NaProTechnology Natural Procreative Technology
|
|
- Kristopher Fleming
- 6 years ago
- Views:
Transcription
1 NaProTechnology Natural Procreative Technology A multifactorial approach to the chronic problem of Infertility Dr. Phil C. Boyle MICGP, MRCGP, CFCMC Galway Clinic, Ireland Prof. Joseph Stanford MD, University of Utah, USA 03 Sept 2011
2
3 Outline Abstract Summary 3 Case Presentations Discussion points
4 Illness can be Acute Sudden onset Shorter duration May resolve spontaneously Tend to have single or few causes May be cured by single intervention or treatment Chronic Gradual onset Longer duration Rarely resolve spontaneously Usually have multiple causes Outcomes improved with multiple sustained interventions
5 Health conditions Acute Appendicitis Respiratory viral infection Fractured bone Chronic Asthma Diabetes Degenerative arthritis
6 Infertility (subfertility) is a chronic health condition.
7 Infertility Gradual, unknown, or early onset Ongoing issues Potential for recurrence Syndrome, not diagnosis Many possible causes Usually, more than one cause or factor present
8 Infertility Rarely completely cured by single intervention Can be treated with multiple interventions Rarely resolves spontaneously
9 Chronic vs Acute approach NaProTechnology Infertility indicates the presence of disease with the challenge to diagnose and treat for optimum health. ART Infertility presents a technical challenge to bypass the dysfunctional process.
10 Chronic vs Acute approach NaProTechnology Seeks to identify longterm health conditions and improve them over a reproductive lifetime Chronic perspective ART Long term health conditions are considered less important for shortterm treatment. Acute perspective
11 Description Infertility is usually a consequence of multiple chronic conditions rather than a single acute condition. We propose that it is erroneous to apply acute medical interventions to a condition that is chronic in nature.
12 Diet & Nutrition Low Hormones Limited Mucus Infection Low Endorphins Infertility & Miscarriage Immunological Surgical Male Factor Adrenal Fatigue Others To be discovered
13 Possible Diagnoses from NaProTechnology Evaluation Hormonal Ultrasound Surgical Other Low Progesterone Immature follicle Endometriosis Limited (hostile) Mucus Low Oestradiol Partial rupture Pelvic Adhesions Adrenal Fatigue Poor Follicular Function Corpus Luteum Insufficiency Luteinised unruptured follicle Delayed Rupture Blocked Fallopian Tubes Hydrosalpinx Chronic Endometritis Endorphin Deficiency * Polycystic Ovaries Afollicularism Fibroid Food Intolerance Reduced ovarian reserve Absent Cumulus Oopherous Polyp Nutritional Deficiency Hypothyroidism Uterine Septum Immune dysfunction *Although these diagnoses are hormonally mediated, at least in part, the diagnosis and management is not based on direct hormonal testing at this time. Fig. 3
14 Method Retrospective analysis of 3 case studies which demonstrate the multifactorial and chronic nature of infertility that were previously managed unsuccessfully with acute intervention using IVF (in Vitro Fertilisation) or ART (Assisted Reproductive Technology).
15 Results Demonstration of the multifactorial approach and 3 successful singleton live births using NPT (Natural Procreative Technology or NaProTechnology).
16 Conclusion Infertility can be treated successfully with a multifactorial approach which takes into account the chronic nature of infertility and targets treatment to manage multiple factors responsible for the condition.
17 Discussion Infertility is not a diagnosis but is often the expression of several underlying ill health conditions which if diagnosed and treated correctly will result in restoration of normal reproductive function.
18 Discussion - Continued Physicians ought to consider broader diagnostic possibilities in their evaluation of infertile couples. A multifactorial treatment strategy for the chronic condition of infertility may be more effective than the widespread acute strategy employed by ART.
19 Discussion - Continued Future studies looking at NPT and ART outcomes Must be cohort studies and Compare populations with similar patient characteristics
20 3 Case Presentations 1. Case A 2. Case B 3. Case C
21 Case A Gravida 0 Para 0, Female aged 41, Male aged 40, Trying to conceive for 2 years, Unexplained infertility, 3 failed IUI and 2 failed IVF.
22 Case A Presented for treatment March 2009 Unexplained Infertility Lap and Dye normal 2007 Semen analysis normal 2007 IUI x 3 FSH/LH and HCG - June 2008 IVF x 2 3 Embryos transferred Aug 2008 & March 2009
23 Case A NPT Diagnoses Chronic Endometritis Progesterone deficiency poor follicular function & corpus luteum insufficiency Hostile Cervical Mucus Clinical endorphin deficiency Mild food intolerance
24
25 Case A NPT Treatments Clinical endorphin deficiency Naltrexone 2mg nocte Mild food intolerance (IgG) Egg yolk and soya
26 Case A NPT treatment Progesterone deficiency poor follicular function & corpus luteum insufficiency Letrozole 2.5mg 10 tabs on day 3 HCG 10,000 iu mid cycle HCG 2,500 iu Peak +3,5,7
27
28 Case A NPT Treatments Hostile Cervical Mucus Cabroceistine 375mg tid x 7 days, day 11 Amoxycillin 500mg tid x 5 days, day 11 PreSeed Vaginal Lubricant
29 Case A NPT Treatments Chronic Endometritis Metronidazole 400mg BD x 3 weeks Clarithromycin 500mg BD x 3 weeks Pro biotic for 6 weeks Start day 14 of cycle
30 10 F 10 F H H H H Antibiotic treatment Positive Test!
