Dr. Riggs PPT

8/4/2019 Dr. Riggs PPT

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RYAN M. RIGGS, MD

Infertility 101

KC INFERTILITY AWARENESS SEMINAR

APRIL 30, 2011


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Infertility

Seek care earlier if: >35 years old irregular menses Post-vasectomy Fibroids Endometriosis

Recurrent pregnancy loss

1 year of inability to conceive

Be Your Own Advocate!


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Causes of Infertility for Couples


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Causes of Female Infertility


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Tubal/peritoneal disease

Male factor

Ovulatory and ovarian dysfunction

Endometriosis

Fibroids/Uterine Adhesions/Uterine Factors

Chromosomal/Genetic

Ovarian Resistance/Advanced Reproductive Age/Poor

Oocyte Quality

Endocrine Disorders

Unexplained

Common Causes of Infertility


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Problems with Getting the Eggs

and the Sperm Together


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Scar Tissue / Endometriosis


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Lack of Ovulation


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Eggs


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1 in 6 couples have troubleconceiving

Broekmans et al., 2007 PMID: 17275321


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Growing Need to Monitor Oocyte Supply

National Vital Statistics Reports, Volume 55, No. 1, September 29, 2006


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y ggs a e e a gPart of the Problem

Oocytes

OogoniaOogoniaNumber (Millions)

TimeSperoff et al., 2005 Gosden et al 1992


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Egg Quantity and QualityDeclines with Age

Egg Number and Quality as a Function of Age

Broekmans et al., 2007 PMID: 17275321


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Monthly Fertility Rates as aFunction of Age

Adapted from Broekmans et al., 2007 PMID: 17275321

Age (Years)

20 25 30 35 40 45 50

RelativeRate

0

20

40

60

80

100

120

15%

9%


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Live Birth Rates as a Functionof Age

SART/CDC National ART Data, 2006

>100,000 IVF Cycles


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Ovarian Reserve

Potential oocyte quantity and quality


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Factors Predictive ofReproductive Ageing

OvarianReserveAge

AMH

FSH

AFC Inhibin B

Genetics

Lifestyle

Iatrogenic

(History)


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Problems with theHome


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Semen Analysis

Assessment of Ovulation

Egg Quality/Quantity (Ovarian Reserve) Testing

Evaluation of Uterus, Tubes and Female Anatomy

Basic Infertiliy Evaluation


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The Semen Analysis


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Measuring Ovarian Reserve

Conventional Measures

Hormones

History

Ultrasound Evaluation


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Scott et al, 2008 PMID: 17603049

E l ti f th Ut d


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Evaluation of the Uterus andTubes


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The Hysterosalpingogram

Surgical Evaluation may also be Considered


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Treatment(s)


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Vary with diagnosis

Range from simple/inexpensive to complex

Per cycle conception rate

Sometimes more expensive costs less

Treatment Options


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O l ti I d ti


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Ovulation InductionOral Medications


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Ovulatory dysfunction, unexplained, mild male

Pregnancy rate averages 8-12% per cycle

Twins 8-12%

IUI doubles pregnancy rate

Side effects rare

Move on after 3-4 cycles

Ovulation Induction:

Clomid/Femara


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Injectable Fertility Medications

CC resistance/failure, unexplained

Pregnancy rate averages 15-20%

per cycle IUI doubles pregnancy rate

Risk of multiple pregnancy,

hyperstimulation

NOT for tubal, severe male, failed

fertilization


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Injectable Medications withSperm Insemination


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How Many Times do I Try?


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Risks Know Them


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In-Vitro Fertilization

Pregnancy rates

Multiple rates

Treats almost all causes

First line treatment for long-standing

infertility, severe male factor,

Tubal-peritoneal causes, advanced age


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Ask and Understand

What is the cause of our infertility?

How will this treatment address the cause(s)?

How does the treatment work?

What is my chance of conception per cycle?

How many cycles will you prescribe?

What is the chance of multiple pregnancy?

Are there alternate treatment options


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The best treatment is the most

conservative treatment likely

to result in the birth of a baby

Think maximize pregnancy/minimize multiple pregnancy!

Get the Facts and Check the


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Get the Facts and Check theStats!

Visit our Website:

www.rrc.com

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www.sart.org
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Derica Anderson Rebecca Brabec

Robin Bomar Brenda Bowen

Mary Ellen Bulmash Toni Clark

Amy Cripe Wanda Dvorak

Marci Hodge Michelle Kiehl

Carol Reese Jonetta Rodgers

Beth Salazar Susan Tomelleri

Marge Vogt Michelle Yergovich

Celeste Brabec, M.D. Ryan Riggs, M.D.

J. Michael Wilson, Ph.D.

Dr. Riggs PPT

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