EVALUATING THE INFERTILE PATIENT-COUPLES. Stephen Thorn, MD
|
|
- Daniela Irma Singleton
- 5 years ago
- Views:
Transcription
1 EVALUATING THE INFERTILE PATIENT-COUPLES Stephen Thorn, MD
2 Overview The field of reproductive medicine continues to evolve rapidly by offering newer diagnostic testing and therapeutic options to improve fertility. Following pages include: Overview of current infertility evaluation Potential impact of several common gynecologic diseases
3 Peak monthly fecundity rate is 35% - while the cumulative peak pregnancy rate after one year of trying to conceive is 85% rising to 92% after 2 years 93% following 3 years Infertility affects 1 in 7 couples Generally accepted to be defined by the absence of a live birth following 1-2 years of attempting pregnancy
4 Basic Infertility Evaluation Remained constant and focused on the most common areas of abnormality 40% female factor: 40 % Ovulation dysfunction 40 % fallopian tube blockage 40% Male Factor 20% Unexplained Insurance Unpredictable insurance coverage Conscious of cost-effective, evidenced based approach
5 History 1. Female Age-Oocyte competence After 27 yrs. Infertility begins to decrease although many women become pregnant after this age Other authors feel after 33 yrs. old 2. Years of Infertility If more than 3 years, success decreases 3. Prior Live Birth Knowing can become pregnant
6 History 4. Chronic Medical Conditions and Medications PCOS Endometriosis Hypertension Thyroid Disease Hyperprolactinemia Elevated BMI 5. Coital Frequency and Timing 6. Sexual Dysfunction On demand may be difficult Use of Viagra, Cialis
7 History 7. Use of Spermicidal Lubricants 8. Complications during prior pregnancies C-Section Post-Partum Hemorrhage Necessitating D+C 9. Prior Gynecologic Surgeries Tubal Myomectomy D+C for missed or incomplete miscarriage Cervical Conizations
8 History 10. History of pelvic infections Chlamydia/Gonorrhea/PID 11. History of Salpingitis i.e Isthmic Nodosam 12. Prior Laparotomy Due to pelvic adhesions 13. Tobacco Use Including secondhand smoke
9 Physical Examination All patients should have undergone physical examination within year of considering pregnancy or treatment for infertility. Attention should be made to the following: BMI ** Extreme body weight changes have posed reproductive challenges for women, usually by impairing ovulation function Multiple studies have demonstrated decreased fertility, increased miscarriage rates, and higher pregnancy complications in women with elevated BMI Evidence of Hirsutism Endocrinologic Abnormalities Galactorrhea, weight changes, acne, frontal balding
10 TVUS In our clinic and most reproductive clinics TVUS-trans vaginal ultrasound has become part of the exam (an extension of the traditional pelvic exam) TVUS allows assessment of the ovaries for PCOS, as well as Leiomyomas within the uterus The advance of 3 and 4 D ultrasound allows a diagnosis of Mullerian anomalies and possibly the intrauterine pathology
11 Laboratory Testing FSH-LH Estradiol Progesterone Prolactin Testosterone Free-Total--?DHEAS TSH Fasting Glucose-Insulin AMH Cholesterol Many of these tests are performed during different days of the patient s cycle
12 Invasive Testing HSG Hysterosalpingogram Hysterosonogram saline Diagnostic Laparoscopy removal of endometriosis, endometriomas, adhesions, ovarian drilling] Endometrial Biopsy It was a considered basic element of any thorough infertility evaluation BUT NO LONGER serum progesterone levels. BBT recordings, monitoring LH urine secretion bx does not provide any more information
13 Medical Issues 1. Endometriosis 2. PCOS 3. Hypothyroidism 4. Uterine Anomalies 5. Other drug abuse, uncontrolled diabetes, obesity Male: Semen analysis performed to ascertain numbers, motility, morphology, wbcs, agglutination If abnormal Urological evaluation necessary
14 Treatment After thorough discussion/labs/history/physical a treatment plan will be decided upon with patient and significant other Indirect-Direct treatments with medication IUI Intrauterine insemination If indicated or no success consider IVF
15 Conclusion The MOST important issue when evaluating is honesty and communication Discuss each step in the process Realize the financial burden that this can be on a couple The entire staff involved in the care of the couple must be: Very compassionate Have patience, understanding and realize what an emotional strain this process can be on a couple
16 1. A 28 year old nulliparous woman comes to your office with her husband after trying to conceive unsuccessfully for 3 years. Over the counter ovulation predictor kits have been consistently positive at mid cycle. Her periods are every 28 days, with no dysmenorrheal. Semen analysis and hysterosalpingogram are normal. The most cost effective initial management for this couple is- A-clomiphene citrate (Clomid, Serophene) B-intrauterine insemination C-clomiphene and intrauterine insemination D-ovulation induction with gonadotropins E-in-vitro fertilization (IVF)
17 Answer: Clomiphene and intrauterine insemination Usually current management of unexplained infertility uses empiric treatments such as oral Clomid with IUI. Cost sensitivity is important. Around 30% of infertility patients have unexplained infertility. If no success after 3-6 cycles consider more invasive treatments with gonadotropins.