31 Case A 42 years old at conception. Hormone support with cyclogest 400mg pv. twice daily until 8 weeks Cyclogest 400mg pv nocte until 16 weeks gestation
32 Case A She delivered a healthy baby boy by Caesarean section in November 2010, weighing 3180g.
33 Case A CrMS Chart was critically important to the process Timing of blood tests Timing of HCG injections Identify hostile mucus Identify Brown Bleed Chronic Endometritis
34 Case A IVF which attempted to solve the symptom of infertility through bypassing the natural process of conception was inappropriate and ineffective as she had several chronic conditions that needed to be treated in a targeted fashion to restore normal reproductive function
35 Case B Gravida 1 Para 0 Female aged 37 Male aged 39 7 years trying to conceive Mildly polycystic ovaries and recurrent implantation failure 3 failed IVF cycles, 3 fresh & 1 frozen transfer.
36 Case B Presented on April 2009 Trying to conceive since Jan 2002 Cycle 32 to 25 days Unplanned miscarriage at 11 weeks 1999 Diagnosis Mild PCOD by ultrasound
37 Case B Normal investigations Laparoscopy 01 & 08, Hysteroscopy 09 Semen analysis several tests Day 3 bloods Thrombophillia Screen Immunological testing Chicago Bloods
38 Case B Treatments Clomiphene 50mg daily for 5 days, from day 3 of cycle x 4 100mg daily for 5 days, from day 3 of cycle x 4 150mg daily for 5 days, from day 3 of cycle x 4 12 cycles in total previously
39 Case B Treatments IVF x 3 stimulated cycles Feb 2006 March 2009 Embryo transfer 3 fresh and 1 frozen 2 3 embryos each time Additional Aspirin, Enoxaparin, Prednisolone 25mg with last IVF cycle despite normal testing
40 Case B NPT Diagnoses Progesterone deficiency with corpus luteum insufficiency - Dramatic chart! Polycystic Ovaries with poor follicular function Clinical endorphin deficiency Clinical Adrenal fatigue
41 F H H H H H 12
42 Case B NPT Treatments Progesterone deficiency with corpus luteum insufficiency - Dramatic chart! Polycystic Ovaries with poor follicular function HCG 2,500iu P+3,5,7,9 Letrozole 2.5mg 16 tabs day 3 HCG 10,000 iu mid cycle
43 10F H H H H 12 10F H H H H 14 10F H H H H 17
44 Case B NPT Treatments Clinical endorphin deficiency Naltrexone 3mg nocte Clinical Adrenal fatigue Hydrocortisone 5mg 7am & 12 noon Supplements Vitamin D3 2,400iu daily Omega mg daily plus Folic acid
45 Case B NPT Outcome With treatment we achieved a normal appearing CrMS chart, with proven follicle rupture by ultrasound, and a healthy happy patient. She conceived on her 5th cycle of treatment (second effective cycle) in April 2010
46 16F H H H H Positive Test!
47 Case B NPT Pregnancy treatment Cyclogest 400mg pv twice daily until 36 weeks gestation Aspirin 75mg daily until 30 weeks Prednisolone 25mg daily until 12 weeks
48 Case B NPT Pregnancy Outcome She had a normal vaginal delivery of a healthy baby boy, Kg in January 2011 Mother was 38 years old at delivery
49 16F H H H H Positive Test!
50 Case B Comments Immediately identified Corpus luteum insufficiency & confirmed restoration of normal function with treatment. Patient s well being improved with naltrexone and cortisol treatment. When this happens, we often find our treatment is more successful.
51 Case B Comments Although we did not feel aspirin or prednisolone were necessary we conceded to the patients request to give these medications as recommended by her previous doctor
52 Case C Gravida 1 (with IVF), Para 0 Female age 38, Male age 38 Oligoasthenozoospermia, progesterone deficiency and endometriosis. 12 cycles of clomiphene 3 IUI 3 IVF cycles
53 Case C Presented in January 2008, female aged 38 Never conceived naturally since trying in February to 32 day cycle Laparoscopy 2003 Mild Endometriosis Unclear if this was treated
54 Case C Semen Analysis Oligoasthenozoospermia Count 6 to 17 million per ml Motility 25 37%.
55 Case C Previous Treatments 12 cycles of ovulation induction with clomiphene, 3 attempts at IUI 3 failed IVF attempts between Dec 2005 and April embryos replaced x 3 IVF cycles Miscarriage at 9 weeks after first attempt
56 Case C NPT Diagnoses Endometriosis Oligoasthenozoospermia Clinical endorphin deficiency Low progesterone and oestradiol combined poor follicle function and corpus luteum insufficiency Obvious from Chart Food Intolerance to eggs
57 Pre-menstrual Spotting with low progesterone levels
58 Case C NPT Treatments Clinical endorphin deficiency Naltrexone 4.5mg nightly Food Intolerance to eggs Change in diet
59 Case C NPT Treatments Endometriosis Laparoscopy and diathermy June 2008 Oligoasthenozoospermia CoEnzyme Q10 200mg daily Tamoxifen 20mg daily FertilityPlus for men Lifestyle (cigarettes, alcohol, caffeine, stress)
60 Case C NPT Treatments Low progesterone and oestradiol combined poor follicle function and corpus luteum insufficiency Clomiphene 150mg daily x 3 days, starting on day 3 of the cycle with HCG 5000 iu mid cycle to facilitate follicle rupture and HCG 2,500 iu on days 3, 5 and 7 after ovulation
61
62 Laparoscopy
63 Laparoscopy Positive Test!
64 Case C NPT Pregnancy Treatments Positive pregnancy test in September 2008 Cyclogest 400mg pv nocte until 14 weeks Naltrexone 4.5mg nocte until 38 weeks
65 Case C NPT Pregnancy outcome They had a healthy baby boy by normal vaginal delivery weighing 3.400kg in June 2009, when mum was 40 years old.
