northwestgynaecology.co.uk
description
Transcript of northwestgynaecology.co.uk
![Page 1: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/1.jpg)
www.omondihealthcare.comwww.northwestgynaecology.co.uk
North West Gynaecology
Gynaecology Update Symposium
24 April 2013
![Page 2: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/2.jpg)
www.omondihealthcare.comwww.northwestgynaecology.co.uk
North West Gynaecology… North West Gynaecology (NWG) is a group of consultant
gynaecologists formed in 2007 to cover the complete spectrum of gynaecological problems.
Gynaecology has many sub-specialist areas and it is no longer possible for one gynaecologist to be an expert in all these areas.
NWG provides a unique service making sure that your patient sees the right gynaecologist to treat their particular problem.
NWG provides comprehensive general gynaecological and subspecialist gynaecological care to the women of Manchester, Cheshire, Lancashire and the rest of the UK
![Page 3: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/3.jpg)
www.omondihealthcare.comwww.northwestgynaecology.co.uk
North West Gynaecology…
Ambulatory Gynaecology
Paediatric and Adolescent Gynaecology
Infertility and Assisted Conception
Urogynaecology
Gynaecological Cancer
![Page 4: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/4.jpg)
www.omondihealthcare.comwww.northwestgynaecology.co.uk
North West Gynaecology…
Kristina Naidoo
Gail Busby
RickClayton
Edmond Edi-Osagie
TonySmith
…The Team
![Page 5: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/5.jpg)
www.northwestgynaecology.co.uk
Programme… Menstrual Disorders in General Practice
- Dr Kristina Naidoo
Common Problems in Paediatric and Adolescent Gynaecology - Dr Gail Busby
Management of the Infertile Couple - Assessment, Investigation, Referral- Dr Edmond Edi-Osagie
Management of female urinary incontinence - new NICE guidelines - Dr Tony Smith
Update on Gynaecological Cancer- Dr Rick Clayton
Panel Discussion - NWG Faculty
![Page 6: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/6.jpg)
www.omondihealthcare.com
The Infertile Couple…
Edmond Edi-Osagie
Consultant GynaecologistSaint Mary’s Hospital
Manchester
…Assessment, Treatment, Referral
www.northwestgynaecology.co.uk
![Page 7: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/7.jpg)
www.omondihealthcare.com
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.northwestgynaecology.co.uk
![Page 8: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/8.jpg)
www.omondihealthcare.com
Female fertility…1
Courtesy of: www.repromed.com
www.northwestgynaecology.co.uk
![Page 9: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/9.jpg)
www.omondihealthcare.com
Female fertility…2
Courtesy of: www.rba-online.com
www.northwestgynaecology.co.uk
![Page 10: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/10.jpg)
www.omondihealthcare.com
Infertility causes…NICE 2013Sperm abnormalities
(30%)Low count
Poor movement
Abnormal shapes
No sperm
Ovulation problems (25%)
Ovulation absent
Poor egg quality
Ovarian failure
Tubal problems (20%)Tubes blocked
Tubes distorted
Tubes absent
Uterine problems (10%)Fibroids
Septum
Adhesions, Polyps
www.northwestgynaecology.co.uk
Unexplained (25%)No cause found
Combined (40%)Male and Female
![Page 11: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/11.jpg)
www.omondihealthcare.com
Investigating Infertility…OVULATORY / OVARIAN FUNCTION
..FSH / LH / Oestradiol / Progesterone / Prolactin / Androgens / AMH..
TUBAL FUNCTION
..HyCoSy / 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.northwestgynaecology.co.uk
![Page 12: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/12.jpg)
www.omondihealthcare.com
Sequellae of PID…I
• Morbidity / Mortality
• Infertility (14x)
• Ectopic pregnancy (6x)
• Chronic pelvic pain (10x)
• Risk of hysterectomy
(8x)
www.northwestgynaecology.co.uk
![Page 13: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/13.jpg)
www.omondihealthcare.comwww.northwestgynaecology.co.uk
Sequellae of PID…II
![Page 14: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/14.jpg)
www.omondihealthcare.com
Fertility Advice…• Age: fertility @ 3 years = 94% of 35 year olds vs. 77% of 38 year olds
• Coital frequency: 2-3x 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.northwestgynaecology.co.uk
![Page 15: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/15.jpg)
www.omondihealthcare.com
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.northwestgynaecology.co.uk
![Page 16: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/16.jpg)
www.omondihealthcare.com
Assisted Conception (AC)…
..IUI / S-IUI / DI..
..IVF..
..ICSI..
..Gamete Donation..
..Surrogacy..
www.northwestgynaecology.co.uk
![Page 17: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/17.jpg)
www.omondihealthcare.com
AC access by PCT…1
www.northwestgynaecology.co.uk
![Page 18: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/18.jpg)
www.omondihealthcare.com
AC access by PCT…2
www.northwestgynaecology.co.uk
![Page 19: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/19.jpg)
www.omondihealthcare.com
NICE guidelines 2013…I
Offer infertility investigations after 12 months of
trying to conceive (down from 24 months)
Offer infertility investigations earlier if the woman
is >36 years and/or there is a known cause of
infertility
www.northwestgynaecology.co.uk
![Page 20: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/20.jpg)
www.omondihealthcare.com
NICE guidelines 2013…II Do not offer Clomid treatment for unexplained
infertility
Do not offer IUI (natural or stimulated) routinely
for Unexplained infertility, Endometriosis, or Mild
male factor infertility
Offer IVF treatment after 2 years of unexplained
infertility www.northwestgynaecology.co.uk
![Page 21: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/21.jpg)
www.omondihealthcare.com
NICE guidelines 2013…III
Offer 3 full cycles of IVF after 2 years of infertility
up to the age of 40 years
Offer 1 full cycle of IVF between 40 and 42 years
to women with satisfactory ovarian reserve who
have not previously had IVF
www.northwestgynaecology.co.uk
![Page 22: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/22.jpg)
www.omondihealthcare.com
…how can NWG help!
www.northwestgynaecology.co.uk
![Page 23: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/23.jpg)
NWG Fertility Services...I
Service Model
..Private Satellite Fertility Service..
Licensed Centres
..St. Mary’s Hospital, Manchester..
..Manchester Fertility Services..
www.northwestgynaecology.co.uk
![Page 24: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/24.jpg)
www.omondihealthcare.com
NWG Fertility Services...II
..fertility profiling..
..comprehensive investigations..
..full range of fertility treatments..
..surgical treatment options..
..support & counselling..
www.northwestgynaecology.co.uk
![Page 25: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/25.jpg)
NWG Fertility Treatments… General = Fertility Profiling & Advice..
Medical = Ovulation induction (Oral & Parenteral)..
Surgical = Tubal surgery, Reversal of Sterilisation,
Ovarian drilling, SSR, Uterine surgery..
AC = IUI, IVF, ICSI..
Egg freezing / donation / sharing / Surrogacy..
www.northwestgynaecology.co.uk
![Page 26: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/26.jpg)
www.northwestgynaecology.co.uk
www.bmihealthcare.co.uk
![Page 27: northwestgynaecology.co.uk](https://reader035.fdocuments.us/reader035/viewer/2022062315/568160f4550346895dd02f80/html5/thumbnails/27.jpg)
Discussion
www.northwestgynaecology.co.uk
www.bmihealthcare.co.uk