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