [ A d Zp [ GF_ p A fi[
A^ AZXL^ A p e T\ ZXL^ \W AT
Cv _\ q Q] \p A _ . \R V}L O flZpA_ AeW
A R AnL p ZLqK \k \e| GR ,A Z AZ}L Q] \p A
.AF^ _| p rQ\ Z F_AE .T\ q A
140
Q\ ..}q
ZpA_ AeW A^
pAkd V}L
(ZpA_ AeW A^ AE pAkd V}L rQ)
A_
LAq ZqE
_UL
eAeW
W LAq ZqE A_ }T pAkd V}L

fi[ ZK .AhF AeW GÂ M|L T\
A "G\}K" E \v flA p }\k
A } A pAkd V}L rw .AhF
l^L l_E Z}E _ A ]\K
.fl\I QZE ]\L [ A } A e
(ICSI) \R }
ZT A}L ^
A
} ^
hF W
141
W }UE hF AeW p }\k fi[ ZLqK

fl\I flN \R } ZXL^CE q ZT Z} .hF
F}v .Q\AE dAW AF^ p SKA \WBK AT p
A \O p A 1992 Ap }\k fi[ xbLK
} Zp A_AE | p ALU ZQ Awqg
V}L }\j ZXL^ A LT ^ T xe
AE Av AI_ OZT }\j GHA AwjBE _ q
} AbL ZqE .ZqE }\k fi[ xbLK AAE
Zp VQA q AQAT iwX \R
k_F fleE .Z rEAd Zp p }K A
flAp Z]K q fl W vZL_ AhF Zp Cv
UE V}K hF AE ,hE 15 - 10 p
10 H A Ek A Zp Cv p ,ZT
A qFj hv . RKA AhF Zp G_T p 15 fi[ hv AW hwL L LT \F Zp Q
h Zq [ p e . A
\vL Cv , A_ A A
T\ ZXL^CE YE\FAE Q A GU^
epididymal sperm aspiration (MESA). _ A }|Z
e p [W \vL Cv ,microsurgical
A A h Zq [ p PUF
}E p A testicular sperm extraction (TESE)._
AE LqQ\ \R }AE dA Aq
.ZpA_ AeW A^
dA A iqE p
A_AE flAh A_Q Q AT
Sperm Antibodies
Q\ ..}q
AT O Qp GF_ AR AUE A fi[ p ZF

GF^ A nq .Z Q [ Z_
\T Aqv ~qK flAh A_Q fi[ Q Vg
] eeXL iqE ZXL_ .. A
. fi[ O fl\O IA AN GRL fl\e| z \Lw
V}L ZXL^ eeXL nq Ve A M|
\R } \ rE 3 Zq pAkd
A nq p flAh A_Q A \NK A
.pAkd V}L AU VRK
AO A ARK AT
Retrograde Egaculation
A fi[ O ZK Z| iqE eeXL ZXL_
A ,L AO K \bE A L Ue
FAE flQ A p e v eqL_
A fi[ ZXL^ F | flA]E zq [W ZqE
.\R }AE dA Qq Z
AE\ [}
Electroejaculation
ALAE Gh} AeL p flZ} Q\ Z}w flZZp AT
wLX AF^ R A fi[ ZUK . A_ \X
,AE fl\I AT\ ,\n AEAd ,Ieq \A
fi[ O ._w q \ A\s ,\_ \
A_ [| q AQ ZXL^ AAE VFd A
A^ AZXL^ A p e
ZXL^ AE\ [} p GkL .wLX flZpA_ AeW
N \b ULv W AW `R AW L N Aq \ZXL
. A_ [| [ A tb
142
Q\ ..}q
A_AE AT Q Zp AT
Azoospermia
ZQ BE {q A_AE AT Q Zp
q Za Z} ,AQp L A fi[ \O E q
AbL [ Ap AR G_E A fi[ O q \I kK
Ap }\k fi[ ZXL^CE wj fl \R } }\j
LX IF^ H \w Z GR q }\j w ..1992
: A_AE AT Q Zp A
A d GHA Z_ 1
Obstructive Azoospermia
>
e A AL AE ZQK A b
T\AE A q ]\L A ..AdK \R E rFkAE
AFU_E A p e r \R } ZXL^CE
Cv , (MESA) _ A }|Z T\ ZXL^CE YE\F
_ A Ap PUF e p [W \vL
fLX GIk AZU q }\k G_ p A .(TESE)
p flZp AFLp rh AFÂ fi\ A G_T Aq
Z_ GF_ Q] ^ ZT Zp fl\Lv j :O
MAj A Cv .. \W p T\ ZQ Z d GHA
GIk d A AFAtv Q] ^ \F ZT Zp fl\Lv
p e r \R } ZXL^CE \QCE feXL
.e p qE YE\F AFU_E A
eAE GF_ A Q Zp 2
Non-obstructive Azoospermia
>
p e r \R } ZXL^CE A q ]\L
_ A Ap PUF e p [WBE A
[ eeXL \O hw A }EA^ A\ A .(TESE)
\Q Q] \hUK AT e p [W ZqE AR
Zp ZQ A Cv ,\ } AK Qp fl
fl]R) AhF GU^ L e R_ A
A fi[ K AE\v AAE A}T (A}EA^
LT ZRL yA \vLK GR A h !!] Z ZQ A \W
GR .A| Qp A K ZXL^ L
A ZXL^CE d AR G_ A \[
ZXL^CE AR G_ p }K e Q\XL_
\O dAwK v\q . A_AE flQ A
.flZpA_ AeW A^ AE Q\AE
143
GÂ q ALX x
? \WBL
q AW p Â^ fleE \WBK p AR ZLq
\qb b fi[ p e \Ov , GÂ
H s\w }T Z , ~| fl\L_ fl\T
: k_ ..ZQ Aqa Aq AFj
11
?q O }\k \} A x
: Ug AEAQ ZZUK Ap GR
Aq GIk AW 1
>
GIk AW AE rQ\
144
q ALX x
? \WBL GÂ
\n
\s \W Z
d
!?fl
!!?Z ZZUK 2
>
Z AN xLX v ,Ak_E _ [ p EAQ ZF Z|