18 2. A 33 year old infertile woman underwent gastric bypass surgery has lost weight and continues to do so. The best recommendation patient can be given her regarding a future pregnancy is that she should try to achieve conception A - immediately B - in six months C - in 12 months D - in 18 months
19 Answer: in 12 Months These operations are associated with postoperative complications-including vomiting, dumping syndrome, and malnutrition(i.e. deficiencies in iron, vitamin B12, folate, calcium, and vitamin D)-It takes about 12 months for a patient to stabilize her body weight and nutritional status.
20 3. A 35 year old female on Hysterosalingogram is noted to have bilateral Hydrosalpinges and no tubal patency. Her husband has a normal semen analysis. For the best chance of conceiving over the next year, the next step is- A - perform a neosalingostomy procedure on both tubes B - perform a unilateral neosalpingostomy on the small diameter hydrosalpinx C In vitro fertilization-embryo transfer-(ivf) D - Bilateral salingectomy before an IVF procedure E - transvaginal aspiration of hydrosalpinx
21 Answer: Bilateral Salingectomy before an IVF Procedure Numerous studies have shown that the presence of a hydrosalpinx has an adverse outcome on IVF cycles. Patients have about ½ the pregnancy rate with IVF if a hydrosalpinx is noted. A bilateral salpingectomy or clip placement near cornua of uterus was noted to improve pregnancy rates.
22 4. A 33 year nulligravid married woman receives a diagnosis of breast cancer. She is scheduled to have a mastectomy and subsequent chemotherapy for 12 weeks with a regimen that includes an alkylating agent. The therapy or intervention that might improve her ability to deliver a child after chemotherapy for breast cancer is- A - use of oral contraceptives during the chemotherapy B - use of a gonadotropin-releasing hormone (GnRH) agonist during her chemotherapy C - obtain ovarian tissue and cryoperserve before chemotherapy D - perform in vitro fertilization (IVF) and cryopreserve embryos before chemotherapy
23 Answer: perform in vitro fertilization (IVF) and cryopreserve embryos before chemotherapy Chemotherapeutic agents damage rapidly dividing cells and specifically injure the structure and function of ovarian granulosa cells. This ultimately leads to premature oocyte depletion and eventual ovarian failure. It appears that alkylating agents cause significant oocyte depletion. The extent of damage appears to be age related - women older than 40 have increased sensitivity to chemotherapeutic agents.
24 5. A 25 year old nulligravid woman has a history of irregular cycles and mid-luteal serum progesterones that are consistent with annovulation. A hysterosalpingogram and semen analysis are normal. Treatment with clomiphene citrate (Clomid, Serophene) 50mg was administered days 5-9 of the menstrual cycle. A luteinizing hormone (LH) surge was detected by urinary monitoring on day 15 of the cycle. The most appropriate timing for intercourse and ovulation to provide the best chance for pregnancy, relative to the day of the LH surge is- A - the same day B 1 day later C - 2 days later D - 3 days later E - 1 week later
25 Answer: The Same Day Ovulation with follicle rupture occurs approximately hours after the onset of the LH surge and 24 hours after the peak. It is suggested that the fertile period occurs before ovulation and then declines rapidly. The egg survives for no more than hours after ovulation. Sperm has been noted to survive in the reproductive tract 3-5 days and to retain the ability to fertilize an ovum even before ovulation occurs.
