Fertility Issues Dr Jane Stewart Newcastle Fertility Centre

Fertility Issues Dr Jane Stewart Newcastle Fertility Centre at LIFE

Fertility w Who to refer w When to refer w How to refer w Secondary care provision and changes w Tertiary care w Licensed treatments w Primary care support

1 in 7 couples will experience a problem with conception in their reproductive lifetime.

Who/when to refer – primary care w Reassurance as appropriate w Referral as appropriate w Other options

Normal Cumulative Pregnancy Rate

Factors important to fertility w Eggs w Sperm w Tubes w Sex

Primary Care Assessment w Fertility n n n Risk factors Ovulation Sperm [Tubes] Sexual function w General n n n NICE 2004 General health and wellbeing Sexual health Weight, smoking, alcohol Folic acid Smear [FBC, TSH], rubella

Who/when to refer w Immediately n n Significant risk factors Identified cause w Early n n Significantly anxious Female age >35 years w Otherwise n At 1 -2 years trying w Issues n n n Female age Relationship Welfare of the child Medical/psychiatric problems Desire to proceed

Old Technologies w Acceptance of childlessness w Adoption w Fostering w Extended families

Unexplained subfertility w 2 years failure to conceive with regular intercourse and normal investigations

Ideal Referral w Details of both partners w Relationship w Duration of trying w Salient risk factors w Significant medical/psychiatric history w Previous pregnancies/children w Wo. C issues w Confirmation of ovulation w FBC, rubella (TSH) w Semen analysis (x 2 if relevant) w [Tubal patency if access] w With results in the letter.

Referral Pathways w PCT directed n n n 2 y/3 y services Patient choice Choose and book Treatment availability There are no eligibility requirements for fertility assessment.

Secondary Care Provision w Investigation n n More detailed investigation Tubal patency testing w Unlicensed treatments w Licensed treatments Overlap with tertiary centres

Aims of Process WITHOUT UNDUE DELAY w Diagnose a cause where possible w Reassure if appropriate w Give an estimate of chance of conceiving without treatment w Offer appropriate treatment options w Provide timely access to appropriate treatment

Unlicensed treatment w Ovulation induction n Clomifene Gonadotrophins Gn. RH w Scanning facilities w Sperm prep facilities w IUI-H w [GIFT] w Changing profiles

EUTCD w HFEA n Bring under licence from April 2007 (now June 2007) l l l Sperm prep IUI-H GIFT w EU directive n Stringent tissue handling conditions

Tertiary Referral w “ 2 y care” facilities w Unlicensed treatments w Licensed treatments n n Non- ART w GP support for tertiary treatment n n Welfare of the child Pregnancy support

GP support for 2 y/3 y treatment w w w w Prompt appropriate referral Welfare of the child Ongoing medical/psychiatric management Weight management Counselling Pregnancy support Shared prescribing

PCT Support w Facilitate access to pathway of care w Provide appropriate funding to comply with the NICE Guidelines and the associated Do. H targets allowing treatment to be provided in a timely fashion w Determine local criteria for application of limited funding w To apply funding criteria equitably w Remain open to new developments

NFCL - What do we do? w w w w w Clinics Trans-vaginal ultrasound scanning Andrology Embryology Treatment Counselling Education Multidisciplinary links Research

Clinics w Fertility n Accept 1 y, 2 y and 3 y referrals n Investigation, results review, treatment options discussed w Gynae-endo n Investigation endocrine related fertility problems n Management ovulatory dysfunction w Young peoples clinic n Advice on fertility for future n Oncology/endocrinology/ urology etc. w IVF clinics n Investigated patients arranging treatment n Follow-up following unsuccessful treatment w PP clinic

Trans-vaginal Ultrasound w Diagnostic w Natural cycle follicle tracking for DI/IUI w Ovulation induction w Ovarian stimulation for IVF w Early pregnancy w Up to 30 scans/morning 5 days/week and Sat am limited facility

Andrology w Diagnostic service n Semen analysis Newcastle w Pre-treatment assessment semen w Epididymal/testicular sperm processing w Sperm storage n n Pre-treatment/post retrieval Oncology w Sperm donor bank

Embryology w IVF w ICSI w Embryo freezing w Embryo culture w [PGD] w Research

Treatments w Ovulation induction n Clomiphene/gonadotrophins/Gn. RH w IVF n ICSI, sperm retrieval, embryo freezing w Donor gametes/ embryos w Surrogacy w Fertility preservation n n Sperm storage Embryo storage

Counselling w Treatment implications counselling w Fertility therapeutic counselling w Psychosexual counselling w Fertility awareness

Other activities w Well established clinical links with other specialties w Education w Research

Future Fertility Issues w Fertility preservation w PGD w Donor recruitment strategies w New technologies

www. nfc-life. org. uk