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IVF update

IVF update. Dr Gregory Jenkins VMO Norwest Private Hospital VMO Sydney West AHS Accredited Specialist Genea. IVF update. Maternal age and AMH Maternal obesity Sperm DNA fragmentation IVF cycles Current success rates. Overview- female age and fertility. Rising female age and fertility.

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IVF update

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  1. IVF update Dr Gregory Jenkins VMO Norwest Private Hospital VMO Sydney West AHS Accredited Specialist Genea

  2. IVF update • Maternal age and AMH • Maternal obesity • Sperm DNA fragmentation • IVF cycles • Current success rates

  3. Overview- female age and fertility

  4. Rising female age and fertility • Concept of ovarian reserve (egg number & quality) • FSH rises (> 15 significant) • AMH (Anti-Mullerian Hormone) falls • Normal range varies with age • Close correlation with egg numbers at IVF • Predictor of poor outcome • Also predicts women at risk of ovarian hyperstim • Fast track to IVF

  5. Maternal obesity & fertility • BMI> 30 50% reduction. BMI >35 further 50% reduction • Anovulation main reason. • Weight in ovulating women is an independent factor too • 5% weight loss can restore ovulation • “Fitness for fertility program” • Need high dose folic acid (5mg)

  6. Maternal obesity & pregnancy • Miscarriage, Fetal abnormality, GDM, pre-eclampsia, DVT, CS and most other obs complications • Maternal obesity is the #1 preventable cause of stillbirth in the developed world • Need to normalise BMI to eliminate excess risk

  7. Sperm • Count, motility and morphology • BUT there is also the DNA within the sperm • SCIT – measures degree of DNA fragmentation as a % (DFI) • > 30% is abnormal • Assoc with 7x reduction in IVF success rate • Menevit/daily ejaculations/TESA

  8. IVF cycle – long HCG Trigger FSH Stimulation GnRH Down Regulation (Lucrin) Period OCP Day 0 Day 21 Day 35 Day 47 Dr A Lighten: June 09

  9. IVF cycle - short HCG Trigger GnRH Antagonist FSH Stimulation Period Day 2-4 +9 days +5 days Dr A Lighten: June 09

  10. Fertilisation Day 2 Day 3 Day 5 Blastocyst Day 5 Blastocyst Day 4

  11. Questions?

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