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Antenatal and fertility

Antenatal and fertility. Nice guideline 2013& 2010. fertility. Definition Any woman of reproductive age who has not conceived after 1 year should be offered further assessment. Consider earlier referral is >36 yrs or known cause of infertility Criteria for referral for IVF

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Antenatal and fertility

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  1. Antenatal and fertility Nice guideline 2013& 2010

  2. fertility • Definition • Any woman of reproductive age who has not conceived after 1 year should be offered further assessment. • Consider earlier referral is >36 yrs or known cause of infertility • Criteria for referral for IVF • Woman <40 offered 3 cycles • 2 years of trying • Woman <42 only offered 1 cycle • 2 years of trying • Never had IVF • No evidence of low ovarian reserve

  3. Offered counselling • Fertility support group • Patient counselling • Intercourse every 2-3 days • ETOH 1 – 2 units per week woman – 3-4 units for men • Smoking is detrimental to fertility (including passive) • BMI <30 • Don’t wear tight pants • Folic acid

  4. Investigations • - semen analysis on 2 occasions if abnormal 3 months apart unless azoospermia • hormone profile woman • D2-4 FSH and LH • D21 progesterone • Antenatal screen bloods eg rubella • Screen chlamydia • Smear

  5. Local guidelines fertility- South central • One cycle per couple • Age 30-35yrs for the woman • No previous fertility treatment on the NHS • Same sex couples or woman not in partnership if demonstrably subfertile. • No previous children (including adoption) • BMI19-29 • Only non smoking

  6. Antenatal pathway • New changes • At booking discuss Vit D • Combined test 11-13+6/40, triple or quadruple between 15-20 weeks • Screen for gestational diabetes • Program • Booking 10/40 • 16/40 • 25/40 if primips • 28/40 • 31- primip • 34/40 • 36/40 • 38/40 • 40/40 – primips • 41

  7. Akt-type questions You have a woman requesting fertility treatment, which of the tests would you request? According to NICE antenatal guidelines when do you screen for sickle cell and thalassaemia? By 8 weeks By 9 weeks By 10 weeks By 11 weeks It doesn’t matter when. • LSH, FSH D14 • Day 21 progesterone, LH and FSH • D2-3 LH, FSH and oestradiol • D2-4 LH, FSH and D21 progesterone

  8. When do you routinely give anti-D in pregnancy? What is the cut off risk for further investgation following combined screening? 1:1000 1:100 1:250 1:3000 1:150 • 16 and 24 weeks • 18 and 30 weeks • 28 and 34 weeks • 28 and 32 weeks. • 32 and 36 weeks

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