Download Free Medical INFERTILITY PowerPoint Presentation

INFERTILITY PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Obstetrics & Gynecology, which is titled "INFERTILITY", to know about assessment and treatment of patients with fertility problems.

Tags : Obstetrics, Gynecology, INFERTILITY, assessment, treatment, fertility problems

Published on : Jul 18, 2021 | Views : 9306 | Downloads : 85

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

INFERTILITY Assessment and treatment of patients with fertility problems Dr Nitu Raje-Ghatge
Slide 2-

Why learn about it? Its in the curriculum ! Infertility – primary/ secondary Investigations eg hormone tests Knowledge of subfertility secondary care investigations Primary care management Knowledge of specialist treatments and surgical procedures
Slide 3-

Why learn about it.. Expectations from secondary care services! Inappropriate timing of referrals (early/late) Incomplete /inadequate investigations
Slide 4-

What is infertility? NICE: Failure to conceive after regular UPSI for 2 years in the absence of reproductive pathology. P.S NICE suggests offer clinical investigations if failure to conceive after 1 year of UPSI. GP NOTEBOOK: Infertility is the failure of conception in a couple having regular, unprotected coitus for 1 year, provided that normal intercourse is occurring not less than twice weekly.
Slide 5-

Natural conception rates: 80% of couples will be pregnant after 12 cycles. 50% of remaining will conceive during a 2nd year ( hence cumulative rate 90%) 50% in the following 4 years.
Slide 6-

PRIMARY/SECONDARY INFERTILITY PRIMARY – Couple without a prior pregnancy SECONDARY – Couple with previous pregnancy including miscarriage/ectopic.
Slide 7-

Etiology: Male factors Female factors Unexplained -20% Mixed – 15%
Slide 8-

Male Account for 25% Hypogonadotrophic hypogonadism Obstructive azoospermia Surgery Erectile dysfunction Anatomical - Hypospadias - Undescended/ maldescended testis
Slide 9-

Female Peritoneal factors 40%, - Endometriosis. Tubal blockage 20%.
Slide 10-

Etiology (female) Ovulatory dysfunction 15-20% - Hypothalamic/hypogonadotrophic hypogonadism - Hypothalamic pituitary dysfunction (PCOS) - Ovarian failure Uterine cavity abnormalities - Asherman's syndrome - Uterine fibroids. Cervical hostility 5-10%, - Infection - Female sperm antibodies.
Slide 11-

Fertility may be impaired in poorly controlled diabetes.
Slide 12-

History taking (female) Symptoms (past or present) - P I D / STD, - dysparenuria - galactorrhoea, - thyroid symptoms Obstetric history
Slide 13-

History taking (female) Menstrual history - irregularities Surgical history – D & C, abdominal/pelvic surgery Contraception - IUCDs Cervical smear
Slide 14-

History taking (male) Symptoms h/o genital tract infection e.g. mumps orchitis, prostatitis Surgical history - Hernia repair - Testicular surgery for torsion/ undescended /maldescended testis - Prostate surgery
Slide 15-

History taking (male) Trauma to the male genital or inguinal region Occupational history - exposure to lead, cadmium Drug history - Sulphasalazine – impairs spermatogenesis - Phenothiazines/ typical antipsychotics/ metoclopramide increase prolactin levels - Immunosuppresants
Slide 16-

IN BOTH Smoking Alcohol intake Psychological factors
Slide 17-

EXAMINATION General health and nutritional status BMI <19 (F) > 29.(M/F) SSC
Slide 18-

Female: Hirsuitism, galactorrhoea Bimanual examination - adnexal masses (tubo/ovarian, ovarian cyst) - tenderness (PID/ endometriosis) - Uterine fibroids
Slide 19-

Male Hypospadias Size and consistency of each testicle and epididymis; Presence of varicocele or hernia; Size of prostate. Gynaecomastia
Slide 20-

Now what?? Investigate Or Refer
Slide 21-

Early referral if.. Female Age >35 years Amenorrhoea/ oligo menorrhoea PID Abnormal pelvic exam Male Undescended testes Previous genital pathology Previous urogenital surgery In Both Prior treatment for cancer HIV, Hep B, Hep C
Slide 22-

Investigations Primary care Female Assess ovulation. Other hormonal tests Tests for PID Male Sperm analysis Secondary care Tubal patency Uterine abnormality
Slide 23-

Assessing ovulation Do if regular cycles with > 1 year of infertility irregular cycles 1) Serum progesterone 2) LH/FSH levels
Slide 24-

