infertility and the gp - royal australian college of general … · 2019-07-25 · infertility and...
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Infertility and the GP
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Acknowledgement of Country
We wish to acknowledge the traditional custodians of the land.
We acknowledge and respect their continuing culture and the
contribution they have made to the life of this city and this region.
We pay our respects to Elders past and present.
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Where is my control panel?
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GoToWebinar tips & tricks
You have been placed on “mute” to optimise the learning experience for you and your peers
Use the question box function to talk to us.
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Poll test
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If you have entered your RACGP number when registering, stay for the whole webinar and complete the survey you will receive 2 category 2 points.
QI&CPD
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Infertility and the GPThis webinar is proudly supported by Healius
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may forget: - endometriosis- genetic conditions in the family- medications in pregnancy problems- is there something else going on???
Important Elements in the History
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- Optimise BMI- Improve sugar control- Stop smoking- Minimise alcohol and coffee- Folate and iodine- Pap smear up to date- Rubella, varicella and flu vaccination- Education about timing and chances naturally- Diagnose their PCOS and manage that if present
Initial Management
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Female Investigations
Day 2-5 of patient’s cycle
o AMHo Prolactino FSHo LHo TSH
o E2 (Oestradiol)o Full Blood Count o Iron Studies
o Rubella serologyo Syphilis serology
o Varicella Zoster serology
Day 5-8 of patient’s cycle
o Up to date Pap Smear (anytime when not bleeding)o Pelvic Ultrasound - specify antral follicle count
Day 21 - if regular 28 day cycle or mid luteal progesterone (one week before period due) if irregular cycle
o Blood group & group Abs o Chlamydia and Gonorrhoea urine PCR
o Glucose (fasting)o Hb Electrophoresis
o Hep B s Ago Hep C serology
o HIVo Progesterone
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Male Investigations•HIV•Hep B•Hep C•Syphilis serology•Chlamydia and Gonorrhoea urine PCR•Semen AnalysisSemen analysis and antisperm antibody:
Element Reference
Volume ≥1.5mL
Concentration ≥15 million/mL
Progressive motility ≥32%
Normal morphology ≥4%
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- AMH- Antral follicle count- Day 2/3 FSH (look at the oestrogen!)
Ovarian reserve testing
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More advanced investigations
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Karyotypes
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Thyroid
- TSH testing is controversial- If > 2.5, test for antibodies- Treat subclinical hypothyroidism if TSH > 4- Grey zone between 2.5 and 4, treat if AB positive
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Endometriosis and what to do?
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Male tests for abnormalities- Repeat the Semen analysis- Karyotype looking for XXY- Y chromosome microdeletion studies- Hormones (FSH, LH, testosterone in morning)- US of testes- Varicocoele assessment- CF carrier status- PRL TSH- Haemochromatosis
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When to refer- After trying naturally for 12 months if < 35- After trying naturally for 6 months if 35 or over- If you find a red flag
- cycle irregularity- blocked tubes- severe endometriosis- low AMH- genetic condition- male issue
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Treatments- Reassure and keep trying naturally +/- Hy Co Sy, optimise- Ovulation induction +/- intra-uterine insemination- IVF +/- ICSI- PGT-A or PGT-D- Surgery
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