Fertility

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Fertility Antenatal Care
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Plan
2.00 - 2.15 Intro Pre-Pregnancy Advice 2.15 -
2.45 Antenatal Care Guidelines 2.45 -
3.05 Problems in Early Pregnancy 3.05 -
3.35 Problems in Late Pregnancy 3.35 -
3.50 Tea/Coffee ( Lydias pee break) 3.50 -
4.15 Infertility Guidelines 4.15 -
4.35 Infertility Treatment Options 4.35 -
4.45 Adoption 4.45 - 5.00 Feedback and Close
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Objectives

• Be able to give appropriate advice to couples
  wanting to conceive
• Understand NICE antenatal Guidelines
• Be able to treat some common pregnancy related
  problems
• Know the local Infertility Guidelines together
  with Ix Rx options available
• Have something to put in your e-Portfolio
  (Curriculum 10.1 10.2)

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Pre-Pregnancy Advice
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Advice

• Removal of Contraceptive Devices
• Diet
• Folic Acid ( Vit D)
• Medicines
• Exercise and Sport
• Alcohol
• Smoking

• BMI
• Rubella Status
• Regular Sex
• No tight underwear for men
• Avoid trauma

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Advice - 2
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Additional Care Required?

• Major Disease
• cardiac
• renal
• endocrine
• haematological
• malignancy
• HIV
• epilepsy
• Psychiatric Disorder
• Previous Problems

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NICE Antenatal Guidelines
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Problems in Pregnancy
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Break Time!!
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Infertility
Definition a failure to conceive after
regular unprotected sexual intercourse (every 2-3
days) for 2 years in the absence of known
reproductive pathology NICE CG11, 2004
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Facts and Figures

• 84 couples attempting to conceive are successful
  after trying for 1 year
• Increases to 92 after 2 years
• Female fertility declines with age
• ( Women aged 38 only 77 at 3 years)
• Prevalence 1 in 7 couples in UK
• Need for infertility services increasing

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Causes

• Primary vs. Secondary
• Ovulatory Failure
• Low Sperm Count or quality
• Tubal Damage
• Endometriosis
• Others
• Unexplained

27 19 14 5 5 30
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When to Ix refer?

• All couples eligible for advice in primary care
• Initiate investigation after 1 year
• Referral depends on several factors
• Maternal Age
• Paternal Age
• Maternal weight
• Living Children
• Compliance
• Previous treatment (DI/IUI)

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Male Female Tests

• Male
• Semen Analysis
• Female
• Assessment of Ovulation
• Tests for tubal occlusion
• Chlamydia screening
• Laparoscopy and dye

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Sperm Tests
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WHO Criteria

• Volume 2.0ml
• Liquefaction time within 60 minutes
• pH 7.2
• Sperm Concentration 20 x 106 per ml
• Total No. Sperm 40 x 106 per ejaculate
• Motility 50 (grades a b)
• Vitality 75 live
• White Blood Cells lt 106 per ml
• Morphology 30 normal

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Ovulation Assessment

• Regular menstrual cycle?
• Blood Test to measure Progesterone at day
  21 (regular 28 day cycle)
• Confirm ovulation

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Ovulation Assessment
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Tubal Damage

• Causes
• PID
• Surgery
• Adhesions
• Screening for Chlamydia
• Hysterosalpingo-contrast sonography (HyCoSy)
• Laparoscopy Dye

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Fertility Treatments
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Summary

• Be able to give appropriate advice to couples
  wanting to conceive
• Understand NICE antenatal Guidelines
• Be able to treat some common pregnancy related
  problems
• Know the local Infertility Guidelines together
  with Ix Rx options available
• Have something to put in your e-Portfolio
  (Curriculum 10.1 10.2)

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