1. IVF update Dr Gregory Jenkins VMO Norwest Private Hospital VMO Sydney West AHS Accredited Specialist Genea

2. IVF update Maternal age and AMH Maternal obesity Sperm DNA fragmentation IVF cycles Current success rates

3. Overview- female age and fertility

4. Rising female age and fertility Concept of ovarian reserve (egg number & quality) FSH rises (> 15 significant) AMH (Anti-Mullerian Hormone) falls – Normal range varies with age – Close correlation with egg numbers at IVF – Predictor of poor outcome – Also predicts women at risk of ovarian hyperstim Fast track to IVF

7. Maternal obesity & fertility BMI> 30 50% reduction. BMI >35 further 50% reduction Anovulation main reason. Weight in ovulating women is an independent factor too 5% weight loss can restore ovulation “Fitness for fertility program” Need high dose folic acid (5mg)

8. Maternal obesity & pregnancy Miscarriage, Fetal abnormality, GDM, pre- eclampsia, DVT, CS and most other obs complications Maternal obesity is the #1 preventable cause of stillbirth in the developed world Need to normalise BMI to eliminate excess risk

9. Sperm Count, motility and morphology BUT there is also the DNA within the sperm SCIT – measures degree of DNA fragmentation as a % (DFI) > 30% is abnormal Assoc with 7x reduction in IVF success rate Menevit/daily ejaculations/TESA

10. Period GnRH Down Regulation (Lucrin) FSH Stimulation HCG Trigger Day 0Day 21Day 35Day 47 IVF cycle – long Dr A Lighten: June 09 OCP

11. Period GnRH Antagonist FSH Stimulation HCG Trigger Day 2-4+9 days +5 days IVF cycle - short Dr A Lighten: June 09

12. Fertilisation Day 2 Day 3 Day 4 Day 5 Blastocyst Day 5 Blastocyst

14. Questions?