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Infertility in General Practice

Infertility in General Practice. Kate Hooks ST2 GP. Curriculum Statements. The General P ractice consultation Women's Health Men's Health Sexual Health. Definition. Failure to conceive after 12 months of regular unprotected intercourse.

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Infertility in General Practice

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  1. Infertility in General Practice Kate Hooks ST2 GP

  2. Curriculum Statements • The General Practice consultation • Women's Health • Men's Health • Sexual Health

  3. Definition Failure to conceive after 12 months of regular unprotected intercourse. • 80% of couples will be pregnant after 12 months. • 50% of those remaining will conceive in the second year. • 50% of those left will conceive within the next 4 years.

  4. The consultation • All couples should receive history taking and examination in primary care. • Need to identify those couples who require early intervention/referral • Those who have modifiable risk factors.

  5. The Woman • Age • Fertility history • Same/new partner • Length of time trying to conceive • Frequency of intercourse and any difficulties • Length of time since stopping contraception and the type

  6. Any suggestion of ovulatory problems- Details of menstrual cycle Galactorrhoea or hirsutism Systemic disease BMI Stress • Relevant Gynaelogical history • Pain/IMB/PCB • Smear history

  7. Drug history • Occupation • Lifestyle • Abdominal and pelvic examination

  8. Male • Previous children • Length of time- frequency/ difficulties/ED • History- Mumps/STDs/Trauma previous urogenital abnormality systemic disease surgery • Drugs • Occupation • Lifestyle

  9. Examine genitalia • Secondary sexual characteristics • Gynaecomastia

  10. General Advice • Find out couples- wishes, plans , beliefs and motives are • Provide stats on normal patterns of conception • Generally do not investigate until trying >1 yr • Be explicit and talk about stress

  11. Provide preconceptual advice • Smoking • BMI • Alcohol • Not recommended- BBTC Ovulation kits Post coital testing • ASAB • www.hfea.gov.uk • www.bica.net

  12. Investigations • <1 year only if identified as less likely to conceive • Female Mid luteal phase progesterone- know cycle!! Serum gonadotrophins- if cycles are irregular. TFTs- if indicated PL- if indicated Chlamydia screen

  13. Male Screen for Chlamydia Semen analysis- advice 1st test abnormal- repeat in 3 months 2nd test abnormal- refer

  14. Referral • Woman <35 years old- hx,exam and inv normal- ref if not conceived within 18 months. • Woman >35 years or findings abnormal ref earlier • Either partner known reason for infertility refer earlier. • Counsel- before/during and after

  15. Secondary and tertiary care • Women- further hormonal tests • Tests of tubal patency • Hysterosalpingogram • Hysterosalpingo-ultrasonography • Problems- diag laparoscopy • Men- more detailed examination semen • Imaging urinary tract • Testicular biopsy

  16. Management • Clomiphine • Metformin BMI>25 unresponsive to clomiphene • Dopamine

  17. IUI- NICE- mild male factor, unexplained, mild endometriosis- up to 6 cycles • IVF- NICE- woman aged 23-39 at time of treatment and infertility for at least 3 years- offered up to 3 stimulated cycle Doh- at least 1 full cycle funded by NHS • ICSI- 44% all IVF • Donor Insemination • Embryo donation • GIFT

  18. Finally.... Be aware of the PCT funding in the area you are working

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