ivf necessary element in gynaecology
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Ivf necessary element in gynaecologyTRANSCRIPT
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IVF NECESSARY ELEMENT IN
GYNAECOLOGY
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What is in it for me?
There are novel concepts in Infertility that we need to know. They will make a
difference in your clinical practice
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IntroductionThe inability to create a desired pregnancy that culminates in the birth of a child is likely to create a life crisis for women and their partners. Women seeking fertility treatment look to nurses for care, counsel and health teaching.
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Introduction (Continued)
• Primary infertility: The inability to conceive after 1 year of unprotected intercourse for a woman younger than 35, or after 6 months of unprotected intercourse for a woman 35 or older (Speroff
& Fritz, 2005).• Secondary infertility: The inability of a
woman to conceive who previously was able to do so (Speroff & Fritz, 2005).
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Introduction (Continued)
Infertility is more common in older women. However, increased age reduces the efficacy of treatment.
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Infertility affects 15 % of couples, and 50-70 % of male infertility is potentially correctable so it name As: Subfertility …….
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DECREASING SPERM QUALITY & QUANTITY: A
GLOBAL PROBLEM?
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Evaluation of decreasing sperm count
Environmental Health Perspectives 108 (10) (Oct. 10, 2000); E. Carlsen et al.British Medical Journal 305 (Sept. 12, 1992).
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Reduction in sperm density
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Reduction in sperm density
Journal of Andrology, Vol. 28, No. 2, March/April 2007
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Reduction in sperm morphology quality
Journal of Andrology, Vol. 30, No. 5, September/October 2009
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Semen analysis• New reference values by WHO
Semen Parameter WHO 1999
WHO 20101
Volume (mL) ≥2.0 1.5
Count (x106/mL) ≥20 15
Total sperm number per ejaculate
≥40 39
Motility (%) ≥50 (a+b) 32 (a+b)
Vitality (%) ≥75 58
Morphology (%)2 (14) 4
Leukocytes (x106/mL) <1.0 <1.01Lower Limit (5% percentile); Recent fathersGrade a = rapid progressive motilityGrade b = slow/sluggish progressive motility 2Strict criteria
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New WHO references valuesHow they were obtained
1,953 semen samples of recent fathers
Time to pregnancy (TTP) ≤ 12 mo 5 studies in 7 countries on 3
continents Laboratories with QC only Morphology by strict criterion
(Kruger) Progressive and non-progressive
motility Lower reference limits (5th centile)13
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Impact of the New WHO Guidelines on Diagnosis and Practice of Male
Infertility 1
1. The Open Reproductive Science Journal, 2011, 3, 7-15
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15
New WHO references valuesCritical Appraisal
USA(Columbia, NYC, Minneapolis, LA)
AUSTRALIA (Melbourne)
NORWAY(Oslo)
FINLAND(Turku)
DENMARK (Copenhagen)
FRANCE(Paris)
UK(Edinburgh)
??
??? ?
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Prevalence and Overview of Treatments
• The overall incidence of infertility has remained relatively unchanged for the past 30 years (Speroff & Fritz, 2005).
• In 2002, about 2 percent of women of reproductive age had an infertility-related medical appointment within the previous year, and 10 percent had an infertility-related medical visit at some point in the past (Chandra et al., 2005).
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Prevalence and Overview of Treatments (Continued)
Approximately half of all women who receive fertility care achieve conception leading to a live birth (Speroff & Fritz, 2005).
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Scope of the ProblemTypes of ART cycles: United States, 2004 (Speroff & Fritz, 2005)
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Incidence of infertility
Previous
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Incidence of infertility
Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, et al. (2012) National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 9(12): e1001356. doi:10.1371/journal.pmed.1001356http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001356
Present: Prevalence of primary infertility among women who seek a child, in 2010.
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Present: Prevalence of secondary infertility among women who have had a live birth and seek another, in 2010.
Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, et al. (2012) National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 9(12): e1001356. doi:10.1371/journal.pmed.1001356http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001356
Incidence of infertility
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Medication: when and how to use antioxidants
Fertile Infertile0
1
2
Seminal Reactive Oxygen Species (ROS) (Log ROS + 1;
cpm)
Pasqualotto et al., Fertil Steril 2000
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Need for fast conception
Success rate:
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Need for fast conception
Reasons : Increase use of contraception
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Semen analysis• New reference values by WHO
Semen Parameter WHO 1999
WHO 20101
Volume (mL) ≥2.0 1.5
Count (x106/mL) ≥20 15
Total sperm number per ejaculate
≥40 39
Motility (%) ≥50 (a+b) 32 (a+b)
Vitality (%) ≥75 58
Morphology (%)2 (14) 4
Leukocytes (x106/mL) <1.0 <1.01Lower Limit (5% percentile); Recent fathersGrade a = rapid progressive motilityGrade b = slow/sluggish progressive motility 2Strict criteria
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New WHO references valuesHow they were obtained
1,953 semen samples of recent fathers
Time to pregnancy (TTP) ≤ 12 mo 5 studies in 7 countries on 3
continents Laboratories with QC only Morphology by strict criterion
(Kruger) Progressive and non-progressive
motility Lower reference limits (5th centile)
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What is IVF
In vitro fertilisation
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What is IVF
In vitro fertilisation In variable fertilisation (100% sure)
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Indications
Previous: tubal factor only Fallopian Tube Damage/Tubal Factor
Bilateral blocked Fallopian tubes Failed reversal of Tubectomy
The only options for treating significant tubal damage are surgical repair or bypassing the tubes with IVF. This decision must be carefully individualized in each situation.
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Indications
Present: Male Factor Infertility
Failed reversal of Vasectomy/ Tubectomy Obstructive azoospermia
Endometriosis Severe endometriosis
Age Related Infertility Premature Menopause Anovulation
Unexplained Infertility Preimplantation Genetic Testing (PGT
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Acceptance by people
Previous: myths – Myth: IVF is only the last option Myth: IVF is only for affluent people Myth: IVF is limited to a younger population
only Myth: IVF is successful in all cases Myth: IVF requires admission in the hospital Myth: IVF always result in multiple pregnancies
like twins or triplets Myth: IVF babies have a significantly high risk
of birth defects and malformations Myth: IVF is covered by insurance Myth: IVF is dangerous
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Acceptance by people
Present : reality- Who Does it Help? In-Vitro Fertilization and the Hermeneutic of
the Gift Woman’s uncensored journey Maternal Age and Blastocyst Development Frozen Blastocyst Cycles The Future
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Acceptance by people
Present : reality- The Future
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Why it was not accepted by drs as routine?
DARR LACK OF CONFIDENCE LACK OF SENIORS SUPPORT LACK OF KNOWLEDGE FROM WHERE TO
LEARN HOW TO ESTABLISH LAB etc…..
IVF Without Surgery - Transvaginal Oocyte Retrieval
Success rate !!!
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Technology
Previous & Present: -Ease of getting equipment & loans -support of companies -disposables& media -hormones( refine technology) -ovum pick up -embryo transfer( role of USG) -endocrinology & lab support -availability of embryologyst - knowledge & skill - ICSI ,IMSCI, PICSI,PGS, PGD,ERRAY , LAH,
STEMCELL etc…..
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Technology
Assisted reproductive technology INTRACYTOPLASMIC SPERM INJECTION
(ICSI) GAMETE INTRAFALLOPIAN TRANSFER
(GIFT) ZYGOTE INTRAFALLOPIAN TRANSFER
(ZIFT)
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Service at door step
By companies By doctors By laboratories
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Medicine updates
Previous: Clomiphene citrate
Present: Various options
GnRH Agonists GnRH Antagonists Gonadotropins hCG Progesterone Medrol Doxycycline
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Complications
Previous: None reported
Present: Ovarian Hyperstimulation Syndrome (OHSS) Ovarian cancer Uterine cancer Cervical Cancer Breast cancer Ectopic pregnancy Heterotopic pregnancy Miscarriage
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Benefits
Fast conception Early identification of factor Demand & supply Dhiraj & dhakka Multiple pregnancy LSCS Both party happiness Remote centre franchise for drs
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Physicians
Previous: Not aware
Present : Many physician refer patient to IVF clinic
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To whom you should refer?
?????
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Why IVF as routine?
Past tense: trial & error fertilisation
Present tense: in vitro & in variable fertilisation
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1. Nowadays, the use of surgically-retrieved sperm and ICSI has become an established procedure for couples wishing to obtain a biological offspring in whom the male Subfertility.
2. So far, the post-natal outcomes of babies born from such fathers are reassuring.
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Conclusion Understand the reproductive potential of
couple undergoing IVF
Success of ICSI (Very sucessfull data)
Male Factors Infertility IVF
~40% live birth ratesFemale Factors Infertility IVF
Higher results than other infertility causes~25% live birth rates
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MICRO-TESE
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Key MessagesAntioxidants helpful to decrease oxidative
stress.Interventions impact on semen quality 60 days
later.
WHO lowered semen analysis reference values.
IVF is beneficial for patient subgroups.
IVF and reproductive potential is dependent on the type of infertility
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Thank You!
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Thanks