1 / 38

Fertility Assessment The Reproductive Medicine Unit UCLH

Fertility Assessment The Reproductive Medicine Unit UCLH. Rehan Salim MD MRCOG Consultant Gynaecologist. Infertility definition. Failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology. Prevalence. 15% of couples

annis
Download Presentation

Fertility Assessment The Reproductive Medicine Unit UCLH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Fertility AssessmentThe Reproductive Medicine UnitUCLH Rehan Salim MD MRCOG Consultant Gynaecologist

  2. Infertility definition • Failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology

  3. Prevalence • 15% of couples • related to age of female partner • related to history of sexually-transmitted disease

  4. Probability of pregnancy • 84% in 1st year • 92% in 2nd year

  5. Age, fertility & miscarriage

  6. Risk of Down’s syndrome birth by maternal age

  7. Assisted conception HFEA 2007

  8. Mean age of mother at birth, England and Wales, 1970-2006office of national statistics

  9. Age at referral HFEA 2007

  10. Infertility general advice • Sexual intercourse every 2-3 days • Stop smoking & reduce caffeine intake • Alcohol • <1-2 units/week for women • <3-4 units/week for men • Folic acid • BMI 19-29

  11. Obesity • BMI < 30 (ideal 28) kg/m2 • Reduces fertility • Increased risk of • Anovulatory cycles • Miscarriage • Gestational diabetes • Hypertension • Thromboembolism • Obstetric delivery problems

  12. Underweight • BMI <20 • Anovulatory & Amenorrhoeic • Increased risk of • Miscarriage • Preterm delivery • Growth restricted baby • Fetal programming

  13. Management • treat couple • refer to specialist clinic • systematic investigation • appropriate treatment • recognise emotional impact • Welfare of the child

  14. When to refer one year unprotected intercourse earlier if • woman over 35 • oligo- or amenorrhoea • significant history • eg previous ectopic pregnancy, PID, endometriosis

  15. Investigations • General health • BMI • Rubella immunity • Hepatitis B,C & HIV • (cervical screening) • Triple swabs

  16. Fertility tests: semen analysis • use lab of referral unit operator-dependent • WHO criteria: count >20 million/ml motility >50% morphology >50% normal

  17. Investigations 1 14 21 28 Day of cycle Ovarian function Ovulation Progesterone

  18. Investigations 1 21 28 35 Day of cycle Ovarian function Progesterone

  19. Investigations 1 11 18 25 Day of cycle Ovarian function Progesterone

  20. Ovarian function • Ovarian reserve • The capacity of the ovary to provide eggs that are capable of fertilization resulting in a healthy and successful pregnancy • Measure of • Fertility • Risk of miscarriage • Chances of success with treatment

  21. Ovarian function • FSH and oestradiol early in the cycle • ovarian ultrasound for antral follicle count FSH Oestradiol

  22. Antral follicle count

  23. AFC and age

  24. Fertility tests: ultrasound

  25. Ovulation • Mid luteal phase progesterone • 28 day cycle • Day 21

  26. Tubal patency

  27. Tubal patency

  28. Laparoscopy

  29. Summary of investigations • Day 1 – 5 • FSH, LH, Oestradiol • Ultrasound • Day 7-10 • HSG • HyCoSy • Day 21 (or 7 days after ovulation) • Progesterone

  30. Summary of investigations • Rubella immunity • Hepatitis B,C & HIV • (cervical screening) • Triple swabs • Semen analysis

  31. Treatment options • Reassure and wait • Ovulation induction • Anovulation • Superovulation & intrauterine insemination • Mild male factor • Unexplained • Mild endometriosis

  32. Treatment options • IVF • tubal damage • severe male factor • severe endometriosis • unexplained infertility – if prolonged or older woman • failure of simple treatment

  33. The Reproductive Medicine Unit • Out-Patient Clinics • Superovulation • Intrauterine Insemination (IUI) • Ovulation Induction (OI) • IVF • Ultrasonography (USS) • Oncology Storage • Fertility and Psycho-sexual counselling

  34. Success Rates 2007IUI

  35. RMU - IVF • Full range of IVF treatments • (IVF, ICSI, Surgical sperm retrieval) • Collaboration with The Assisted Conception Unit • PCT contracts • Haringey • Kensington & Chelsea • ?Barnet

  36. ACU – IVF success rates

  37. Fertility AssessmentThe Reproductive Medicine UnitUCLH Rehan Salim MD MRCOG Consultant Gynaecologist

More Related