66
67 Case C repeat attempt Second attempt in February 2010 Same treatment approach successfully conceived by September Healthy baby boy delivered 19th May 2011 when mum was 42 years old.
68 Case C Comments CrMS chart demonstrated premenstrual spotting indicating a problem with endometrial integrity in the luteal phase of the cycle It is important to adequately treat mild endometriosis as this has been shown to improve pregnancy and live birth rates
69 Case C Comments We continued Naltrexone throughout pregnancy in this case because the patient felt dramatically better preconception with treatment. It appears she had significant endorphin deficiency which needed ongoing treatment Over 100 pregnancies with naltrexone
70 Appropriate Diagnosis NaProTechnology Seeks to diagnose all underlying causes. Seeks to identify all possible exacerbating and mitigating factors. ART Less concerned about diagnosis except for factors that may directly impact effectiveness of IVF treatment.
71 Appropriate Treatment NaProTechnology Seeks to optimize health of baby, mother, father ART Acute approach- do something to get pregnant as quickly as possible, almost at any cost
72 Impact on health of the baby NaProTechnology Expected lower miscarriage rates Low birth weight rates under 5% Expected lower rates of prematurity, perinatal mortality ART High miscarriage rates Low birth weight rates 30%+ Also higher rates of prematurity (2.0x), perinatal mortality (2.2x), and birth defects (2.0x) J Amer Board Fam Med, 2008 Obstet Gynecol 2004 NEJM 2002
73 Appropriate evidence Chronic approach Cumulative outcomes over time Cohort analysis Full picture Acute approach Short-term outcomes only No context for cumulative outcomes over time Misleading
74 Appropriate evidence Case C - 3 failed IVF Miscarriage at 9 weeks Recorded as Success with IVF Clinical pregnancy following embryo transfer A Cohort analysis would not do this
75 National Registries for ART USA- SART and CDC Europe- ESHRE UK- HFEA All have data in terms of treatment cycles Unknown number of women Unknown cycles per woman
76 Cochrane evaluation of IVF Outcomes should be reported as pregnancy rates per woman or couple, because repeat cycle data are not statistically independent and are less relevant to the patient. Pandian et al. Cochrane Database Sys Rev 2005
77 Cochrane evaluation of IVF The effectiveness of IVF relative to other treatment options for unexplained infertility remains unproven. Adverse events and the costs associated with the interventions compared have not been adequately assessed. Pandian et al. Cochrane Database Sys Rev 2005
78 Cumulative pregnancy rates In couples without clear indications for IVF, the main benefit of early IVF may be to shorten time to pregnancy, a benefit that must be weighed against costs and potential adverse outcomes. Stanford JB, et al. Fertil Steril 2010
79 Cumulative live birth rates Per couple, not per cycle Adjusted live birth rates Couples who drop-out of treatment are no longer counted after they drop out Crude live birth rates Include all couples who start treatment, whether or not they continue (intention to treat)
80 Cumulative live birth ratesexample 100 couples 50 drop out after 3 months 50 get pregnant after 9 months Crude live birth rate: 50% Adjusted live birth rate: 100% True value somewhere in between
81 Appropriate evidence Accounts for population characteristics that impact the prognosis
82 Comparing cohorts- NPT and ART Ireland NPT Netherlands ART JABFM 2008 Hum Reprod 2007
83 Comparing cohorts- NPT and ART Ireland NPT N=1072 Mean female age=35.8 Duration infertility=5.6 yrs Prior ART=33% Prior pregnancy=47% 2 years Adjusted=52.8% BIRTH Crude=25.5% BIRTH JABFM 2008 Netherlands ART N=1351 Mean female age=32.8 Duration infertility=3.6 yrs Prior ART=0% Prior pregnancy=47% 1 year Adjusted=64.7% pregnancy Crude=42.4 pregnancy Hum Reprod 2007
84 Comparing cohorts- NPT and ART Ireland NPT N=1072 Mean female age=35.8 Duration infertility=5.6 yrs Prior ART=33% Prior pregnancy=47% 2 years Adjusted=52.8% BIRTH Crude=25.5% BIRTH JABFM 2008 Netherlands ART N=1351 Mean female age=32.8 Duration infertility=3.6 yrs Prior ART=0% Prior pregnancy=47% 1 year Adjusted=64.7% pregnancy Crude=42.4 pregnancy Hum Reprod 2007
85 Comparing cohorts- NPT and ART Ireland NPT Netherlands ART Twins 4.5% Birth < 2500 grams 4.5% Twins 22% Birth < 2500 grams Not reported JABFM 2008 Hum Reprod 2007
86 Spiritual dimensions NaProTechnology Partnership between CFCP, CFCMC, couple Acknowledges God inherently Goal is healthy baby, mother, father ART Technological accomplishment of the physician Promotes mastery of man Goal is a baby, quickly, at almost any cost
87 Spiritual dimensions NaProTechnology Profound respect for human life from its earliest stages of development ART Embryonic stages of life are treated instrumentally as a means to an end
88 Summary Infertility is a chronic health condition, and should be diagnosed and treated accordingly. The diagnostic evaluation should search for all underlying causes and contributing factors. Treatment should address all known causes and contributing factors, in order to maximize health of the baby, mother, and father.
89 Summary Evaluation of infertility treatment outcomes should be done on a cohort basis, over time. Comparisons between studies need to account for differences in study populations.
