Reproductive Testing: Less is More G. Wright Bates, Jr., M.D. Professor and Director Reproductive Endocrinology and Infertility Objectives
|
|
- Janice McCormick
- 5 years ago
- Views:
Transcription
1 Reproductive Testing: Less is More G. Wright Bates, Jr., M.D. Professor and Director Reproductive Endocrinology and Infertility Objectives 1. Review definition of infertility and impact of age 2. Stress evidence based approach to the diagnosis of infertility 3. Highlight unnecessary and potentially harmful test and interventions The speaker has no conflict of interest or relevant disclosures Infertility Definition and Evaluation Failure to achieve a successful pregnancy after 12 months of unprotected appropriately timed intercourse Evaluation is warranted after 6 months in a woman over 35 years of age Evaluation is warranted earlier if medical history or physical exam indicated abnormality Ovulatory dysfunction / Endocrinopathy Pelvic pain Male factor ASRM Practice Committee Statement Fertil Steril 2013;99:63. 1
2 WHAT TEST SHOULD WE DO?!?!?! HSG Basal Body Temp Semen Analysis Immunologic Hysteroscopy Testing TSH CCCT Laparoscopy Prolactin Vitaminsi DHEAS Post coital Test 17-OH Progesterone Antisperm Antibodies Testosterone Hamster Penetration Assay Estrogen FSH AMH Chromosome Analysis Inhibin MIS Ovarian Reserve Testing Amenorrhea failure to menstruate by age 15 in the presence of normal secondary sexual development within five years after breast development if that occurs before age 10 (Failure to initiate breast development by age 13) No menses for 3 months if history of regular cycles No menses for 9 months if cycles irregular 10% will have POI Irregular or short cycles > 35 years of age 2008 and 2015 ACOG Committee Opinion Age and Fertility 2
3 Ovarian Reserve Testing Clomiphene Citrate Challenge Test Day 3 FSH, Estradiol CC 100 mg days 5 9 Day 10 FSH, Estradiol Day 3 FSH PLUS Estradiol Gonadotropin Stimulation Test Basal Antral Follicle Count** Inhibin B AMH Gonadotropin Stimulation 2008; 2015 ACOG Committee Opinion Aims to promote conversations between clinicians and patients by helping patients choose care that is: Supported by evidence Not duplicative of other tests or procedures already received Free from harm Truly necessary 1/24/16 Prolactin in ovulatory women org 1/22/16 Unless Galactorrhea Ovulatory Dysfunction Recurrent Pregnancy Loss Measure twice If elevated MRI Don t forget IGF1 3
4 Ovulation Confirmation Menstrual history Predictable, Cyclic, Confounders LH surge Done correctly Kept in perspective Luteal progesterone Highly accurate but retrospective Basal Body Temperature Endometrial biopsy Ultrasound assessment Cervical mucous changes Mittelschmerz Recent technologies (Skin and Saliva) Advantages Low Cost Accessibility Establishes a pattern of ovulation Disadvantages Accuracy (predict the LH surge to the day at 18.3% 30%; 30%; within 1 day at 56.7% 70%) 70%) Added Stress Brezina, PR, et.al., F&S 95(6)1867, 2011 Urinary LH Testing Begin testing based on shortest cycle in last 6 months 28 day cycle begin day (21 begin 5 7, 35 begin 16 18) 18) Optimum time for testing is late afternoon Ovulation follows in hours Approximately 10% false positive, 20% false negative Product variability Delay testing until 3 days after CC ASRM Practice Committee. Diagnostic Evaluation of Infertile female, 2012 Brezina, PR, et.al., F&S 95(6)1867,
5 Post Coital Testing Invasive on many levels Endometrial biopsy Unless symptoms, age, obesity, anovulation, endometrial thickness warrant Bx Post Coital Test Four board certified REI evaluated PCT Agreement 39% sperm number and motility 11% cellularity 14% spinnbarkeit 14% overall test impression (kappa statistic 0.13 (poor) 0.51 (fair) Glatstein, et al, ACOG, 1995 Possible exception: coital concerns Endometrial Biopsy 847 subjects NIH RMN Biopsies early (21 22) and late (26 27) after LH surge Out of phase biopsy greater 2 day discrepancy Out of phase biopsies Early: fertile: 49.4%, infertile: 43.2% late luteal phase: fertile: 35.3%, infertile 23.0% Coutifaris, Diamond, et al, Fert Steril
