North West Gynaecology Update Symposium 24 April 2013

North West Gynaecology Update Symposium 24 April 2013 www. omondihealthcare. com www. northwestgynaecology. co. uk

North West Gynaecology… q North West Gynaecology (NWG) is a group of consultant gynaecologists formed in 2007 to cover the complete spectrum of gynaecological problems. q Gynaecology has many sub-specialist areas and it is no longer possible for one gynaecologist to be an expert in all these areas. q NWG provides a unique service making sure that your patient sees the right gynaecologist to treat their particular problem. q NWG provides comprehensive general gynaecological and subspecialist gynaecological care to the women of Manchester, Cheshire, Lancashire and the rest of the UK www. omondihealthcare. com www. northwestgynaecology. co. uk

North West Gynaecology… q Ambulatory Gynaecology q Paediatric and Adolescent Gynaecology q Infertility and Assisted Conception q Urogynaecology q Gynaecological Cancer www. omondihealthcare. com www. northwestgynaecology. co. uk

North West Gynaecology… …The Team Kristina Gail Edmond Rick Tony Naidoo Busby Edi-Osagie Clayton Smith www. omondihealthcare. com www. northwestgynaecology. co. uk

Programme… q Menstrual Disorders in General Practice - Dr Kristina Naidoo q Common Problems in Paediatric and Adolescent Gynaecology - Dr Gail Busby q Management of the Infertile Couple - Assessment, Investigation, Referral - Dr Edmond Edi-Osagie q Management of female urinary incontinence - new NICE guidelines - Dr Tony Smith q Update on Gynaecological Cancer - Dr Rick Clayton q Panel Discussion - NWG Faculty www. northwestgynaecology. co. uk

The Infertile Couple… …Assessment, Treatment, Referral Edmond Edi-Osagie Consultant Gynaecologist Saint Mary’s Hospital Manchester www. omondihealthcare. com www. northwestgynaecology. co. uk

Infertility…some facts 85% of couples conceive after 12 months of UPSI 92% of couples conceive after 24 months of UPSI 1 -in-6 (15%) of couples experience some difficulty conceiving WHO, 1975 17. 2% prevalence of subfertility among 14, 141 couples Collins, 1995 www. omondihealthcare. com www. northwestgynaecology. co. uk

Female fertility… 1 Courtesy of: www. repromed. com www. omondihealthcare. com www. northwestgynaecology. co. uk

Female fertility… 2 Courtesy of: www. rba-online. com www. omondihealthcare. com www. northwestgynaecology. co. uk

Infertility causes…NICE 2013 Sperm abnormalities (30%) Ovulation problems (25%) Low count Ovulation absent Poor movement Poor egg quality Abnormal shapes Ovarian failure No sperm Tubal problems (20%) Tubes blocked Unexplained (25%) Tubes distorted No cause found Tubes absent Combined (40%) Uterine problems (10%) Male and Female Fibroids Septum Adhesions, Polyps www. omondihealthcare. com www. northwestgynaecology. co. uk

Investigating Infertility… OVULATORY / OVARIAN FUNCTION. . FSH / LH / Oestradiol / Progesterone / Prolactin / Androgens / AMH. . TUBAL FUNCTION. . Hy. Co. Sy / HSG / Laparoscopy. . UTERINE CAVITY. . Transvaginal scan / Hydrosonography / Hysteroscopy. . SPERM FUNCTION. . Semen analysis / Sperm DNA damage / Anti-sperm antibodies. . ? OTHERS. . ? Uterine Doppler / ? Immunological tests / ? Anti-Phospholipids Abs. . www. omondihealthcare. com www. northwestgynaecology. co. uk

Sequellae of PID…I • Morbidity / Mortality • Infertility (14 x) • Ectopic pregnancy (6 x) • Chronic pelvic pain (10 x) • Risk of hysterectomy (8 x) www. omondihealthcare. com www. northwestgynaecology. co. uk

Sequellae of PID…II www. omondihealthcare. com www. northwestgynaecology. co. uk

Fertility Advice… • Age: fertility @ 3 years = 94% of 35 year olds vs. 77% of 38 year olds • Coital frequency: 2 -3 x weekly (avoid timed intercourse) • Alcohol: excessive intake detrimental • Smoking: detrimental to male and female fertility • Body weight: Ideal BMI = 19 -29 • Caffeine: uncertain impact in natural conception; detrimental to IVF treatment • Drug use: best avoided if not essential • Complementary therapies: potentially beneficial but no robust evidence www. omondihealthcare. com www. northwestgynaecology. co. uk

Fertility Treatment Options… OVULATORY DYSFUNCTION…OVULATION INDUCTION. . Clomid / Metformin / Gonadotrophins / Ovarian drilling. . TUBAL FACTORS…SURGERY. . Tubal canulation / Peri-tubal adhesiolysis / Cuff salpingostomy / IVF-ICSI. . UTERINE FACTORS…SURGERY. . Metroplasty / Adhesiolysis / Fibroid/Polyp resection. . SPERM DYSFUNCTION…AC. . IUI / SSR / IVF-ICSI. . ? OTHERS. . ? Immunotherapy / ? Steroids / ? Complementary therapies. . www. omondihealthcare. com www. northwestgynaecology. co. uk

Assisted Conception (AC)…. . IUI / S-IUI / DI. . IVF. . ICSI. . Gamete Donation. . Surrogacy. . www. omondihealthcare. com www. northwestgynaecology. co. uk

AC access by PCT… 1 www. omondihealthcare. com www. northwestgynaecology. co. uk

AC access by PCT… 2 www. omondihealthcare. com www. northwestgynaecology. co. uk

NICE guidelines 2013…I q Offer infertility investigations after 12 months of trying to conceive (down from 24 months) q Offer infertility investigations earlier if the woman is >36 years and/or there is a known cause of infertility www. omondihealthcare. com www. northwestgynaecology. co. uk

NICE guidelines 2013…II q Do not offer Clomid treatment for unexplained infertility q Do not offer IUI (natural or stimulated) routinely for Unexplained infertility, Endometriosis, or Mild male factor infertility q Offer IVF treatment after 2 years of unexplained infertility www. omondihealthcare. com www. northwestgynaecology. co. uk

NICE guidelines 2013…III q Offer 3 full cycles of IVF after 2 years of infertility up to the age of 40 years q Offer 1 full cycle of IVF between 40 and 42 years to women with satisfactory ovarian reserve who have not previously had IVF www. omondihealthcare. com www. northwestgynaecology. co. uk

…how can NWG help! www. omondihealthcare. com www. northwestgynaecology. co. uk

NWG Fertility Services. . . I Service Model. . Private Satellite Fertility Service. . Licensed Centres. . St. Mary’s Hospital, Manchester. . Manchester Fertility Services. . www. northwestgynaecology. co. uk

NWG Fertility Services. . . II. . fertility profiling. . comprehensive investigations. . full range of fertility treatments. . surgical treatment options. . support & counselling. . www. omondihealthcare. com www. northwestgynaecology. co. uk

NWG Fertility Treatments… q General = Fertility Profiling & Advice. . q Medical = Ovulation induction (Oral & Parenteral). . q Surgical = Tubal surgery, Reversal of Sterilisation, Ovarian drilling, SSR, Uterine surgery. . q AC = IUI, IVF, ICSI. . q Egg freezing / donation / sharing / Surrogacy. . www. northwestgynaecology. co. uk

www. bmihealthcare. co. uk www. northwestgynaecology. co. uk

www. bmihealthcare. co. uk Discussion www. northwestgynaecology. co. uk