90 Summary NaProTechnology has comparable live birth rates to ART, with healthier babies. NaProTechnology seeks to maximize the longterm health outcomes for baby, mother, and father.
91 NaProTECHNOLOGY Any Questions? Dr. Phil Boyle
NaProTechnology after previous IVF Galway, Ireland
NaProTechnology after previous IVF 2004-2012 Galway, Ireland Salt Lake City, July 2012 Dr. Phil Boyle MICGP, MRCGP, CFCP IVF Report.. Sunday Times 2009 1 in 6 couples - Infertility 1.25% (1 in 80) have
More informationNaProTechnology. An Integrated Approach to Infertility. Tracy Parnell. Geneva 2005
NaProTechnology An Integrated Approach to Infertility Tracy Parnell Geneva 2005 Outline Scientific foundations Illustrative case history Research Discussion and questions NPT Natural Procreative Technology(NPT)
More informationLow AMH and natural conception. Dr. Phil Boyle Galway, Ireland IIRRM Annual Meeting, 7 th August 2013
Low AMH and natural conception Dr. Phil Boyle Galway, Ireland IIRRM Annual Meeting, 7 th August 2013 Anti Mullerian Hormone AMH levels are commonly measured in fertility clinics to assess ovarian reserve
More informationDr Manuela Toledo - Procedures in ART -
Dr Manuela Toledo - Procedures in ART - Fertility Specialist MBBS FRANZCOG MMed CREI Specialities: IVF & infertility Fertility preservation Consulting Locations East Melbourne Planning a pregnancy - Folic
More informationLow Dose Naltrexone. Novel uses for a licenced medication. Dr. Phil Boyle, New Orleans, August 2013
Low Dose Naltrexone Novel uses for a licenced medication Dr. Phil Boyle, New Orleans, August 2013 Faculty Disclosure Doctor Phil Boyle, MD Dr. Boyle has listed no financial interest/arrangement that would
More informationNICE fertility guidelines. Hemlata Thackare MPhil MSc MRCOG Deputy Medical Director London Women s Clinic
NICE fertility guidelines Hemlata Thackare MPhil MSc MRCOG Deputy Medical Director London Women s Clinic About the LWC 4 centres around the UK London Cardiff Swansea Darlington The largest sperm bank in
More informationInfertility F REQUENTLY A SKED Q UESTIONS. Q: Is infertility a common problem?
Infertility (female factors). In another one third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.
More informationFemale Reproductive Physiology. Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF
Female Reproductive Physiology Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF REFERENCE Lew, R, Natural History of ovarian function including assessment of ovarian reserve
More informationInfertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary
Subfertility Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary Infertility affects about 15 % of couples. age of the female. Other factors that
More informationInfertility: A Generalist s Perspective
Infertility: A Generalist s Perspective Learning Objectives Fertility and Lifestyle: Patient education Describe the basic infertility workup Basic treatment strategies unexplained Heather Huddleston, MD
More informationNeil Goodman, MD, FACE
Initial Workup of Infertile Couple: Female Neil Goodman, MD, FACE Professor of Medicine Voluntary Faculty University of Miami Miller School of Medicine Scope of Infertility in the United States Affects
More informationEVALUATING THE INFERTILE PATIENT-COUPLES. Stephen Thorn, MD
EVALUATING THE INFERTILE PATIENT-COUPLES Stephen Thorn, MD Overview The field of reproductive medicine continues to evolve rapidly by offering newer diagnostic testing and therapeutic options to improve
More informationFERTILITY & TCM. On line course provided by. Taught by Clara Cohen
FERTILITY & TCM On line course provided by Taught by Clara Cohen FERTILITY & TCM FERTILITY AND TCM THE PRACTITIONER S ROLE CAUSES OF INFERTILITY RISK FACTORS OBJECTIVES UNDERSTANDING TESTS Conception in
More informationRecent Developments in Infertility Treatment
Recent Developments in Infertility Treatment John T. Queenan Jr., MD Professor, Dept. Of Ob/Gyn University of Rochester Medical Center Rochester, NY Disclosures I don t have financial interest or other
More informationFertility Apps Do not Help You Get pregnant
Fertility Apps Do not Help You Get pregnant Fertility Apps Do not Help You Get pregnant Beyond Regular Intercourse Many women use fertility apps to track their menstrual cycle and time intercourse. Tracking
More informationFertility 101. About SCRC. A Primary Care Approach to Diagnosing and Treating Infertility. Definition of Infertility. Dr.