6 Routine diagnostic laparoscopy org 1/22/16 History / Exam Pain dysmenorrhea, dyspareunia, dyschezia Surgery appendectomy, tubal surgery Infection PID, chlamydia, GC If L/S all infertile patients: NNT 40 Advanced spermatozoa function Hemizona assay Hamster Penetration Assay Sperm DNA testing Immunologic testing Thrombophilia Testing MTHFR Limited testing (APAS) for recurrent pregnancy loss 6
7 Do NOT perform the following test: FSH to determine menopausal transition as a cause of abnormal uterine bleeding Karyotype for initial evaluation of secondary amenorrhea Do NOT administer: Any form of testosterone or androgens to men who might pursue fertility Vitamin D Vitamin D deficiency suggested as an etiology of Infertility PCOS Ovarian Reserve Uterine fibroids Success with IVF Deficiency Excess No effect No evidence of improved outcomes with Supplementation or Replacement Irani M and Merhi Z, Fertil Steril, August 2014 Recommendations Infertility Evaluation Thyroid Confirm Ovulation Consider Ovarian Reserve Anatomic Evaluation Semen Analysis Avoid Unnecessary Test CHOOSE WISELY 7
5/5/2010. 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 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 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 informationClinical evaluation of infertility
Clinical evaluation of infertility DR. FARIBA KHANIPOUYANI OBSTETRICIAN & GYNECOLOGIST PRENATOLOGIST Definition: inability to achieve conception despite one year of frequent unprotected intercourse. Male
More informationThe assessment and investigation of the infertile couple
The assessment and investigation of the infertile couple BIRUTE ZILAITIENE, MD, PHD, PROF., FECSM DEPARTMENT OF ENDOCRINOLOGY AND INSTITUTE OF ENDOCRINOLOGY, LITHUANIAN UNIVERSITY OF HEALTH SCIENCES, KAUNAS,
More informationInfertility INA S. IRABON, MD, FPOGS, FPSRM, FPSGE OBSTETRICS AND GYNECOLOGY REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY
Infertility INA S. IRABON, MD, FPOGS, FPSRM, FPSGE OBSTETRICS AND GYNECOLOGY REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY To download lecture deck Reference Comprehensive Gynecology 7 th edition, 2017 (Lobo
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 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: DIAGNOSIS, WORKUP AND MANAGEMENT FOR THE COMMUNITY PHYSICIAN
INFERTILITY: DIAGNOSIS, WORKUP AND MANAGEMENT FOR THE COMMUNITY PHYSICIAN Caitlin Dunne, MD, FRCSC Clinical Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics
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 informationLABORATORY TESTS IN DIAGNOSIS OF FEMALE INFERTILITY
LABORATORY TESTS IN DIAGNOSIS OF FEMALE INFERTILITY Sara Mokhtar M.D. Infertility Fellowship Avicenna Research Institute. Couples wish to know why they have not been able to conceive and,depending on the
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 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 informationOverview of Reproductive Endocrinology
Overview of Reproductive Endocrinology I have no conflicts of interest to report. Maria Yialamas, MD Female Hypothalamic--Gonadal Axis 15 4 Hormone Secretion in the Normal Menstrual Cycle LH FSH E2, Progesterone,
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 informationPolycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018
Polycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018 Learning Objectives At the conclusion of this lecture, learners should: 1) Know the various diagnostic
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 informationNEW PATIENT DATA SHEET Please complete as best you can. It is not necessary to have all information before speaking with a doctor. PATIENT INFORMATION
NEW PATIENT DATA SHEET Please complete as best you can. It is not necessary to have all information before speaking with a doctor. PATIENT INFORMATION PATIENT NAME DOB AGE PARTNER NAME DOB AGE STREET CITY
More informationTest Briefing on Hormonal Disorders and Infertility
Test Briefing on Hormonal Disorders and Infertility Test Briefing on Hormonal Disorders Common Tests FSH LH Progesterone Estradiol Prolactin Testosterone AFP AMH PCOS Panel FSH (Follicle Stimulating Hormone)