..\ A ^ wj fl d rFkAE
p ]\L \tK fl\O flZZp (\W p) WZ ZUK Z|
Z p ZU AqQ [ !!\W Z \aAF Z
d A \_K [ A}Lp (fl ) \aAF
Â^ Z ~}UK A AE eK \W Z
:AO [E ]t ZF A \_w Ap ..fl
AO
A|AeL Q Q] ZT Zp \WBK GF^ ZF Z|
A H A} ~q A ) Q] Zp AE
A ^ T\Q \Q q \Lw A ,(hF
Z VFd A :A|AeL K wAn W kF VLwE
A dAW qwAE Z| ,A|AeL v
v) Z [ ,"k_E" A|AeL \td Q] ^
d Zq Â^ Z ~}UK p AE ZU Z| (A|AeL
AAE xqh iqE QE A M\L| fl
.
AO AO
Zp A | \WBL \An GF_ Z|
q G_ flA] A FTAe \ Gs [ ]
,\ F_ | r AAE "}" zL
A Zp _UL wLX AQp [WBE ] ZF A
A_ AUK \K q H fl\O flZZp a hK Z|
A ZqE M| _UK AhqE \b Z| [
A Zp _UK " ] Z A VFe E
Â^ Z p AZT Z| A AUg ZF A ... "
B_ GR d p A]\K A ,\W Z
A Zp _UK AR G_ A :
A h _UL , AqIj Aq ZU QZ
G_ _UK r AAE "}" zL q
Aq ~jAE wLX q AUE AKZT EAQ ,\
,T AT BE fl\I M_ _UL G_ A wLX
Zp Ae} GF^ AT 10 9 T dAW
\s A GF_E n A v\q A Ug A
hv A !!Ae} [ [ }} GF_
.fl\aAF Z d q \W }\j Q] ALX
145
!!q wLX ZF ZZUK 3

>
GR A A `w q wLX ZE ZQK AT nq
A rQ {q .\| AXK F| AQ] v\q
zN AW ZF \eUK Z| ,ZF fi[ rQ A e
:AL ZF T q wLX \k fLK .A G_T
q ALX x
? \WBL GÂ
.Q] ZT Z EeAE ~qLK [W >

.Q] ZT EeW _UL T\Q \Q >
pAkd V}L >
GHA AwjBE \q A ^ _ AW AeW >
.\R }
A p e r \R \R } >
.A G_T wLX T\ GAÂE e
.{FL >
!!q ZZUK A_wL^ 4

