Fa gp presentation march 2015 simon

Infertility Diagnosis When to refer?

What’s New? Dr Simon Kelly Medical Director Fertility Associates, Auckland

Look how far we have come?

The amazing story of IVF: 37 years and 5 million babies later!

Infertility • 1 in 7 couples • Age single most important factor Combined 10%

Other 5%

Male 30%

Unexplained 25%

Female 30%

When to refer?

• Trying for 12 months • Ask about contraception

Infertility: (n) A medical condition that diminishes self-esteem, your social life as well as your checking and savings accounts. Causes sudden urges to pee on sticks, cry,scream and a fear of pregnancy announcements.

Treated by a Medical Specialist who you pay to knock you up-this does not always work Affects about 1 in 10 couples

Who to refer?

• Consider early referral if: • >35yrs • Irregular or absent periods • Medical or surgical conditions that may affect fertility eg endometriosis/pelvic surgery/chemo or radiotherapy • Family history early menopause • Recurrent miscarriage • Genetic conditions amenable to PGD • Patient Request

Free Nurse Consult - available for your patients • 15 minute phone consult with a fertility nurse • Answers questions like: • When to seek help • Treatment options • Costs • Public funding • Their % chance of having a baby • Chinese speaking Free Nurse Consult now available

Investigations • Male • Semen Analysis • Hep B/C/HIV • Female • FSH/Estradiol day 2-4cycle • Thyroid function • Rubella status/ Hep B/C HIV • Prolactin if irreg cycles/galactorhoea • HSG or HYCOSY if suspect tubal disease or previous PID* • Ultrasound* • AMH* • Chlamydia swabs • Check smear current

Advice- Improving Fertility •Start Folic Acid and Iodine •Minimize alcohol •Reduce caffeine consumption •Stop smoking •Maintain ideal BMI (20-25) •Improve diet •Exercise •Reduce Stress

New Diagnostic Tools • AMH – Currently best measure of ovarian reserve – produced by small follicles as they grow on ovary

• Sperm DNA Fragmentation Testing

AMH

Sperm DNA Fragmentation Testing • High levels DNA fragmentation may be associated with: – Poor fertility outcome – miscarriage

• Causal Factors: – – – – – –

Environmental / pollution exposure Advanced age Varicocoele Drug use Smoking Chronic Disease

Sperm Chromatin Structure Assay - SCSA

Sperm DNA Fragmentation How do we treat?

-Antioxidants -IMSI -Surgical sperm retrieval