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 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 informationPOTION OR POISON? MEDICAL TREATMENT ALTERNATIVES TO THE PILL. Lester Ruppersberger, D.O., FACOOG,CNFPI NFP only Gynecologist
POTION OR POISON? MEDICAL TREATMENT ALTERNATIVES TO THE PILL Lester Ruppersberger, D.O., FACOOG,CNFPI NFP only Gynecologist THE PILL Released to US market in 1960 10-15 x dose of hormones in HRT Over 10-14
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 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 informationEVALUATION OF MALE AND FEMALE INFERTILITY ANDREA BARRUECO AMERICAN CENTER FOR REPRODUCTIVE MEDICINE CLEVELAND CLINIC ART TRAINING 2018
EVALUATION OF MALE AND FEMALE INFERTILITY ANDREA BARRUECO AMERICAN CENTER FOR REPRODUCTIVE MEDICINE CLEVELAND CLINIC ART TRAINING 2018 The evaluation of an infertile couple requires an understanding of
More informationCynthia Morris DO, FACOOG, FACOS Medical Director, Women s Wellness Center Fayette County Memorial Hospital
Cynthia Morris DO, FACOOG, FACOS Medical Director, Women s Wellness Center Fayette County Memorial Hospital Touchdown to CME Eighth District Academy of Osteopathic Medicine & Surgery October 8. 2017 Goals
More informationAMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Formerly The American Fertility Society OVULATION DETECTION A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive
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 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 information2/14/2017. Pre Pregnancy Tune Up: Predicting Success and Avoiding Liability. Objectives. Disclosure. Participant will be able to:
Pre Pregnancy Tune Up: Predicting Success and Avoiding Liability February 9, 2017 G. Wright Bates, Jr., M.D. Professor and Director Reproductive Endocrinology and Infertility Objectives Participant will
More informationPolycystic Ovary Syndrome (PCOS):
Polycystic Ovary Syndrome (PCOS): Current diagnosis and treatment Anatte E. Karmon, MD Disclosures- Anatte Karmon, MD No financial relationships to disclose 2 Objectives At the end of this presentation,
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 informationReproductive Health and Pituitary Disease
Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives
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 informationNew Patient Medical History
New Patient Medical History MR #: Initial Appointment Date: / / Name: Birth Date: / / Address: City: State: Zip: Best Phone # to reach you: ( ) Second contact #: ( ) Email Address: Occupation: Marital
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 informationMULTIPLE CHOICE: match the term(s) or description with the appropriate letter of the structure.
Chapter 27 Exam Due NLT Thursday, July 31, 2015 Name MULTIPLE CHOICE: match the term(s) or description with the appropriate letter of the structure. Figure 27.1 Using Figure 27.1, match the following:
More informationCauses of Infertility and Treatment Options
Causes of Infertility and Treatment Options Dr Mrs.Kiran D. Sekhar Former vice President-FOGSI Former Chairperson- Genetics and Foetal medicine-fogsi Founder and Medical Director-Kiran Infertility centre
More informationROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU)
ROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU) In 1935, Stein and Leventhal described 7 women with bilateral enlarged PCO, amenorrhea or irregular menses, infertility and masculinizing
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 informationLori Arnold, M.D., F.A.C.O.G Reproductive Endocrinology and Fertility
Lori Arnold, M.D., F.A.C.O.G Reproductive Endocrinology and Fertility NEW PATIENT HISTORY A. FEMALE IDENTIFYING DATA Date this form completed Your name: _ Partner s Name: Age Birth date Height Weight How
More informationSubfertility B Y A L I S O N, B E N A N D J O H N
Subfertility B Y A L I S O N, B E N A N D J O H N Contents Definition Causes Male Female Hx & Ex Investigations Treatment Definition Failure to conceive after a year of frequent, unprotected communion.