Dr. Shahin Ghadir A Primary Care Approach to Diagnosing and Treating Infertility St. Charles Bend Grand Rounds November 30, 2018 I have no conflicts of interest to disclose. + About SCRC State-of-the-art
More informationEvaluation of the Infertile Couple
Overview and Definition Infertility is defined as the inability of a couple to fall pregnant after one year of unprotected intercourse. Infertility is a very common condition as in any given year about
More informationInfertility. F r e q u e n t l y A s k e d Q u e s t i o n s. Q: What causes infertility in men? A: Infertility in men is most often caused by:
Infertility Q: What is infertility? A: Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who can get pregnant but are unable to
More informationPRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018
PRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018 Clinical Assessment A thorough clinical evaluation is a prerequisite for ART A thorough clinical evaluation as detailed in the female and male
More informationEmbryo Selection after IVF
Embryo Selection after IVF Embryo Selection after IVF Many of human embryos produced after in vitro fertilization carry abnormal chromosomes. Placing a chromosomally normal embryo (s) into a normal uterus
More informationINFERTILITY CAUSES. Basic evaluation of the female
INFERTILITY Infertility is the inability to conceive after 12 months of unprotected intercourse. There are multiple causes of infertility and a systematic way to evaluate the condition. Let s look at some
More informationInfertility History Form
Date form completed: Infertility History Form Patient s name: _ Age: Date of Birth: Occupation: Partner s name: Age: Date of Birth: Occupation: Prior marriage: Yes No # Prior marriage: Yes No # Attempted
More information5/5/2010. Infertility FINANCIAL DISCLOSURE. Infertility Definition. Objectives. Normal Human Fertility. Normal Menstrual Cycle
Infertility FINANCIAL DISCLOSURE I HAVE NO FINANCIAL INTEREST IN ANY OF THE PRODUCTS MENTIONED IN MY PRESENTATION Bryan K. Rone, M.D. University of Kentucky Obstetrics and Gynecology I AM RECEIVING COMPENSATION
More informationAge and Fertility. A Guide for Patients Revised 2012 Copyright 2012 by the American Society for Reproductive Medicine
1 Age and Fertility A Guide for Patients Revised 2012 Copyright 2012 by the American Society for Reproductive Medicine INTRODUCTION Fertility changes with age. Both males and females become fertile in
More informationUpdate on inest. and CrM chart comparison study. Joseph B. Stanford, MD, MSPH, CFCMC Director of Research, IIRRM
Update on inest and CrM chart comparison study Joseph B. Stanford, MD, MSPH, CFCMC Director of Research, IIRRM Professor and Director, Office of Cooperative Reproductive Health Department of Family and
More informationContemporary Clinical Delivery in Academic Practice
Contemporary Clinical Delivery in Academic Practice Patrick Yeung Jr., MD, FACOG Director, SLUCare Restorative Fertility Clinic Director, SLUCare Center for Endometriosis Gynecologic Surgical Subspecialties
More informationInfertility. Thomas Lloyd and Samera Dean
Infertility Thomas Lloyd and Samera Dean Infertility Definition Causes Referral criteria Assisted reproductive techniques Complications Ethics What is infertility? Woman Reproductive age Has not conceived
More informationLaboratoires Genevirer Menotrophin IU 1.8.2
Important missing information VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Infertility is when a woman cannot get pregnant (conceive) despite having regular unprotected sexual
More informationUnexplained infertility Evidence based management
Unexplained infertility Evidence based management Dr Mark Hamilton Consultant Gynaecologist NHS Grampian/University of Aberdeen m.hamilton@abdn.ac.uk www.iffs-reproduction.org @IntFertilitySoc Int@FedFertilitySoc
More informationInfertility in Women over 35. Alison Jacoby, MD Dept. of Ob/Gyn UCSF
Infertility in Women over 35 Alison Jacoby, MD Dept. of Ob/Gyn UCSF Learning Objectives Review the effect of age on fertility Fertility counseling for the patient >35 - timing - lifestyle - workup Fertility
More informationLUTEINIZED UNRUPTURED FOLLICLE SYNDROME: A SUBTLE CAUSE OF INFERTILITY*
FERTILITY AND STERILITY Copyright c 1978 The American Fertility Society Vol. 29, No.3, March 1978 Printed in U.S.A. LUTEINIZED UNRUPTURED FOLLICLE SYNDROME: A SUBTLE CAUSE OF INFERTILITY* JAROSLA V MARIK,
More informationFemale Consultation Questionnaire
Female Consultation Questionnaire In order to schedule a consultation with the doctor, an overview of your medical history along with a copy of your medical records are requested. Dr. Zouves will review
More informationFertility Treatment: Do not be Distracted
Fertility Treatment: Do not be Distracted Fertility Treatment: do not be distracted by worthless recommendation Fertility Treatment: Do not be Distracted When contemplating options for fertility treatment
More informationUnderstanding Infertility, Evaluations, and Treatment Options
Understanding Infertility, Evaluations, and Treatment Options Arlene J. Morales, M.D., F.A.C.O.G. Fertility Specialists Medical Group, Inc. What We Will Cover Introduction What is infertility? Briefly
More informationFertility assessment and assisted conception
Fertility assessment and assisted conception Dr Geetha Venkat MD FRCOG Director Pulse Learning Women s health 14 September 2016 Disclosure statement Dr Venkat is a director of Harley Street Fertility Clinic.