26 6. A 32 year old nulligravid female with infertility is found to have a 8-cm posterior uterine fibroid on transvaginal ultrasound. A hysterosalgingogram shows uterine cavity distortion from a submucosal location. In discussing complications of abdominal myomectomy, you inform her that the most likely risk is- A - conversion to hysterectomy B - uterine rupture with labor C - pelvic adhesions D - blood transfusions E - intrauterine synechiae
27 Answer: Pelvic Adhesions Fibroids in the submucosal position can cause heavy periods, pain, and infertility. Before a myomectomy is performed all risks should be discussed i.e.-operative risks, anesthesia, infection, adhesions, increased likelihood for cesarean section, small risk of uterine rupture, and recovery time. Interceed did decrease incidence of adhesions. Hysterectomy conversion is rare with experienced surgeon.
28 7. A 31 year old woman has a history of a prior cesarean delivery with an associated Pomeroy tubal ligation. The patient had endometritis after her delivery that was treated with antibiotics. She has recently remarried. Her husband has not fathered a child but does have a normal semen analysis. She desires information regarding tubal reanastomosis versus in vitro fertilization (IVF) to help her conceive another child. The factor that best predicts the success rate for pregnancy and delivery after a tubal reanatomosis versus IVF is- A - age of woman requesting treatment B - prior history of an cesarean section C - type of tubal ligation performed D - history of endometritis E - absence of any prior conception with the husband s sperm
29 Answer: Age of woman requesting treatment Data shows that difference between IVF and Tubal reanatomosis, 52% and 59.5% respectively, but when age of woman considered a significant difference was noted-age less than 37-Surgical versus IVF %-respectively. More than 37 years the advantage of reanastomosis was lost Surgical versus IVF-36% 51.4 respectively.
Neil 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 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 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 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 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. 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationReproductive Testing: Less is More G. Wright Bates, Jr., M.D. Professor and Director Reproductive Endocrinology and Infertility Objectives
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
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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 informationInfertility: An Overview
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 informationWhat is PCOS? PCOS THE CONQUER PCOS E-BOOK. You'll be amazed when you read this...
PCOS What is PCOS? You'll be amazed when you read this... What is PCOS?. Who is at risk? How to get tested? What are the complications. Is there a cure? What are the right ways to eat? What lifestyle changes
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 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 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 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 informationPlease fill out the following information and have it returned to our office prior to your consultation.
Please fill out the following information and have it returned to our office prior to your consultation. Patient s Name Partner s Name Address: City: State: Zip: Phone (day#): ( ) (eve#) ( ) (cell) ( )
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 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 informationOptimizing Fertility and Wellness After Cancer. Kat Lin, MD, MSCE
Optimizing Fertility and Wellness After Cancer Kat Lin, MD, MSCE University Reproductive Care University of Washington Nov. 6, 2010 Optimism in Numbers 5-year survival rate 78% for all childhood cancers
More informationFERTILITY SERVICES PERSONAL HISTORY
FERTILITY SERVICES PERSONAL HISTORY ONE FERTILITY KITCHENER WATERLOO 4271 King St E., Suite 200 KITCHENER, Ontario N2P 2X7 P 519-650-0011 F 519-650-0033 www.onefertilitykw.com Date: Age: Height: Weight:
More informationObstetrics and Gynecology. Infertility. Dr. Layla Zaghal. Definition
Obstetrics and Gynecology Infertility Dr. Layla Zaghal Definition The term infertility is no more used and has been replaced by the term subfertility ; when you tell a couple that they are infertile, it
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 informationRealizing dreams booklet.indd 1 5/20/ :26:52 AM
Realizing dreams. 18891booklet.indd 1 5/20/2010 11:26:52 AM The Journey To Parenthood The first Gator Baby was born in 1988 through the in vitro fertilization program at the University of Florida. Since
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 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 informationInfertility: An Overview
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 informationFEMALE PATIENT HISTORY
ew Hope. ew Life. ew Beginnings. A Division of MID-ATLATIC WOME S CARE, PLC FEMALE PATIET HISTORY PLEASE OTE: Infertility patients please complete ALL sections. All other patients, complete section 1.,
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 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 informationI. ART PROCEDURES. A. In Vitro Fertilization (IVF)
DFW Fertility Associates ASSISTED REPRODUCTIVE TECHNOLOGY (ART) Welcome to DFW Fertility Associates/ Presbyterian-Harris Methodist Hospital ARTS program. This document provides an overview of treatment