>
:q }\j ZUK Ik q p A_wL^

}\j Q] ZUK wLX Ik q ZZq ZQK
: Aq GIk Ap A_wL^ GR q
>
? ZT \v q [ _U 1
?q [ [W Z j L| AwpAh A 2
?q [ AR p Ek z] fl\Lw A 3
?q ZF \k A 4
ARL p \N }\k fi[ ZXL^ q [ AqL^ 5
?}\k VRK ZF \k
?ZF \k q A wL A 6
?q VR A 7
>
>
>
>
>
>
>
146
AW ZUK Ik \s q p A_wL^
:q }\j
>
q ALX x
? \WBL GÂ
1000 x AhF Zp
10000
Q] ^ 1
>
z_ \E AhF ]X AwX Vg AH ^
AwX r\^ Zq
37 ^ ZqE Zq
1000
100
10
fl Zp
1
0
10
20
30
(z^) _
40
50
p q _ Ap \FLq
\n Q] F_Av ,j
AhF ]XE _ AFK
, hqK fiZZRK [
ALQAT Z _ ZU
d \k \^ ZXL^
A Z}L ] A T ..
d A TA \O _
!p\_E
\W flA \dAp \NBK 2

>
fi\w^ fi\O ] ZQK Zp

Q] p p q \NBK
AwLT WZL p ALA flA l \tK AT
. Z GÂ E
. A\R p Aq v\q \NBK
>
>
>
>
A q 3
>
K AZp dAW [ ,A Z A w Z| \WBK p

:AL flAp\ GR flZU A
AztK LT fl\I QZ G_ A rwK\K }\k ZZUK >
.x \L p
.wL p fl\aAF }\kE \N [ q GÂ A ZZUK >
]L^ q M| j \e| M| d >
.A
\s SAL Z| eeXL \s AQ Zp AUL \Q >
: A }|
.GF_ Aq ZR \s\W A_ q fiARK \tK
.\ flZp AUL flAp
.M| \E A ]L^ q \WBK
>
>
LT wLX ZFAE q yA \vL [ A AW >

q ZE Q] G_ AE q AW L
\TAE ` [ ,Q] Z}K A A
?! G_
147
!!jA A}Lp 5
>
fl Z xAX \WBK p BkW iqF Z}Lq Z|

AeW A^ \W iqF Z}Lq .AqK AUF^
AE rQ\ .qIj \s ^ \s wj K flZpA_
.flZpA_ AeW A^ AE jA A}Lp
q ALX x
? \WBL GÂ
!QA th 6
>
,q Aq A|Zd A ^
A I^ _w \N A A FAs ..Awj r GqK LT
AFLp \[K GR g [ r AqL Zp ,lth [ R
:
T Zp flQ b A eXa b ` \WBK >
Q]L 5 H ZT {q A ,Q]L %20
.. \WBK Q^
\ v eXa Gp ` \WBK A \[L GR >
[ ZUL BE \ [WB GR . Z A_ `
.eXa Z} BE g
] fl]Q fl\Lv W ] v ZT >
Q BE A_ \qb GR [ ,q fl] Z `
.A fl\Lw ZT Zp \R f}
148
q ALX x
? \WBL GÂ
\WBK
A }p `
\WBK Aq \O ZpA^ OZ q GA^ >

ZE \WBK } |Z oT [ ..
p Z]K fl\Lw ZT Zp A iqE Q Z}v ,}p
AR AqK AUF^ ~L ZU N A Ap \bq
\O qwAE ZT A ) flZpA_ AeW A^ ZXL^
?^ \bq fl\Lv _ G_ Av ,(A \O
,^ \bp flZ A \WBK fl\Lv A , EAQ ?}p fl\Lv
ZT Zp xd Cv [ . ZT A A}p MA A
Bk \WBK p ~k GR MAj A z fl\Lw
.A }p _
H AwKAE Qq SA\F d GR VhL ~F^ A
\O v ..Aq GIk ] ,Q] :NO \j
a ,Qp ZE ZQK E q ZT ~\j ZQ AT
WZLK q Ik \dAq flAp\ Z| GIk
:AE \} \dAp fK A A .fl\O flZZp
q }\j 1
|\tL_K [ M| 2
A wL 3
E Ap weE ` Qq }\k fi[ ZXL^CE AR \v 4
\W ZF AR \v [ ,q L [ A
.ZQ
F}K AF}K Z }EA_ \dAq p _w q 5
.vW wK M| AKA]L_
>
>
>
>
>
149
!!! ~A}T ..ApAa