More informationFertility in the 21 st Century Dr Leigh Searle
Fertility in the 21 st Century Dr Leigh Searle Fertility Specialist, Obstetrician, Gynaecologist FRANZCOG, PGDipOMG, MBChB Dr Kate Van Harselaar Fertility Specialist, Obstetrician and Gynaecologist Overview
More informationDr Guy Gudex. Director Repromed. 17:00-17:30 Recent Advances in Fertility Management
Dr Guy Gudex Director Repromed 17:00-17:30 Recent Advances in Fertility Management Recent Advances in Fertility Management Practice Nurses Programme NZMA GP CME June 2018 Dr Guy Gudex ART in NZ -2014 ACART
More informationThe evidence for insemination versus intercourse or IVF
To inseminate or not: that s the question! The evidence for insemination versus intercourse or IVF B.Cohlen, Genk 2009 There are believers and non-believers Ovarian stimulation protocols (anti-oestrogens,
More informationFertility Assessment and Treatment Pathway
Rejected referrals sent back to GP Fertility Assessment and Treatment Pathway Patients with fertility problems go to the GP GP Advice and Assessment GP to inform patient of access criteria for NHS-funded
More informationDirector of Commissioning, Telford and Wrekin CCG and Shropshire CCG. Version No. Approval Date August 2015 Review Date August 2017
Commissioning Policy for In Vitro Fertilisation (IVF)/ Intracytoplasmic Sperm Injection (ICSI) within tertiary Infertility Services, in Shropshire and Telford and Wrekin Owner(s) Version No. Director of
More informationBiology of fertility control. Higher Human Biology
Biology of fertility control Higher Human Biology Learning Intention Compare fertile periods in females and males What is infertility? Infertility is the inability of a sexually active, non-contracepting
More informationAssisted Reproduction. By Dr. Afraa Mahjoob Al-Naddawi
Assisted Reproduction By Dr. Afraa Mahjoob Al-Naddawi Learning Objectives: By the end of this lecture, you will be able to: 1) Define assisted reproductive techniques (ART). 2) List indications for various
More informationLOW RESPONDERS. Poor Ovarian Response, Por
LOW RESPONDERS Poor Ovarian Response, Por Patients with a low number of retrieved oocytes despite adequate ovarian stimulation during fertility treatment. Diagnosis Female About Low responders In patients
More informationACT TRYING TO HAVE A BABY? YOUR STEP-BY-STEP GUIDE TO ASSISTED CONCEPTION THE ACT PATHWAY
ACT TRYING TO HAVE A BABY? YOUR STEP-BY-STEP GUIDE TO CONCEPTION THE ACT PATHWAY ACT HOW TO USE THE ACT PATHWAY BOOKLET Firstly: You are not alone. Up to 1 in 6 couples around the world will experience
More informationInformation Booklet. Exploring the causes of infertility and treatment options.
Information Booklet Exploring the causes of infertility and treatment options www.ptafertility.co.za info@ptafertility.co.za +27 12 998 8854 Faith is taking the first step even if you don t see the whole
More informationSt Helens CCG NHS Funded Treatment for Subfertility Policy 2015/16
St Helens CCG NHS Funded Treatment for Subfertility Policy 2015/16 1 Standard Operating Procedure St Helens CCG NHS Funded Treatment for Sub Fertility Policy Version 1 Implementation Date May 2015 Review
More informationInfertility treatment
In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation
More informationInfertility DR. RAHUL BEVARA
Infertility DR. RAHUL BEVARA Definitions Infertility is defined as the inability to conceive after one year of unprotected coitus. Affects 10-15% of couples Primary Infertility, that is inability to conceive
More informationPuerto Rico Fertility Center
Puerto Rico Fertility Center General Information of the In-Vitro Fertilization Program Dr. Pedro J. Beauchamp First test-tube baby IN PUERTO RICO Dr. Pedro Beauchamp with Adlin Román in his arms. Paseo
More informationInfertility for the Primary Care Provider
Infertility for the Primary Care Provider David A. Forstein, DO FACOOG Clinical Associate Professor Obstetrics and Gynecology University of South Carolina School of Medicine Greenville Disclosure I have
More informationInfertility. Review and Update Clifford C. Hayslip MD Intrauterine Inseminations
Infertility Review and Update Clifford C. Hayslip MD Intrauterine Inseminations Beneficial effects of IUI not consistently documented in studies No deleterious effects on fertility 3-4 cycles of IUI should
More informationVirginia Center for Reproductive Medicine
Virginia Center for Reproductive Medicine New Patient Questionnaire Date: Patient Name: Date of Birth: / / Age: Social Security #: Address: Phone: (H) ( ) (W) ( ) Cell Phone: ( ) Pharmacy: ( ) Partner
More informationTreating Infertility
Treating Infertility WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 About 10% of couples in the United States are infertile. Infertility is a condition in which a woman has not been able
More informationChapter 1. Chapter 2. Chapter 3
Summary To perform IUI some conditions are required. This includes 1) a certain amount of progressively motile spermatozoa, 2) the presence of ovulation, 3) the presence of functional fallopian tubes,
More informationBlackpool CCG. Policies for the Commissioning of Healthcare. Assisted Conception
1 Introduction Blackpool CCG Policies for the Commissioning of Healthcare Assisted Conception 1.1 This policy describes circumstances in which NHS Blackpool Clinical Commissioning Group (CCG) will fund
More informationAn Overview of Uterine Factors That Influence Implantation
An Overview of Uterine Factors That Influence Implantation Bulent Urman, M.D. Dept. of Obstetrics and Gynecology Koc University School of Medicine Assisted Reproduction Unit, American Hospital, ISTANBUL
More informationFertility. Assessment and treatment for people with fertility problems. Issued: February NICE clinical guideline 156. guidance.nice.org.
Fertility Assessment and treatment for people with fertility problems Issued: February 2013 NICE clinical guideline 156 guidance.nice.org.uk/cg156 NICE has accredited the process used by the Centre for
More informationThe Center for Reproductive Health. Patient Questionnaire
The Center for Reproductive Health Edwin D. Robins, MD Patient Questionnaire Date: Reason for Visit: Patient Name: Last First Middle Date of Birth: Age: Social Security #: Address: City: State: Zip Code:
More informationHonorary Fellow of the Royal College of Obs. & Gyn. First Indian to receive FIGO s Distinguished Merit Award for Services towards women s health.