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 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 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 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 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 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 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 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 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 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 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 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 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 informationWeb Activity: Simulation Structures of the Female Reproductive System
differentiate. The epididymis is a coiled tube found along the outer edge of the testis where the sperm mature. 3. Testosterone is a male sex hormone produced in the interstitial cells of the testes. It
More informationAustin Fertility and Reproductive Medicine
NEW PATIENT QUESTIONNAIRE 1. GENERAL INFORMATION Name: Age Date of Birth Occupation Partner s Name (if applicable): Partner s Date of Birth Partner s Occupation Age Who referred you/how did you hear about
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 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 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 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 informationMedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: PA.018.MH Last Review Date: 08/04/2016 Effective Date: 01/01/2017
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL PA.018.MH Infertility- Treatment This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP (Not Covered) MedStar
More informationPrepare your first visit to Sakthi Fertility
Prepare your first visit to Sakthi Fertility Infertility History Form CONTACT INFORMATION FEMALE: First Name Middle Initial Last Name Date of birth (MM/DD/YY) / / Occupation Health card number Version
More informationNEW PATIENT CONSULTATION CLINICAL QUESTIONNAIRE
NEW PATIENT CONSULTATION CLINICAL QUESTIONNAIRE 1 M a k i n g t he w o r l d s m os t b ea u t if u l c o n ne c t i o ns. Please complete this questionnaire and bring to your appointment. Feel free to
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 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 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 informationMelanoma-What Every Woman Need to Know about Fertility and Pregnancy
Melanoma-What Every Woman Need to Know about Fertility and Pregnancy Women diagnosed with melanoma may require counseling for fertility preservation, fertility treatment and safety of pregnancy after treatment.
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 informationWe hope this welcome packet will assist you during your fertility journey and help you understand all of the services that we provide.
Welcome On behalf of the entire Denver Fertility-Albrecht Women s Care staff, we would like to take this opportunity to welcome you as a new member of our family. We realize that this is a stressful time
More informationA Couple s Guide to Infertility (Eric Daiter, MD Board Certified in Reproductive Endocrinology and Infertility)
A Couple s Guide to Infertility (Eric Daiter, MD Board Certified in Reproductive Endocrinology and Infertility) The goal of this guide is to provide a medical expert s answers to the common questions:
More informationChapter 7 Infertility, Contraception, and Abortion
Chapter 7 Infertility, Contraception, and Abortion Infertility Incidence Affects about 10% to 15% of reproductive-age population Subfertility: prolonged time to conceive Sterility: inability to conceive
More informationReproduction and Development. Female Reproductive System
Reproduction and Development Female Reproductive System Outcomes 5. Identify the structures in the human female reproductive system and describe their functions. Ovaries, Fallopian tubes, Uterus, Endometrium,
More informationWhat to do about infertility?
What to do about infertility? Dr. M.A. Fischer Section Head, Division of Urology, Department of Surgery Assistant Clinical Professor, Department of Obstetrics and Gynecology Hamilton Health Sciences, Hamilton,
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 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 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 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 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 informationSurgery and Infertility
Surgery and Infertility Dr Phill McChesney BHB MBChB FRANZCOG MRMed CREI Laparoscopy Prior to Considering IVF Diagnostic Tubal Surgery Treatment of peritubal adhesions Reconstructive surgery Sterilization
More informationClinical Policy Committee
Clinical Policy Committee Commissioning policy: Assisted Conception Fertility assessment and investigations are commissioned where: A woman is of reproductive age and has not conceived after one (1) year
More informationSetting The setting was secondary care. The economic study was carried out in Turkey.
Letrozole versus human menopausal gonadotrophin in women undergoing intrauterine insemination Baysoy A, Serdaroglu H, Jamal H, Karatekeli E, Ozornek H, Attar E Record Status This is a critical abstract
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 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 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 information