AAL^ \WBLE }qL UUe \s Aq ZZq ZQK
!! AK\O s\AE A Z}E
\WBK ZT F_ flA qK \b flZ :(1) pAa
AN iFK ZT \bflZ qIj a flZ :(1) }}
iFL ZT {q Q {q .}EA_ flZ
M| . flZ K iFL xqg ZQ Z}v ,flZ fleE
:AL T GIk qQ\ GR _w
.Q] A AN W DE qb >
A_T ZF B : \b flZAE }qL q A| AE qb >
Z| flZ ] W \L_K \b flZ ZE F| } A AE
.flZ ]E ]
.\b flZ j kF w^BE dAW AE qb >
ZT Zp Q] ] H Z ~vK Zp :(2) pAa
.
. ZT Zp A_ARK Zp Z Aev H |p :(2) }}
\WBK A W A_ \W :(3) pAa
ZqE F A_ iqE \W ZQ qIk :(3) }}
\W GF_E Zp \WBK \O Z}Lq ,fl\aAF A
A A Zp W Zp {q Cv A_ [ iqE
fl\aAq W A_ [| K A Z Z .T\
WZ^ A A Zp Z v F W Q]
.(A qIj A_ A A ) T\
W T\ rg A rg H |p ZQK :(4) pAa
.T\ A
.H |p ZQK :(4) }}
Z b x RL T\ b :(5) pAa
. ZT yA T\ rg H |p ZQK :(5) }}
ZU LT A A L GR :(6) pAa
48 fl\ ÂL A W A cqK :(6) }}
. ZU LT A A \ ] [ pA^ 72 LT A AN Q] T MUK "flZX" rg GR :(7) pAa
. ZU
.j p qw qw ZQ :(7) }}
\a) AFLAE iI fl\ iFL ZU :(8) pAa
(A_ \a
12
150
!!! ~A}T ..ApAa
151
AL [ ZU v ,VUd \s [ :(8) }}
ZqE [ \tK ZT iI a NN flZ iFL B ZU
.
~} ] ^ ZqE ZT Zp GF^ :(9) pAa
Q]L Z_ nqv , ZT Zp ~} GF_ :(9) }}
Zp lE p v [ ,~} `w Z ZT \nL A OZT
.~}AE ZT
.nL \s v 28 ZUK flZ MA :(10) pAa
. A_L z \Lv p ZUK A {q flZ AnL :(10) }}
A| {q AE AL \p ZU :(11) pAa
flZ_ \s (T\ iI H dK flA}) Av
AE AL ZT ,VUd \s [ :(11) }}
.AL \p ZU [ Z e
.A_ xb W \WBK GF^ ZBL :(12) pAa
Ahp ^ ÂL A ^ ZBL :(12) }}
.A_ xb W wm
UL fl\ A LEAN GR A Zp :(13) pAa
A_
,UK ALEAN A Zp :(13) }}
| r|L v UK
| A Zp A
.Zq `w \TAE ` ,OAO fl\
,Q] fl\aAq AN Q\ Z Ab ZQK A :(14) pAa
A_ EeW Q Ab ZQK v
,Ee _ flAw H vp ZQ :(14) }}
GHA AwjB flZpA_ AeW A^ AR G_ :(15) pAa
.wLX Qq ]\ H LEAN
AF^ flZq wLX ]\ H G_ AwK ZQ :(15) }}
ZU qIj \ ,flZpA_ AeW A^ AE ALqQ\
.flA AR nq
\w GR A_ Zp flA QK \e :(16) jAW
. Zp \WBK p
A) A_ AE ~W Fs \v ~T flE :(16) }}
iqE ` .KAFs ~}U \v ~T (AyZ flA F
!! AkW N \W rvZ \ Zp nK _U A
` v ,A_AE T] b (rÂb \w r) } B
,bAE A_ Zp Z] LT flA^ \Lb GR flA^ Z
.\k Ve A_ ZXL^ Za\ hv
A_T.
GHA Awj \WBK p AbL^
ZL A_ \ AbL^
Ee H q hp
}q Ee \ q hp
Z - }q ZL A_ \ hp
ZL A_ \ H q hp
A_ \ \mA yAk\F q hp
: Qq ^
Z ^
Z}K AK , Ab q_ A_ Gj >
wLX flA AR fiZpA^ QK p
q Z}L AQL fi[ ZXL^ .Ue A
U_ A Aj A \b k \WBK
.Z
\WBK b AeXK Z| Q] p fl\n >
GIk fiZFL A \FK , Awj U
.d }b Q]
p " \qL " A^ ZXL_K GR >
.q \L^ }O FK GIk
\^ Zp lkXL ]\L |Z >
.Z d
Q] Ug q fXbL kW rg >
[ VQA q fl] ;flZU z AL|LE
.\k \e| Z e
,MFO q GkAE \q A p q ZLq GR >
~IkK p ]K\ , Z}L Aq ~Fk [
p ` q AUE rR KZ Qp S
. eXa Ij
sOM ]\ Aq Z] qL^
Tel.: 419 3274 / 419 3198
5242321 / 5260069 :wK
fl\A} - c - Aq A\^ \E
152
A_T.
GEA Awj U \WBK p ]\
AR flZpA_ flkL AQL ~FkK
AU ~|Z }L AFkL @
( E ) Z ~vZK A}E T\ iF }K @
(\R }U - GEA Awj ) QAX AeW q @
EeX p dK A ZT p ]R e
A_ ÀX AE A} Q p A}EAE V_
U \WBK AF^ eeXK Ap @
pAkd V}K @
GEA Awj @
\R }U @
fl[ \ flAp @
www.ganinivf.com
fl\A} - c - Aq A\^ \E
5242321 / 5260069