More informationWHY INVESTIGATE FOR INFERTILITY
WHY INVESTIGATE FOR INFERTILITY Intrauterine Insemination 1 About this booklet This series of booklets has been developed and written with the support of leading fertility clinics across Australia, and
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 informationAndrogens Hormones that are produced by the testes of the male and in small amounts by the ovaries and adrenal glands of the female.
http://www.myfertility.ca/glossary.xhtml (February 27, 2015) Glossary Acrosome This is a membrane-bound cap-like structure found at the head of the sperm. It contains enzymes that are thought to help the
More informationAt the conclusion of the first two year, the resident should be able to:
Reproductive Endocrinology/Infertility Rotations PGY-I COMPETENCY 1. Patient Care, Provide patient centered care that is compassionate, appropriate, and effective for the treatment of health problems and
More informationDr Mary Birdsall. Fertility Associates Auckland
Dr Mary Birdsall Fertility Associates Auckland Period Problems Mary Birdsall Medical Director Fertility Associates Auckland Period Problems Basic Physiology No Periods Irregular Periods Heavy Periods
More informationOVERVIEW. FEMM (Fertility Education & Medical Management) is headquartered in New York City, NY. 1
OVERVIEW FEMM (Fertility Education & Medical Management) is headquartered in New York City, NY. 1 FEMM is a three-tiered women s healthcare project. Grounded in revolutionary, peer-reviewed research in
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 informationPalm Beach Obstetrics & Gynecology, PA
Palm Beach Obstetrics & Gynecology, PA 4671 S Congress Avenue 4631 N Congress Avenue Lake Worth, FL 33461 West Palm Beach, FL 33407 INSTRUCTIONS FOR INFERTILITY WORKUP Please read these handouts carefully.
More informationThe Pharmacology of PCOS
The Pharmacology of PCOS G. Wright Bates, Jr., M.D. Director Reproductive Endocrinology & Infertility University of Alabama at Birmingham Objectives Review the diagnosis of PCOS Highlight lifestyle modifications
More informationCASE 41. What is the pathophysiologic cause of her amenorrhea? Which cells in the ovary secrete estrogen?
CASE 41 A 19-year-old woman presents to her gynecologist with complaints of not having had a period for 6 months. She reports having normal periods since menarche at age 12. She denies sexual activity,
More informationNew PCOS guidelines: What s relevant to general practice
New PCOS guidelines: What s relevant to general practice Dr Michael Costello Fertility Specialist IVF Australia UNSW Royal Hospital for Women Sydney How do we know if something is new? Louvre Museum, Paris
More informationCancer Risks of Ovulation Induction
Cancer Risks of Ovulation Induction 5th World Congress on Ovulation Induction September 13-15, 2007 Louise A. Brinton, Ph.D. National Cancer Institute Rockville, Maryland, USA Ovulation Induction and Cancer
More informationAbnormal Uterine Bleeding Case Studies
Case Study 1 Abnormal Uterine Bleeding Case Studies Abigail, a 24 year old female, presents to your office complaining that her menstrual cycles have become a problem. They are now lasting 6 7 days instead
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 informationInfertility: Current Testing and Treatment Methods
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/infertility-current-testing-and-treatmentmethods/9902/
More informationPolycystic Ovarian Syndrome (PCOS) LOGO
Polycystic Ovarian Syndrome (PCOS) Ma qianhong Ob/Gyn Department LOGO Contents Epidemiology and Definition Pathophysiology, Endocrinological Features Diagnostic Criteria Treatment Prognosis Introduction
More informationHormonal Control of Human Reproduction
Hormonal Control of Human Reproduction Bởi: OpenStaxCollege The human male and female reproductive cycles are controlled by the interaction of hormones from the hypothalamus and anterior pituitary with
More informationPolycystic Ovary Syndrome
What is the polycystic ovary syndrome? Polycystic Ovary Syndrome The polycystic ovary syndrome (PCOS) is a clinical diagnosis characterized by the presence of two or more of the following features: irregular
More informationUnexplained Infertility
Unexplained Infertility Kaylen M. Silverberg, M.D. Thomas C. Vaughn, M.D. Texas Fertility Center Austin, Texas Introduction Infertility is generally defined as the inability to conceive following one year
