Practical Workshop about Fertility in NZ

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2 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 of Otago

3 Individualised Fertility Assessment and Counselling Dr Sarah Wakeman FRANZCOG, CREI Medical Director Fertility Associates Christchurch

4 Who will come to see you? Couples heterosexual - same sex Single women After trying to conceive for a while Before trying to conceive Seeking contraception and future advice

5 Patient assessment female History How long trying for Previous pregnancies outcomes and how long to conceive Menstrual history Timing of intercourse Gynaecological history past surgery, STDs Medical/surgical history Family medical history Lifestyle ETOH, smoking, weight, exercise, work

6 Patient assessment female Examination Target history Ht Wt, BP Pelvic exam smear and swabs bimanual

7 Patient assessment male History Issues with sexual intercourse Pelvic or abdominal injuries or surgery Other medical history Family medical history Lifestyle ETOH, smoking, weight, exercise, work

8 Patient assessment male Examination HT, wt, BP Scrotum, testes, epididymis, vas deferens, penis Masses Testicular size Varicocele

9 Investigations Female Smear and swabs Day 3 FSH (plus AMH) Day 21 progesterone (or adjust to cycle length) Rubella status, Hep B, C, HIV, TSH, prl, FBE Perhaps pelvic USS Early in cycle, TV, antral follicle count, ovarian volume

10 Investigations AMH GP should only do if comfortable interpreting High levels -? PCOS Low levels for age Low ovarian reserve Earlier menopause May effect fertility

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12 Investigations Male Semenalysis Count 15million/ml Motility more than 40% motile Morphology may not be available If available more than 4% normal using WHO 2010 criteria IF SA ABNORMAL PLEASE REPEAT

13 Density *10 6 /ml Fertile Man - Once/wk for 2 yrs

14 Investigations Specialist level Tubal patency HSG or SIS Laparoscopy and dye test and hysteroscopy

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16 Management in General Practice Refer early if clear problem Eg infrequent periods Severe pelvic pain Abnormal semenalysis x2 Unexplained delay of less than months could be managed in general practice

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18 Chance of Pregnancy Drops with age Age < 30 years 37 years 40 years

19 Management in General Practice Improve lifestyle Smoking ETOH Caffeine Weight Sperm health loose underwear, frequency of ejaculation, avoid laptops on thighs Timing of intercourse/ expectant management Folic acid and iodine

20 Lifestyle and Fertility Smoking Females Longer to conceive reduces chances of pregnancy by half on treatment Earlier menopause Effects on fetus and newborn Males Longer for partner to conceive Effects sperm count, motility and morphology Increased risk of child having leukaemia Note passive smoking

21 Lifestyle and Fertility Alcohol Females Reduced fertility with heavy drinking Many studies showing effect even with low-mod amounts ETOH Safest advice is no alcohol Males Reduced fertility with 20 units or more a week

22 Lifestyle and Fertility Caffeine coffee, tea, soft drinks, chocolate Females Some evidence of fertility delay and lower chances of pregnancy with treatment with higher intakes Increased risk stillbirth with higher intakes Males Less evidence

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24 Lifestyle and Fertility Weight Females Overweight greater BMI, less chance of pregnancy Increased risks in pregnancy Long term effects on child Underweight Males Ovulation disorders Lower chance of conceiving Overweight Effects sperm parameters Partner may have lower chance conceiving

25 Timing of intercourse Woman cycle length Mucous changes - Apps - Fertility Friend, Period Tracker - Regular intercourse every 2 nd day - From day 10 of cycle for a week

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29 When to refer? Before a year if clear problem At a year if problem or if woman older than 35 yrs Definitely by 2 years for others Health Pathways criteria for public referral Fertility Associates Christchurch Christchurch Women s hospital Otago Fertility Service

Fertility Issues Update. Dr Sarah Wakeman FRANZCOG, CREI, Medical Director, Fertility Associates Christchurch

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