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Fertility Issues

Fertility Issues. Dr Jane Stewart Newcastle Fertility Centre at LIFE. Fertility. Who to refer When to refer How to refer Secondary care provision and changes Tertiary care Licensed treatments Primary care support.

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Fertility Issues

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  1. Fertility Issues Dr Jane Stewart Newcastle Fertility Centre at LIFE

  2. Fertility • Who to refer • When to refer • How to refer • Secondary care provision and changes • Tertiary care • Licensed treatments • Primary care support

  3. 1 in 7 couples will experience a problem with conception in their reproductive lifetime.

  4. Who/when to refer – primary care • Reassurance as appropriate • Referral as appropriate • Other options

  5. Normal Cumulative Pregnancy Rate

  6. Factors important to fertility • Eggs • Sperm • Tubes • Sex

  7. Fertility Risk factors Ovulation Sperm [Tubes] Sexual function NICE 2004 General General health and wellbeing Sexual health Weight, smoking, alcohol Folic acid Smear [FBC, TSH], rubella Primary Care Assessment

  8. Immediately Significant risk factors Identified cause Early Significantly anxious Female age >35 years Otherwise At 1-2 years trying Issues Female age Relationship Welfare of the child Medical/psychiatric problems Desire to proceed Who/when to refer

  9. Old Technologies • Acceptance of childlessness • Adoption • Fostering • Extended families

  10. Unexplained subfertility • 2 years failure to conceive with regular intercourse and normal investigations

  11. Details of both partners Relationship Duration of trying Salient risk factors Significant medical/psychiatric history Previous pregnancies/children WoC issues Confirmation of ovulation FBC, rubella (TSH) Semen analysis (x2 if relevant) [Tubal patency if access] With results in the letter. Ideal Referral

  12. Referral Pathways • PCT directed • 2y/3y services • Patient choice • Choose and book • Treatment availability • There are no eligibility requirements for fertility assessment.

  13. Investigation More detailed investigation Tubal patency testing Unlicensed treatments Licensed treatments Overlap with tertiary centres Secondary Care Provision

  14. Aims of Process WITHOUT UNDUE DELAY • Diagnose a cause where possible • Reassure if appropriate • Give an estimate of chance of conceiving without treatment • Offer appropriate treatment options • Provide timely access to appropriate treatment

  15. Ovulation induction Clomifene Gonadotrophins GnRH Scanning facilities Sperm prep facilities IUI-H [GIFT] Changing profiles Unlicensed treatment

  16. HFEA Bring under licence from April 2007 (now June 2007) Sperm prep IUI-H GIFT EU directive Stringent tissue handling conditions EUTCD

  17. “2y care” facilities Unlicensed treatments Licensed treatments Non- ART ART GP support for tertiary treatment Welfare of the child Pregnancy support Tertiary Referral

  18. GP support for 2y/3y treatment • Prompt appropriate referral • Welfare of the child • Ongoing medical/psychiatric management • Weight management • Counselling • Pregnancy support • Shared prescribing

  19. PCT Support • Facilitate access to pathway of care • Provide appropriate funding to comply with the NICE Guidelines and the associated DoH targets allowing treatment to be provided in a timely fashion • Determine local criteria for application of limited funding • To apply funding criteria equitably • Remain open to new developments

  20. NFCL - What do we do? • Clinics • Trans-vaginal ultrasound scanning • Andrology • Embryology • Treatment • Counselling • Education • Multidisciplinary links • Research

  21. Fertility Accept 1y, 2y and 3y referrals Investigation, results review, treatment options discussed Gynae-endo Investigation endocrine related fertility problems Management ovulatory dysfunction Young peoples clinic Advice on fertility for future Oncology/endocrinology/urology etc. IVF clinics Investigated patients arranging treatment Follow-up following unsuccessful treatment PP clinic Clinics

  22. Trans-vaginal Ultrasound • Diagnostic • Natural cycle follicle tracking for DI/IUI • Ovulation induction • Ovarian stimulation for IVF • Early pregnancy • Up to 30 scans/morning 5 days/week and Sat am limited facility

  23. Andrology • Diagnostic service • Semen analysis Newcastle • Pre-treatment assessment semen • Epididymal/testicular sperm processing • Sperm storage • Pre-treatment/post retrieval • Oncology • Sperm donor bank

  24. Embryology • IVF • ICSI • Embryo freezing • Embryo culture • [PGD] • Research

  25. Treatments • Ovulation induction • Clomiphene/gonadotrophins/GnRH • IVF • ICSI, sperm retrieval, embryo freezing • Donor gametes/ embryos • Surrogacy • Fertility preservation • Sperm storage • Embryo storage

  26. Counselling • Treatment implications counselling • Fertility therapeutic counselling • Psychosexual counselling • Fertility awareness

  27. Other activities • Well established clinical links with other specialties • Education • Research

  28. Future Fertility Issues • Fertility preservation • PGD • Donor recruitment strategies • New technologies

  29. www.nfc-life.org.uk

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