Prof.Duru Shah Founder President The PCOS Society (India) President Elect of the Indian Society for Assisted Reproduction (ISAR) Honorary Fellow of the Royal College of Obs. & Gyn. First Indian to receive
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal myomectomy in leiomyoma management, 77 Abnormal uterine bleeding (AUB) described, 103 105 normal menstrual bleeding vs., 104
More informationF REQUENTLY A SKED Q UESTIONS
Polycystic heart, blood vessels, and appearance. Women with PCOS have these characteristics: Ovarian high levels of male hormones, also called androgens an irregular or no menstrual cycle Syndrome may
More informationAchieving Pregnancy: Obesity and Infertility. Jordan Vaughan, MSN, APN, WHNP-BC Women s Health Nurse Practitioner Nashville Fertility Center
Achieving Pregnancy: Obesity and Infertility Jordan Vaughan, MSN, APN, WHNP-BC Women s Health Nurse Practitioner Nashville Fertility Center Disclosures Speakers Bureau EMD Serono Board of Directors Nurse
More informationFemale fertility problems How Chinese medicine may help
Female fertility problems How Chinese medicine may help Prevalence of fertility problems According to figures issued by the Human Fertility and Embryology Authority (HFEA) in 2006, between 1 in 6 or 7
More informationLUTEAL PHASE SUPPORT. Doç. Dr. Nafiye Yılmaz. Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi
LUTEAL PHASE SUPPORT Doç. Dr. Nafiye Yılmaz Zekai Tahir Burak Kadın Sağlığı Eğitim Araştırma Hastanesi TAJEV, 2014 1 ART & success *Live birth rate 2 Optimal luteal phase Etiology of luteal phase deficiency
More informationIs it the seed or the soil? Arthur Leader, MD, FRCSC
The Physiological Limits of Ovarian Stimulation Is it the seed or the soil? Arthur Leader, MD, FRCSC Objectives 1. To consider how ovarian stimulation protocols work in IVF 2. To review the key events
More informationProgesterone level 14 on clomid
Search Search Progesterone level 14 on clomid I haven't heard of using Clomid for LP Defect but have you tried any of the other progesterone suppliments? I know Prometrium is what my doc first Rxed for
More informationPatient Past Medical History
Patient Past Medical History A. Identifying Data Date this form when completed Your name Partner's name Age Birth date Height Weight Length of marriage (or relationship) How long have you been trying unsuccessfully
More informationIntrauterine Insemination - FAQs Q. How Does Pregnancy Occur?
Published on: 8 Apr 2013 Intrauterine Insemination - FAQs Q. How Does Pregnancy Occur? A. The female reproductive system involves the uterus, ovaries, fallopian tubes, cervix and vagina. The female hormones,
More informationIndian Journal of Basic and Applied Medical Research; September 2015: Vol.-4, Issue- 4, P
Original article: To study post intrauterine insemination conception rate among infertile women with polyp and women with normal uterine endometrium cavity 1Dr. Archana Meena, 2 Dr. Renu Meena, 3 Dr. Kusum
More informationFertility Assessment and Treatment Pathway
Fertility Assessment and Treatment Pathway Rejected referrals sent back to GP Patients with fertility problems go to the GP GP Advice and Assessment GP to inform patient of access criteria for NHS-funded
More informationNHS FUNDED TREATMENT FOR SUBFERTILITY. ELIGIBILITY CRITERIA POLICY GUIDANCE/OPTIONS FOR CCGs
NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA POLICY GUIDANCE/OPTIONS FOR CCGs CONTENTS Page 1. INTRODUCTION 2 2. GENERAL PRINCIPLES 2 3. DEFINITION OF SUBFERTILITY AND TIMING OF ACCESS TO
More informationImpact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles
1 st SEUD Meeting, 9 May 2015, Paris, France Impact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles ENDOMETRIOSIS ovarian endometrioma
More informationReproductive Health Questionnaire
133 Catherine St Leichhardt NSW 2040 ph: 9555 8806 email: reception@darlinghealth.com.au Reproductive Health Questionnaire Please attach to this completed form copies of any past pathology results including
More informationInfertility treatment other than ART. Dr. Prue Johnstone FRANZCOG MRepMed
Infertility treatment other than ART Dr. Prue Johnstone FRANZCOG MRepMed What is Subfertility? (not infertility!) Primary subfertility Absence of conception after 12 months of unprotected intercourse timed
More informationCase 1 Dear Dr Re: Joan and John Baldwin, 2 Union Road, Clifton, Bristol. General investigation of infertility. Case 3
General investigation of infertility What is relevant in Primary Care? Case 1 Re: Joan and John Baldwin, 2 Union Road, Clifton, Bristol Would you please see this couple. Mr and Mrs Baldwin present to the
More information1 - Advanced clinical course for ART with Hands on
1 of 7 1 - Advanced clinical course for ART with Hands on Duration: 30 days Course Fee: Rs 1,00,000 I. Anatomy & Physiology of Male & Female reproduction. II. Evaluation of infertile couple III. Counselling
More informationApproach to ovulation induction and superovulation in women with a history of infertility. Anatte E. Karmon, MD
Approach to ovulation induction and superovulation in women with a history of infertility Anatte E. Karmon, MD Disclosures- Anatte Karmon, MD No financial relationships to disclose 2 Objectives At the
More informationASSISTED CONCEPTION NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA & POLICY GUIDANCE
ASSISTED CONCEPTION NHS FUNDED TREATMENT FOR SUBFERTILITY ELIGIBILITY CRITERIA & POLICY GUIDANCE Version 1.0 Page 1 of 11 MARCH 2014 POLICY DOCUMENT VERSION CONTROL CERTIFICATE TITLE Title: Assisted Conception
More informationINDICATIONS OF IVF/ICSI
