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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

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fertility assessment the reproductive medicine unit uclh

Fertility AssessmentThe Reproductive Medicine UnitUCLH

Rehan Salim MD MRCOG

Consultant Gynaecologist

infertility definition
Infertility definition
  • Failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology
prevalence
Prevalence
  • 15% of couples
    • related to age of female partner
    • related to history of sexually-transmitted disease
probability of pregnancy
Probability of pregnancy
  • 84% in 1st year
  • 92% in 2nd year
mean age of mother at birth england and wales 1970 2006 office of national statistics
Mean age of mother at birth, England and Wales, 1970-2006office of national statistics
infertility general advice
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
obesity
Obesity
  • BMI < 30 (ideal 28) kg/m2
  • Reduces fertility
  • Increased risk of
    • Anovulatory cycles
    • Miscarriage
    • Gestational diabetes
    • Hypertension
    • Thromboembolism
    • Obstetric delivery problems
underweight
Underweight
  • BMI <20
  • Anovulatory & Amenorrhoeic
  • Increased risk of
    • Miscarriage
    • Preterm delivery
    • Growth restricted baby
    • Fetal programming
management
Management
  • treat couple
  • refer to specialist clinic
  • systematic investigation
  • appropriate treatment
  • recognise emotional impact
  • Welfare of the child
when to refer
When to refer

one year unprotected intercourse

earlier if

  • woman over 35
  • oligo- or amenorrhoea
  • significant history
    • eg previous ectopic pregnancy, PID, endometriosis
investigations
Investigations
  • General health
  • BMI
  • Rubella immunity
  • Hepatitis B,C & HIV
  • (cervical screening)
  • Triple swabs
fertility tests semen analysis
Fertility tests: semen analysis
  • use lab of referral unit

operator-dependent

  • WHO criteria:

count >20 million/ml

motility >50%

morphology >50% normal

investigations18
Investigations

1 14 21 28

Day of cycle

Ovarian function

Ovulation

Progesterone

investigations19
Investigations

1 21 28 35

Day of cycle

Ovarian function

Progesterone

investigations20
Investigations

1 11 18 25

Day of cycle

Ovarian function

Progesterone

ovarian function
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
ovarian function22
Ovarian function
  • FSH and oestradiol early in the cycle
  • ovarian ultrasound for antral follicle count

FSH

Oestradiol

ovulation
Ovulation
  • Mid luteal phase progesterone
  • 28 day cycle
    • Day 21
summary of investigations
Summary of investigations
  • Day 1 – 5
    • FSH, LH, Oestradiol
    • Ultrasound
  • Day 7-10
    • HSG
    • HyCoSy
  • Day 21 (or 7 days after ovulation)
    • Progesterone
summary of investigations31
Summary of investigations
  • Rubella immunity
  • Hepatitis B,C & HIV
  • (cervical screening)
  • Triple swabs
  • Semen analysis
treatment options
Treatment options
  • Reassure and wait
  • Ovulation induction
    • Anovulation
  • Superovulation & intrauterine insemination
    • Mild male factor
    • Unexplained
    • Mild endometriosis
treatment options33
Treatment options
  • IVF
    • tubal damage
    • severe male factor
    • severe endometriosis
    • unexplained infertility –

if prolonged or older woman

    • failure of simple treatment
the reproductive medicine unit
The Reproductive Medicine Unit
  • Out-Patient Clinics
  • Superovulation
  • Intrauterine Insemination (IUI)
  • Ovulation Induction (OI)
  • IVF
  • Ultrasonography (USS)
  • Oncology Storage
  • Fertility and Psycho-sexual counselling
rmu ivf
RMU - IVF
  • Full range of IVF treatments
    • (IVF, ICSI, Surgical sperm retrieval)
  • Collaboration with The Assisted Conception Unit
  • PCT contracts
    • Haringey
    • Kensington & Chelsea
    • ?Barnet
fertility assessment the reproductive medicine unit uclh38

Fertility AssessmentThe Reproductive Medicine UnitUCLH

Rehan Salim MD MRCOG

Consultant Gynaecologist