Fertility Inc Assisted Reproduction

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FertilityInc Assisted Reproduction

• Ruth Gooch

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Objectives

• Different types of fertility treatments
• Conception rates
• Funding
• Summary

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The basics...

• Need an egg and a sperm
• Male donors friends/anonymous. Should be
  screened. May have future legal implications if
  contact with the child is desired.
• Female donors eggs or surrogacy. Similar
  problems can ensue.

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Human Fertilisation and Embryology Act 1990 (HFE
Act)

• Any fertility clinic in the UK must take into
  account the welfare of the potential child
  BEFORE treatment
• This includes the determination of who will have
  parental responsibility for the child
• There are detailed assessments etc which must be
  adhered too

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Ovulation Induction

• Clomifene citrate
• A selective oestrogen receptor modulator
• Used in infertility due to anovulation (also in
  PCOS)
• NICE recommend USS monitoring in at least the 1st
  cycle of treatment to reduce the risk of
  multifollicular development and therefore
  multiple pregnancy.

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Ovulation Induction (2)

• Approximately 70 of anovulatory women ovulate in
  response to clomifene and 40-50 will conceive
• Side effects of clomifene include multiple
  pregnancy (up to 13) and ovarian
  hyperstimulation.

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Ovulation Induction (3)

• Metformin - oral biguanide insulin-sensitising
  agent which has received much attention since
  insulin resistance has been identified in PCOS.
• Spontaneous ovulation can occur rapidly and
  normal menstrual rhythm achieved within three
  months from the start of therapy
• In several studies the ovulation rate increased
  with no change in weight suggesting the effect
  is independent of weight loss

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Ovulation Induction (4)

• Overall, the treatment effect of metformin is
  equivalent to an increase from a baseline of one
  to two ovulations per five-month interval
• When clomifene is used after pre-treatment with
  metformin, ovulation rates are 64 higher than
  with clomifene alone. Since metformin does not
  require ultrasound monitoring, it may be
  considered a more suitable first-line drug to
  start in primary care.

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IVF

• Eggs collected, fertilised with partners sperm
• Fertilised eggs put in womb to implant
• Pregnant
• Suitable for unexplained infertility, blocked
  tubes, after other unsuccessful treatments
• 1 in 4 IVF pregnancies are multiple (40 babies
  are twins)

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ICSI

• Intracytoplasmic sperm injection
• Not a treatment alone used in conjunction with
  IVF
• Sperm is injected into the egg
• Useful when there is a problem with the sperm
  (poor mobility etc)

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IUI

• Intrauterine Insemination
• Sperm inserted into the womb at the womans most
  fertile time (ovulation)
• Sperm sort prior to insertion only the best
  ones used!
• Used if male partner has low sperm count or if
  sperm not surviving journey to the womb.
• Also good if woman is using donated sperm

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Conception Rates

• Maximum of 3 embryos implantations is recommended
• 1 embryo replaced 14 conception rate
• 2 embryo replaced 28 conception rate
• 3 embryo replaced 42 conception rate
• Little overall difference in IVF, GIFT or ZIFT

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Female Age

• Optimal female age for IVF treatment is 23-39
  years.
• Chances of a live birth per treatment cycle are
• gt20 for women aged 23-35 years
• 15 for women aged 36-38 years
• 10 for women aged 39 years
• 6 for women aged 40 years and over

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Who is NOT eligible for free treatment?

• Women over 38-years
• Males over 50-years
• Female BMI lt19 or gt30
• When either partner has a child (inc adopted)
• Reversal of sterilisation
• If there are any adverse factors which could
  affect the child
• If couple are unlikely to adhere to treatment
• If the couple have had a previous attempt at
  assisted reproduction

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What treatment do eligible people get?

• NHS funding will provide a maximum of 6 cycles of
  donor insemination (DI) or a maximum of 3 cycles
  of intrauterine insemination (IUI) treatment and
  1 cycle of stimulated IVF/ICSI depending on which
  treatment best meets the couples needs and is
  most likely to be successful.

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Summary

• Fertility treatments include - ovulation
  induction, IVF, ICSI, IUI- which each have their
  own indications
• Metformin could be commenced by GPs
• How successful treatment is depends on a number
  of factors inc M/F age, PMHx
• Eligibility for free treatment includes age,
  previous children and number of attempts