INVESTIGATIONS (Female) 1) Serum progesterone (mid luteal phase ie day 21 of 28 week cycle) Timing is important!!! Regular cycles - 7 days before next MP Irregular cycles - day 28/35 wk then weekly till menstruation occurs
Slide 25-

Interpretation of test
Slide 26-

Assessing ovulation 2) LH/FSH levels High levels – poor ovarian function High LH compared to FSH -PCOS
Slide 27-

Other hormonal tests E2, Testosterone levels – PCOS Prolactin ONLY if - ovulation problems - galactorrhoea, - pituitary problem.
Slide 28-

Other hormonal tests Thyroid tests - only with symptoms/ signs Other androgen profile (DHEAS, Androstenedione, SBHG) – as per etiology
Slide 29-

Tests for PID HVS Chlamydia screening
Slide 30-

Don’t forget!! Rubella status - check immunity - Vaccinate if non immune, avoid conception for 3 months
Slide 31-

Cervical hostility Post coital test - no longer recommended by NICE Mucus invasion test - doubtful significance
Slide 32-

Investigations (Male) Semen analysis Needs prior appointment with lab Abstinence for atleast 3 days Transport to lab in 30- 60 min Repeat abnormal test in next 3 months, earlier if gross abnormality
Slide 33-

Semen analysis- interpretation (WHO values) Volume 2 mls or more Sperm concentration - 20 million/ml Sperm morphology - atleast 30% normal Sperm number - 40 million/ ejaculate Sperm motility – 50% Vitality – 75% WBC - <1 million/ml Anti sperm antibody tests- not recommended by NICE
Slide 34-

Investigations in secondary care
Slide 35-

Tests for uterine/tubal problems HSG/hystero salpingo-contrast USG Laparoscopy + dye test Done only when ovulation tests/Sperm tests normal. Choice of tests depends upon co morbidities
Slide 36-

Management in primary care Principles of care Couple centred management Access to evidence based information Counselling (third person) Contact with fertility support groups Specialist teams
Slide 37-

Positive approach Reassure about cumulative pregnancy rates
Slide 38-

Management in primary care Lifestyle changes - Weight reduction, BMI 19-29 - Smoking cessation- offer support groups - Alcohol reduction <1-2 units/week for women <3-4 units/week for men - S I every 2-3 days - Information about OTC/ recreational drugs
Slide 39-

Management in primary care Pre conceptual advice - Folic acid supplementation - Rubella status - Cervical screening Management of erectile dysfunction - psychosexual couselling - drugs
Slide 40-

Management in secondary care Depends upon the etiology..
Slide 41-

Hypogonadotrophic hypogonadism Pulsatile GnRH Gonadotrophins with LH activity Bromocriptine ( for hyperprolactinaemia)
Slide 42-

Ovarian dysfunction ( hypothalamic dysfunction) 1) Anti- oestrogens eg Clomiphene/ Tamoxifen - 1st line - use for atleast 12 months if ovulating - initiated in secondary care - under USG guidance ( to adjust dose) - shared care when dose established - S/E risk of multiple pregnancy, OHSS
Slide 43-

Ovulatory dysfunction- treatment 2) Metformin - not licensed for ovulatory disorders in UK - used 2nd line with Clomiphene in - anovulatory women with PCOD + BMI >25 + no response to CC
Slide 44-

Others… 3) Gonadotrophins 4) Luteal phase support – - progesterone, - clomiphene 5) Laparoscopic ovarian drilling
Slide 45-

Peritoneal problems (endometriosis) Laparoscopic surgical ablation/ resection of endometriosis + adhesiolysis If ovarian endometriomas, laparoscopic cystectomy
Slide 46-

Uterine/ tubal factors Tubal factors: - Laparoscopic tubal surgery/ tubal microsurgery - Salpingography + tubal catheteristion - Hysteroscopic tubal cannulation Uterine factors - hysteroscopic adhesiolysis - myomectomy
Slide 47-

Assisted reproduction techniques Intra uterine insemination (IUI)
Slide 48-

In vitrio fertilisation Intracytoplasmic sperm injection (ICSI) Donor insemination Oocyte donation
Slide 49-

ppt slide no 49 content not found
Slide 50-

ppt slide no 50 content not found
Slide 51-

ppt slide no 51 content not found
Slide 52-

ACON at CRH Satellite IVF unit Counselling, monitoring and most of treatment , except egg retrieval and embryo transfer.
Slide 53-

Central unit Clarendon Wing, LGI SJUH, Leeds CARE, Manchester
Slide 54-

Questions…..zzzz??