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 informationObjectives 06/21/18 STILL A PLACE FOR PILLS DON T IVF EVERYTHING. Clomiphene citrate and Letrozole. Infertility Case Studies. Unexplained Infertility
STILL A PLACE FOR PILLS DON T IVF EVERYTHING Jeff Roberts M.D. Co-Director, Pacific Centre for Reproductive Medicine Objectives 1 2 3 4 5 Clomiphene citrate and Letrozole Infertility Case Studies Unexplained
More informationTreatment Plan Page1 TREATMENT PLAN TREATMENT PLAN TYPE TREATMENT PLANNED. New Update Management Review Committee
Treatment Plan Page1 TREATMENT PLAN TREATMENT PLAN TYPE New Update Management Review Committee TREATMENT PLANNED Diagnostic Cycle Natural Cycle CCT Ovulation Induction CC Gonadotropins Letrozole Metformin
More informationCase Questions. Polycystic Ovarian Syndrome: Treatment Goals and Options. Differential Diagnosis of Hyperandrogenic Anovulation
Polycystic Ovarian Syndrome: Treatment Goals and Options Marc Cornier, MD Division of Endocrinology, Metabolism and Diabetes Colorado Center for Health and Wellness University of Colorado School of Medicine
More informationGPVTS TEACHING APRIL 2016 FERTILITY
GPVTS TEACHING APRIL 2016 FERTILITY Djavid Alleemudder - Consultant Obstetrics & Gynaecology DEFINITIONS What is the definition of infertility? Failure to conceive after 12 months despite regular, unprotected
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 informationFemale Reproductive Endocrinology
Female Reproductive Endocrinology Dr. Channa Jayasena PhD MRCP FRCPath Clinical Senior Lecturer & Consultant Endocrinologist Department of Gynaecology, Hammersmith Hospital Anovulation is a common cause
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 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 informationPERIMENOPAUSE. Objectives. Disclosure. The Perimenopause Perimenopause Menopause. Definitions of Menopausal Transition: STRAW.
PERIMENOPAUSE Patricia J. Sulak, MD Founder, Living WELL Aware LLC Author, Should I Fire My Doctor? Author, Living WELL Aware: Eleven Essential Elements to Health and Happiness Endowed Professor Texas
More informationAll referrals for out-patient appointments can also be discussed with the Obstetrics and Gynaecology registrar as necessary. Presence of ascites
Gynaecology Referral Pathway for GPs to Aid Triage for Gynaecology Services in the Rotunda For acute gynaecology (suspected torsion, acute PID, etc..) or acute early pregnancy referrals please consider
More informationAcacio Fertility Center, Inc. Brian Acacio, MD Mission Viejo Laguna Niguel Bakersfield. Name of Patient DOB Age. Name of Partner DOB Age
Acacio Fertility Center, Inc. Brian Acacio, MD Mission Viejo Laguna Niguel Bakersfield CLINICAL QUESTIONNAIRE Please complete this questionnaire as accurately as possible. Feel free to keep a copy for
More informationInfertility. Rhian Allen & David Rogers.
Infertility Rhian Allen & David Rogers http://www.worldofsurrogacy.com Objectives Definition & Epidemiology Female Gonadal Axis Normal Menstrual Cycle Causes Patient History Patient Examination Investigations
More informationReproductive Endocrinology and Infertility Rotation Objectives. Reproductive Endocrinology and Infertility Specialists
Reproductive Endocrinology and Infertility Rotation Objectives Reproductive Endocrinology and Infertility Specialists Terry O Grady M.D., FRCSC Sarah Healey M.D., FRCSC Deanna Murphy M.D., FRCSC Sean Murphy
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 informationDifficulty Conceiving? Yes No. Yes No. Yes No. Yes No
FEMALE INFORMATION Name: _ Birth date: _ Total Number of Pregnancies: Occupation: Married Single Term births: Race: Height: ft inches Pre-term births: Religious Affiliation: Weight: pounds Miscarriages/Abortions:
More informationMedical Affairs Policy
Medical Affairs Policy Service: Infertility and Recurrent Pregnancy Loss Testing and Treatment PUM 250-0018-1706 Medical Policy Committee Approval 06/16/17 Effective Date 10/01/17 Prior Authorization Needed
More informationPractical Workshop about Fertility in NZ
Practical Workshop about Fertility in NZ Dr Sarah Wakeman Fertility Associates Christchurch Dr Mary Birdsall Fertility Associates Auckland Professor Wayne Gillett Otago Fertility Service and University
