Transcript Fertility
Fertility Issues
Dr Jane Stewart
Newcastle Fertility Centre at LIFE
Fertility
Who to refer
When to refer
How to refer
Secondary care provision and changes
Tertiary care
Licensed treatments
Primary care support
1 in 7 couples will experience a problem
with conception in their reproductive
lifetime.
Who/when to refer – primary
care
Reassurance as appropriate
Referral as appropriate
Other options
conceived
% of couples that have
Normal Cumulative
Pregnancy Rate
100
90
80
70
60
50
40
30
20
10
0
0
1
Years
2
Factors important to
fertility
Eggs
Sperm
Tubes
Sex
Primary Care Assessment
Fertility
Risk factors
Ovulation
Sperm
[Tubes]
Sexual function
General
NICE 2004
General health and
wellbeing
Sexual health
Weight, smoking, alcohol
Folic acid
Smear
[FBC, TSH], rubella
Who/when to refer
Immediately
Significant risk factors
Identified cause
Early
Significantly anxious
Female age >35 years
Otherwise
At 1-2 years trying
Issues
Female age
Relationship
Welfare of the child
Medical/psychiatric
problems
Desire to proceed
Old Technologies
Acceptance of childlessness
Adoption
Fostering
Extended families
2 years failure to
conceive with
regular intercourse
and normal
investigations
100
80
conceived
% of couples that have
Unexplained subfertility
60
40
20
0
0
1
2
Years
<35yrs
>40yrs
Ideal Referral
Details of both
partners
Relationship
Duration of trying
Salient risk factors
Significant
medical/psychiatric
history
Previous
pregnancies/children
WoC issues
Confirmation of
ovulation
FBC, rubella (TSH)
Semen analysis (x2 if
relevant)
[Tubal patency if
access]
With results in the
letter.
Referral Pathways
PCT directed
2y/3y services
Patient choice
Choose and book
Treatment availability
There are no eligibility requirements for
fertility assessment.
Secondary Care Provision
Investigation
More detailed
investigation
Tubal patency
testing
Unlicensed
treatments
Licensed
treatments
Overlap with tertiary
centres
Aims of Process
WITHOUT UNDUE DELAY
Diagnose a cause where possible
Reassure if appropriate
Give an estimate of chance of conceiving
without treatment
Offer appropriate treatment options
Provide timely access to appropriate
treatment
Unlicensed treatment
Ovulation induction
Clomifene
Gonadotrophins
GnRH
Scanning facilities
Sperm prep
facilities
IUI-H
[GIFT]
Changing profiles
EUTCD
HFEA
Bring under licence
from April 2007
(now June 2007)
Sperm prep
IUI-H
GIFT
EU directive
Stringent tissue
handling conditions
Tertiary Referral
“2y care” facilities
Unlicensed
treatments
Licensed
treatments
Non- ART
ART
GP support for
tertiary treatment
Welfare of the child
Pregnancy support
GP support for 2y/3y
treatment
Prompt appropriate referral
Welfare of the child
Ongoing medical/psychiatric management
Weight management
Counselling
Pregnancy support
Shared prescribing
PCT Support
Facilitate access to pathway of care
Provide appropriate funding to comply with
the NICE Guidelines and the associated DoH
targets allowing treatment to be provided in
a timely fashion
Determine local criteria for application of
limited funding
To apply funding criteria equitably
Remain open to new developments
NFCL - What do we do?
Clinics
Trans-vaginal ultrasound scanning
Andrology
Embryology
Treatment
Counselling
Education
Multidisciplinary links
Research
Clinics
Fertility
Accept 1y, 2y and 3y
referrals
Investigation, results
review, treatment
options discussed
Gynae-endo
Investigation endocrine
related fertility
problems
Management ovulatory
dysfunction
Young peoples clinic
Advice on fertility for
future
Oncology/endocrinology/
urology etc.
IVF clinics
Investigated patients
arranging treatment
Follow-up following
unsuccessful treatment
PP clinic
Trans-vaginal Ultrasound
Diagnostic
Natural cycle follicle
tracking for DI/IUI
Ovulation induction
Ovarian stimulation for
IVF
Early pregnancy
Up to 30 scans/morning
5 days/week and Sat
am limited facility
Andrology
Diagnostic service
Semen analysis
Newcastle
Pre-treatment
assessment semen
Epididymal/testicular
sperm processing
Sperm storage
Pre-treatment/post
retrieval
Oncology
Sperm donor bank
Embryology
IVF
ICSI
Embryo freezing
Embryo culture
[PGD]
Research
Treatments
Ovulation induction
Clomiphene/gonadotrophins/GnRH
IVF
ICSI, sperm retrieval, embryo freezing
Donor gametes/ embryos
Surrogacy
Fertility preservation
Sperm storage
Embryo storage
Counselling
Treatment implications counselling
Fertility therapeutic counselling
Psychosexual counselling
Fertility awareness
Other activities
Well established clinical links with
other specialties
Education
Research
Future Fertility Issues
Fertility preservation
PGD
Donor recruitment strategies
New technologies
www.nfc-life.org.uk