Infertility - North West Gynaecology

Report
North West Gynaecology
Gynaecology Update Symposium
24 April 2013
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North West Gynaecology…
 North West Gynaecology (NWG) is a group of consultant
gynaecologists formed in 2007 to cover the complete spectrum
of gynaecological problems.
 Gynaecology has many sub-specialist areas and it is no longer
possible for one gynaecologist to be an expert in all these areas.
 NWG provides a unique service making sure that your patient sees
the right gynaecologist to treat their particular problem.
 NWG provides comprehensive general gynaecological and
subspecialist gynaecological care to the women of Manchester,
Cheshire, Lancashire and the rest of the UK
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North West Gynaecology…
 Ambulatory Gynaecology
 Paediatric and Adolescent Gynaecology
 Infertility and Assisted Conception
 Urogynaecology
 Gynaecological Cancer
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North West Gynaecology…
…The Team
Kristina
Gail
Edmond
Rick
Tony
Naidoo
Busby
Edi-Osagie
Clayton
Smith
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Programme…
 Menstrual Disorders in General Practice
- Dr Kristina Naidoo
 Common Problems in Paediatric and Adolescent Gynaecology
- Dr Gail Busby
 Management of the Infertile Couple - Assessment, Investigation, Referral
- Dr Edmond Edi-Osagie
 Management of female urinary incontinence - new NICE guidelines
- Dr Tony Smith
 Update on Gynaecological Cancer
- Dr Rick Clayton
 Panel Discussion - NWG Faculty
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The Infertile Couple…
…Assessment, Treatment, Referral
Edmond Edi-Osagie
Consultant Gynaecologist
Saint Mary’s Hospital
Manchester
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Infertility…some facts
85% of couples conceive after 12 months of UPSI
92% of couples conceive after 24 months of UPSI
1-in-6 (15%) of couples experience some difficulty conceiving
WHO, 1975
17.2% prevalence of subfertility among 14,141 couples
Collins, 1995
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Female fertility…1
Courtesy of: www.repromed.com
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Female fertility…2
Courtesy of: www.rba-online.com
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Infertility causes…NICE 2013
Sperm abnormalities
(30%)
Ovulation problems
(25%)
Low count
Ovulation absent
Poor movement
Poor egg quality
Abnormal shapes
Ovarian failure
No sperm
Tubal problems (20%)
Tubes blocked
Unexplained (25%)
Tubes distorted
No cause found
Tubes absent
Combined (40%)
Uterine problems (10%)
Male and Female
Fibroids
Septum
Adhesions, Polyps
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Investigating Infertility…
OVULATORY / OVARIAN FUNCTION
..FSH / LH / Oestradiol / Progesterone / Prolactin / Androgens / AMH..
TUBAL FUNCTION
..HyCoSy / HSG / Laparoscopy..
UTERINE CAVITY
..Transvaginal scan / Hydrosonography / Hysteroscopy..
SPERM FUNCTION
..Semen analysis / Sperm DNA damage / Anti-sperm antibodies..
?OTHERS
..?Uterine Doppler / ?Immunological tests / ?Anti-Phospholipids Abs..
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Sequellae of PID…I
• Morbidity / Mortality
• Infertility (14x)
• Ectopic pregnancy (6x)
• Chronic pelvic pain (10x)
• Risk of hysterectomy (8x)
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Sequellae of PID…II
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Fertility Advice…
• Age: fertility @ 3 years = 94% of 35 year olds vs. 77% of 38 year olds
• Coital frequency: 2-3x weekly (avoid timed intercourse)
• Alcohol: excessive intake detrimental
• Smoking: detrimental to male and female fertility
• Body weight: Ideal BMI = 19-29
• Caffeine: uncertain impact in natural conception; detrimental to IVF treatment
• Drug use: best avoided if not essential
• Complementary therapies: potentially beneficial but no robust evidence
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Fertility Treatment Options…
OVULATORY DYSFUNCTION…OVULATION INDUCTION
..Clomid / Metformin / Gonadotrophins / Ovarian drilling..
TUBAL FACTORS…SURGERY
..Tubal canulation / Peri-tubal adhesiolysis / Cuff salpingostomy / IVF-ICSI..
UTERINE FACTORS…SURGERY
..Metroplasty / Adhesiolysis / Fibroid/Polyp resection..
SPERM DYSFUNCTION…AC
..IUI / SSR / IVF-ICSI..
?OTHERS
..?Immunotherapy / ?Steroids / ?Complementary therapies..
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Assisted Conception (AC)…
..IUI / S-IUI / DI..
..IVF..
..ICSI..
..Gamete Donation..
..Surrogacy..
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AC access by PCT…1
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AC access by PCT…2
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NICE guidelines 2013…I
 Offer infertility investigations after 12 months of
trying to conceive (down from 24 months)
 Offer infertility investigations earlier if the woman
is >36 years and/or there is a known cause of
infertility
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NICE guidelines 2013…II
 Do not offer Clomid treatment for unexplained
infertility
 Do not offer IUI (natural or stimulated) routinely
for Unexplained infertility, Endometriosis, or Mild
male factor infertility
 Offer IVF treatment after 2 years of unexplained
infertility
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NICE guidelines 2013…III
 Offer 3 full cycles of IVF after 2 years of infertility
up to the age of 40 years
 Offer 1 full cycle of IVF between 40 and 42 years
to women with satisfactory ovarian reserve who
have not previously had IVF
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…how can NWG help!
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NWG Fertility Services...I
Service Model
..Private Satellite Fertility Service..
Licensed Centres
..St. Mary’s Hospital, Manchester..
..Manchester Fertility Services..
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NWG Fertility Services...II
..fertility profiling..
..comprehensive investigations..
..full range of fertility treatments..
..surgical treatment options..
..support & counselling..
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NWG Fertility Treatments…
 General = Fertility Profiling & Advice..
 Medical = Ovulation induction (Oral & Parenteral)..
 Surgical = Tubal surgery, Reversal of Sterilisation,
Ovarian drilling, SSR, Uterine surgery..
 AC = IUI, IVF, ICSI..
 Egg freezing / donation / sharing / Surrogacy..
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Discussion
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