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 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 informationDr Stella Milsom. Endocrinologist Fertility Associates Auckland. 12:30-12:40 When Puberty is PCO
Dr Stella Milsom Endocrinologist Fertility Associates Auckland 12:30-12:40 When Puberty is PCO Puberty or Polycystic Ovary Syndrome? Stella Milsom Endocrinologist Auckland DHB, University of Auckland,
More informationNelson: Primary Care Work Up for the Infertile Couple
Primary Care Work Up for the Infertile Couple Conflict of Interest Disclosure Anita L. Nelson, MD Anita L. Nelson, MD Professor OB-GYN David Geffen School of Medicine at UCLA 38 th Annual CAPA Conference
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 informationCentre for Reproductive Immunology and Pregnancy Pre-Appointment History Sheet
Please fill in the below table with your details: Title First Name Surname Date of Birth and age Occupation Do you smoke? (please circle) If yes, how many per day?. ne Low Moderate High How is your alcohol
More informationAbnormal Uterine Bleeding: Evaluation of Premenopausal Women. Vanessa Jacoby, MD, MAS Assistant Professor Ob, Gyn, & Reproductive Sciences UCSF
Abnormal Uterine Bleeding: Evaluation of Premenopausal Women Vanessa Jacoby, MD, MAS Assistant Professor Ob, Gyn, & Reproductive Sciences UCSF Objectives Define normal and abnormal uterine bleeding Review
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 information12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman
Polycystic Ovarian Syndrome (PCOS) for the Family Physician Barbara S. Apgar MD, MS Professor or Family Medicine University of Michigan Ann Arbor, Michigan Important references for PCOS Endocrine Society
More informationPolycystic Ovary Syndrome
Polycystic Ovary Syndrome Definition: the diagnostic criteria Evidence of hyperandrogenism, biochemical &/or clinical (hirsutism, acne & male pattern baldness). Ovulatory dysfunction; amenorrhoea; oligomenorrhoea
More informationIdeal preparation for pregnancy
Ideal preparation for pregnancy The following examinations are recommended before the start of a fertility treatment: 1) Rubella or varicella antibodies If an expecting mother is infected with rubella
More informationCASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology
CASE 4- Toy et al. CASE FILES: Obstetrics & Gynecology A 49-year-old woman complains of irregular menses over the past 6 months, feelings of inadequacy, vaginal dryness, difficulty sleeping, and episodes
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 informationPCOS guidelines: What s relevant to general practice
PCOS guidelines: What s relevant to general Dr David Molloy Medical Director, Queensland Fertility Group International evidence based PCOS guidelines 1st ever internationally endorsed & evidence based
More informationQuestionnaire for Women
Questionnaire for Women General Information Name Date Address Telephone Home _Work _ Cell Birth date Age _ Occupation Ethnic Background _ Height _ Weight _ Highest Education _ Partner s Name Marriage date
More informationSexual dysfunction of chronic kidney disease. Razieh salehian.md psychiatrist
Sexual dysfunction of chronic kidney disease Razieh salehian.md psychiatrist Disturbances in sexual function are a common feature of chronic renal failure. Sexual dysfunction is inversely associated with
More informationPCOS and Obesity DUB is better treated by OCPs
PCOS and Obesity DUB is better treated by OCPs Dr. Ritu Joshi Senior consultant Fortis escorts Hospital, Jaipur Chairperson Family welfare com. FOGSI (20092012) Vice President FOGSI 2014 Introduction One
More informationLA IVF CLINICAL QUESTIONNAIRE
1 LA IVF CLINICAL QUESTIONNAIRE West Los Angeles Fertility Clinic 10309 Santa Monica Boulevard Suite 300 Los Angeles, CA 90025 Pasadena Fertility Clinic 10 Congress Street Suite 509 Pasadena, CA 91105
More informationMedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: PA.017.MH Last Review Date: 08/04/2016 Effective Date: 01/01/2016
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL PA.017.MH Infertility- Diagnosis This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP (Not Covered) MedStar
More informationMULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.
MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) Which of the following hormones controls the release of anterior pituitary gonadotropins? A) LH
More information