Book

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Book

Uploaded by

Copyright:

Available Formats

!?

SAq GIk ALXK x

GIkAW ... \WBK

flA fi[ F A AqK AUF^

,\W iqF VR iqF VR fiZb A d Aq^

,fi\WBK ZqE ZT q_ [ p v\q V

[ fl\ ^AL A qIk L p \qL GR ,q fXbL T ZF F|

T\ ~p fiA_ F p T\ ULv AQAW \w flAF Abs ZLK fiA}

Sh L ,Sh T\ AL AhE flZp ZFK \a

(\w) QA ^AL Ahp -2

\WBLK ^ 9 ^ Zp ZFK ,ZOAE ZUK \tL >

bE flAp ZF iFL \b flZ PT ,A \a iFL

:AL A GIk flAbL^ QE A fi GR

\tL_K .AL flZ

,flZ fi[ W iIAE ZU A \b flZ w

flZ r \kK hF V}K

p q A :AN A ^AL A \wK (Y

p AhE flZp ZFK flZ

Q\L^ flZ xe AhF \wK

n AAE jAU hF fld

ZqE jAU hF [}E AZ Aq fi[ LK..

AW A_} VgK dpR

flA A ~\j p N fAe UL L

`w wLX hE V}K R ZU :EAbL \s L 2

:{q [ A ^ A ^AK AQ fl\ 1

fl\Lw :AeW fl\Lv W _ |q LK 4

A} ZqE q flZ Aq A qg Q] [XLK GR @

[ ,_ }E p ]qE ` Q\ fl\ ^ ^AL A

} Z_ iFL Zp AT \OK rQ\K

AN WZL OZ flZZq A^Z MLFN Z}

AvA Ap L_ p LUK AE\b [s GRK >

yZq \dAq AAL

_A ZZA yZq \dAq AAL QA ]K

AL Ah Ap Z| p Ah LUK A w iT Ap Z| p LUK flZF oT

:O Ee p fl\aAF fleE \ iqE \NK Z|

AkE ^A^ ]Q O ZUK Z| I_ AN

:A AF^ flZq Ee p fl\N j p q fl\ ^ \FLq

(AF\}K) hIAE flQ AhF Zp

?AhF "R\L^ ]X" r|K x

\k iqE ZQK ..AhIAE AhF Zp p flZ Ug fl\v kqK q }\j ZQK

? feXL GIk flAbL^ GR L

eXbL SA\F AL^ a ZE GR 1

Z q fXbL SA\E flkW GR

: wLX AAI [WBE flAp GIk ZF

AAI N A eXb AAI [WBE flAp GIk ZF

PT dAW \b h flZ p A AAH [WB

A_ \ wLX \p p _AE L^ GIk

Q AwK O fl\aAF AQ fl AL fl\Lw dAW

q [ wLX AdUw Avb GIk \kL

GIk flA] M|K

:Zv flZq GIk r A} Zp Q] ZQK hw

\hUK GR [ ,Aj \e| GIk r hK [ M|

GIk r hK [ M| O ZXL^ >

,dA Z}Lp AX p ^ a GIk \ >

: AUv g A w Zp \L^ MnT Cv

de Ap |q G_ Av\q \Z}LAE Q AZp

: v\q GR ]\ GIk flA Zp >

| [ eeXL A wLX flA AR B >

!? G^A GIk \bL_K \qK x

p \b flZ j LW Z] flZ AnL {q

H fl\Lw xeL q \pBE Z_ iqE \qbK Z|

iFL ZqE 1 - 1/2 ZqE _ fl\T Q rwK\K

Zp GF_K AbL AF^ \O iI `K \FLq

:iI `LE kFK\ \p Awe -1