Presentation on theme: "New Developments in Assisted Reproduction"— Presentation transcript:
1New Developments in Assisted Reproduction Cork Fertility CentreDr John Waterstone
2Ovarian ReserveWomen are very different to men with regard to reproductive ageing.A woman’s entire lifetime’s supply of eggs is present at birth.Decreasing ovarian reserve is inevitable with increasing age, resulting in complete infertility by ageDecreasing ovarian reserve has a significant negative effect on a couple’s reproductive prospects from age 37 onwards but earlier for some women.Ovarian reserve is a measure of how well the ovaries are still functioning at a certain point in time.
3Measures of Ovarian Reserve FSH (Follicle Stimulating Hormone)- lower is better (Normal <10 iu/L)test cycle day 2-4fluctuates between cycles when ovarian reserve poorAMH (Anti Mullerian Hormone)higher is better (normal>5pmol/L)less fluctuation between cycles
4Measures of Ovarian Reserve Antral Follicle Count (AFC)higher is better5-10 AF’s per ovary –normal reserve<3 AF’s per ovary –poor reserve>10-15 AF’s per ovary – ‘polycystic’Menstrual cycle length– shortening cycles indicate deteriorating ovarian reserve
7Polycystic Ovaries & PCOS Most women with polycystic ovaries do not have polycystic ovary syndromePCOS = PCOD = Stein Levinthal SyndromePCOS = Polycystic Ovaries + Oligo or AmenorrhoeaVariable abnormalities in PCOSRaised LHRaised AndrogensHirsutismObesityImpaired Glucose Tolerance
8Management of PCOSGood ovarian reserve but may be difficult to manage.May succeed on first cycle of OII with ClomidMay undergo OII, IUI, Ovarian drilling, IVFIVF also difficult because of risk of Ovarian Hyperstimulation Syndrome (OHSS)Metformin –no longer recommended for OII nor as an adjunct to IVF; may help patients lose weight.
9Tests of Tubal Function Laparoscopy- Gold standard test- Carried out at Bon Secours HospitalDetects adhesions /endometriosisHystero Salpingography (HSG)- Less invasive- Carried out Bon Secours HospitalDoes not detect adhesions/endometriosisHystero Contrast Salpingography (HyCoSy)- Poor diagnostic test- No longer used at Cork Fertility Centre
10Pre-IVF Surgery for Hydrosalpinges Communicating hydrosalpinges must be removed or blocked proximally prior to IVF
11Tertiary Care – AR Options Ovulation Induction (Clomid or low dose FSH)IUI (low dose FSH)IVF / ICSI (LHRH analogue, high dose FSH injections, egg collection, embryo transfer)
18Day 5 Embryo Transfer Advantages Embryo Selection Reduction in number of embryos for ET resulting in reduction in multiple gestations
19Egg Donation For patients with poor ovarian reserve Alternative to adoption or childlessnessSuccess Rate ~ 50% per cycleKnown v Anonymous DonorsRemuneration of Donors (Europe v USA)Reproductive Tourism
20Egg Donation at Cork Fertility Centre Egg Donation available since 2006Donors almost all known to recipient coupleLive Birth Rate (per embryo transfer) for 2006 – 2010: 61%
21Cryopreservation of Gametes & Embryos Cryopreservation of semen – successful & robustCryopreservation of viable embryos – technically easyCryopreservation of unfertilised eggs technically difficult but useful for:creating donor egg bankspreserving fertility in young cancer survivorspreserving fertility in women deferring reproduction
22CFC IVF/ICSI Success Rates 2010 Live birth rates per Embryo TransferPatient Age<3535-3738-4041-42>42Cork Fertility Centre 201049%46%35%22%8.5%Success Rates” which quote “pregnancies” or “pregnancy rates” are misleading as a significant proportion of early pregnancies miscarry