PROCESS OF IVF/ICSI INDICATIONS OF IVF/ICSI IVF is most clearly indicated when infertility results from one or more causes having no other effective treatment; Tubal disease. In women with blocked fallopian
More informationReproductive Endocrinology & Infertility Glossary
Reproductive Endocrinology & Infertility Glossary The following is a glossary of terms you may hear during your association with the University of Mississippi Health Care's reproductive endocrinology and
More informationBACKGROUNDER. Pregnitude A Fertility Dietary Supplement for Reproductive Support Offers an Additional Option for Women Who Are Trying to Conceive
BACKGROUNDER Pregnitude A Fertility Dietary Supplement for Reproductive Support Offers an Additional Option for Women Who Are Trying to Conceive Studies find that increased chances of ovulation, menstrual
More informationUTERINE LEIOMYOSARCOMA. About Uterine leiomyosarcoma
UTERINE LEIOMYOSARCOMA Uterine Lms, Ulms Or Just Lms Rare uterine malignant tumour that arises from the smooth muscular part of the uterine wall. Diagnosis Female About Uterine leiomyosarcoma Uterine LMS
More informationFertility Policy. December Introduction
Fertility Policy December 2015 Introduction Camden Clinical Commissioning Group (CCG) is responsible for commissioning a range of health services including hospital, mental health and community services
More informationHALTON CLINICAL COMMISSIONING GROUP NHS FUNDED TREATMENT FOR SUBFERTILITY. CONTENTS Page
HALTON CLINICAL COMMISSIONING GROUP NHS FUNDED TREATMENT FOR SUBFERTILITY CONTENTS Page 1. INTRODUCTION 2 2. GENERAL PRINCIPLES 2 3. DEFINITION OF SUBFERTILITY AND TIMING OF ACCESS TO TREATMENT 3 4. DEFINITION
More information16 East 40 th St, 2 nd Fl, New York, NY Ph fax
Page 1 of 9 16 East 40 th St, 2 nd Fl, New York, NY 10016 Ph 212-679-2289 fax 212-679-2288 Please complete the following: Fertility Evaluation Name: Date of birth: Age: Partner s Name: Date of birth: Age:
More informationAdoption and Foster Care
GLOSSARY Family building via Adoption and Foster Care October 2018 www.familyequality.org/resources A Anonymous Donor: A person who donated sperm or eggs with the intention of never meeting resulting children.
More informationIgniting future research in NaProTechnology
Igniting future research in NaProTechnology Joseph B. Stanford, MD, MSPH, CFCMC Professor Director, Office of Cooperative Reproductive Health Department of Family and Preventive Medicine University of
More informationINTRACYTOPLASMIC SPERM INJECTION
1 Background... 2 2 Male Factor Infertility... 2 3 ICSI... 3 4 Surgical sperm aspiration... 4 5 What is the chance of success?... 6 6 What are the risks?... 7 M Rajkhowa, October 2004 Authorised by V Kay
More informationFacts About Folic Acid
Facts About Folic Acid How much folic acid a woman needs 400 micrograms (mcg) every day. When to start taking folic acid For folic acid to help prevent major birth defects, a woman needs to start taking
More informationSubfertility & prognostic factors & intrauterine insemination
Subfertility & prognostic factors & intrauterine insemination N.Cem FIÇICIOĞLU, M.D., Ph.D. Professor and Director Department of Gynecology & Obstetrics and IVF Center Yeditepe University, School of Medicine
More informationInternational Federation of Fertility Societies. Global Standards of Infertility Care
International Federation of Fertility Societies Global Standards of Infertility Care Standard 8 Reducing the incidence of multiple pregnancy following treatment for infertility Name Version number Author
More informationConception.LifeTips.com
Conception.LifeTips.com Category: Conception Basics Subcategory: Conception Basics Tip: How to Figure Out Your Due Date Based on Your Conception Date In the past, doctors used the first day of the mother's
More informationUnit 2 Physiology and Health Part (a) The Reproductive System HOMEWORK BOOKLET
Unit 2 Physiology and Health Part (a) The Reproductive System HOMEWORK BOOKLET Name: Homework Date Due Mark % Key Area 1 The structure and function of reproductive organs Key Area 2 Hormonal control of
More informationThe friendly guide to fertility
hannamfertility.com The friendly guide to fertility Written by fertility doctors, translated for everyone. Visit FERTILITY.CA for more info Get busy. Just starting? Many women get pregnant the first month
More informationTHE WONDERFUL WORLD OF IVF-
THE WONDERFUL WORLD OF IVF- What is IVF? A. In-Vitro Fertilization & Embryo Transfer IVF is a process by which one of more eggs (oocytes) are removed from the ovaries by a Non-surgical needle aspiration
More informationManagement of Female infertility Tim Chang
Management of Female infertility Tim Chang www.drtchang.com.au Assess and manage as a couple because: 30% infertility male factor related emotional support Role of the physician 1) diagnose and treat the
More informationChris Davies & Greg Handley
Chris Davies & Greg Handley Contents Definition Epidemiology Aetiology Conditions for pregnancy Female Infertility Male Infertility Shared infertility Treatment Definition Failure of a couple to conceive
More informationAMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE INFERTILITY: AN OVERVIEW A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the
More informationTop 10 questions in fertility
Top 10 questions in fertility Mr Rehan Salim MD MRCOG Head of Reproductive Medicine Consultant Gynaecologist & Subspecialist in Reproductive Medicine Imperial College NHS Trust Learning objectives Patient
More informationManaging infertility when adenomyosis and endometriosis co-exist
Managing infertility when adenomyosis and endometriosis co-exist Jinhua Leng Beijing,China Endometriosis Endometriosis (EM) is a common, benign, ovary hormone-dependent gynecologic disorder which affects
More information