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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
Join our blog and facebook:
Visit SART Website:
www.sart.org
http://www.rrc.com/http://www.rrc.com/http://www.rrc.com/8/4/2019 Dr. Riggs PPT
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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.