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1 North West Gynaecology Gynaecology Update Symposium 24 April 2013

2 North West Gynaecology…  North West Gynaecology (NWG) is a group of consultant gynaecologists formed in 2007 to cover the complete spectrum of gynaecological problems.  Gynaecology has many sub-specialist areas and it is no longer possible for one gynaecologist to be an expert in all these areas.  NWG provides a unique service making sure that your patient sees the right gynaecologist to treat their particular problem.  NWG provides comprehensive general gynaecological and subspecialist gynaecological care to the women of Manchester, Cheshire, Lancashire and the rest of the UK

3 North West Gynaecology…  Ambulatory Gynaecology  Paediatric and Adolescent Gynaecology  Infertility and Assisted Conception  Urogynaecology  Gynaecological Cancer

4 North West Gynaecology… Kristina Naidoo Gail Busby Rick Clayton Edmond Edi-Osagie Tony Smith …The Team

5 Programme…  Menstrual Disorders in General Practice - Dr Kristina Naidoo  Common Problems in Paediatric and Adolescent Gynaecology - Dr Gail Busby  Management of the Infertile Couple - Assessment, Investigation, Referral - Dr Edmond Edi-Osagie  Management of female urinary incontinence - new NICE guidelines - Dr Tony Smith  Update on Gynaecological Cancer - Dr Rick Clayton  Panel Discussion - NWG Faculty

6 The Infertile Couple… Edmond Edi-Osagie Consultant Gynaecologist Saint Mary’s Hospital Manchester …Assessment, Treatment, Referral

7 Infertility…some facts 85% of couples conceive after 12 months of UPSI 92% of couples conceive after 24 months of UPSI 1-in-6 (15%) of couples experience some difficulty conceiving WHO, 1975 17.2% prevalence of subfertility among 14,141 couples Collins, 1995

8 Female fertility…1 Courtesy of:

9 Female fertility…2 Courtesy of:

10 Infertility causes…NICE 2013 Sperm abnormalities (30%) Low count Poor movement Abnormal shapes No sperm Ovulation problems (25%) Ovulation absent Poor egg quality Ovarian failure Tubal problems (20%) Tubes blocked Tubes distorted Tubes absent Uterine problems (10%) Fibroids Septum Adhesions, Polyps Unexplained (25%) No cause found Combined (40%) Male and Female

11 Investigating Infertility… OVULATORY / OVARIAN FUNCTION..FSH / LH / Oestradiol / Progesterone / Prolactin / Androgens / AMH.. TUBAL FUNCTION..HyCoSy / HSG / Laparoscopy.. UTERINE CAVITY..Transvaginal scan / Hydrosonography / Hysteroscopy.. SPERM FUNCTION..Semen analysis / Sperm DNA damage / Anti-sperm antibodies.. ?OTHERS..?Uterine Doppler / ?Immunological tests / ?Anti-Phospholipids Abs..

12 Sequellae of PID…I Morbidity / Mortality Infertility (14x) Ectopic pregnancy (6x) Chronic pelvic pain (10x) Risk of hysterectomy (8x)

13 Sequellae of PID…II

14 Fertility Advice… Age: fertility @ 3 years = 94% of 35 year olds vs. 77% of 38 year olds Coital frequency: 2-3x weekly (avoid timed intercourse) Alcohol: excessive intake detrimental Smoking: detrimental to male and female fertility Body weight: Ideal BMI = 19-29 Caffeine: uncertain impact in natural conception; detrimental to IVF treatment Drug use: best avoided if not essential Complementary therapies: potentially beneficial but no robust evidence

15 Fertility Treatment Options… OVULATORY DYSFUNCTION…OVULATION INDUCTION..Clomid / Metformin / Gonadotrophins / Ovarian drilling.. TUBAL FACTORS…SURGERY..Tubal canulation / Peri-tubal adhesiolysis / Cuff salpingostomy / IVF-ICSI.. UTERINE FACTORS…SURGERY..Metroplasty / Adhesiolysis / Fibroid/Polyp resection.. SPERM DYSFUNCTION…AC..IUI / SSR / IVF-ICSI.. ?OTHERS..?Immunotherapy / ?Steroids / ?Complementary therapies..

16 Assisted Conception (AC)…..IUI / S-IUI / DI....IVF....ICSI....Gamete Donation....Surrogacy..

17 AC access by PCT…1

18 AC access by PCT…2

19 NICE guidelines 2013…I  Offer infertility investigations after 12 months of trying to conceive (down from 24 months)  Offer infertility investigations earlier if the woman is >36 years and/or there is a known cause of infertility

20 NICE guidelines 2013…II  Do not offer Clomid treatment for unexplained infertility  Do not offer IUI (natural or stimulated) routinely for Unexplained infertility, Endometriosis, or Mild male factor infertility  Offer IVF treatment after 2 years of unexplained infertility

21 NICE guidelines 2013…III  Offer 3 full cycles of IVF after 2 years of infertility up to the age of 40 years  Offer 1 full cycle of IVF between 40 and 42 years to women with satisfactory ovarian reserve who have not previously had IVF

22 …how can NWG help!

23 NWG Fertility Services...I Service Model..Private Satellite Fertility Service.. Licensed Centres..St. Mary’s Hospital, Manchester....Manchester Fertility Services..

24 NWG Fertility Services...II..fertility profiling....comprehensive investigations....full range of fertility treatments....surgical treatment & counselling..

25 NWG Fertility Treatments…  General = Fertility Profiling & Advice..  Medical = Ovulation induction (Oral & Parenteral)..  Surgical = Tubal surgery, Reversal of Sterilisation, Ovarian drilling, SSR, Uterine surgery..  AC = IUI, IVF, ICSI..  Egg freezing / donation / sharing / Surrogacy..


27 Discussion

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