advertisement

Management of the Infertile Couple in a Primary Care Setting. Part I

50 %
50 %
advertisement
Information about Management of the Infertile Couple in a Primary Care Setting. Part I
Health & Medicine

Published on March 4, 2014

Author: MilieNwoye

Source: slideshare.net

Description

This is intended for primary care physicians. It is a 2 part presentation that begins with gynecologic cancer screening and ends with the evaluation and management of the infertile couple
advertisement

MANAGEMENT OF THE INFERTILE COUPLE IN A PRIMARY CARE SETTING PART ONE MILIE NWOYE MD SHAPE ARMY MEDICAL CLINIC FEBRUARY 20TH 2014

OUTLINE • GENERAL GYNECOLOGY • Gynecologic cancer screening • Pre-conception counselling • Tests for ovarian reserve • THE INFERTILE COUPLE • Definition • Evaluating the infertile couple • Managing the infertile couple (PART 1)

CERVICAL CANCER SCREENING • Screening starts at age 21 regardless of sex initiation • Ages 21-29: Pap test only every 3 years • Ages 30-65: Pap test every 3 years OR Pap and high risk HPV testing every 5 years • Women without a cervix: No Pap test required except less than 20 year history of high grade abnormality OR history of DES in-utero exposure

Population Recommended Screening Method Women younger than 21 years No screening Women aged 21–29 years Cytology alone every 3 years Women aged 30–65 years Human papillomavirus and cytology co-testing (preferred) every 5 years Comment Screening by HPV testing alone is not recommended Cytology alone (acceptable) every 3 years Women older than 65 years No screening is necessary after adequate negative prior screening results Women with a history of CIN 2, CIN 3 or adenocarcinoma in situ should continue routine age-based screening for at least 20 years Women who underwent total hysterectomy No screening is necessary Applies to women without a cervix and without a history of CIN 2, CIN 3, adenocarcinoma in situ, or cancer in the past 20 years Practice bulletin, ACOG, November 2012

BREAST CANCER SCREENING • Mammography has a false negative rate of 20%* • Age <40: Self breast awareness • Age >40: Self breast awareness, annual clinical breast exam and mammogram (except women with first degree relatives with premenopausal breast cancer OR women with BRCA mutation) ACOG guidelines *National Cancer Institute

Mammography American College of Obstetricians and Gynecologists Age 40 years and older annually Clinical Breast Examination Age 20-39 years every 1-3 years Breast SelfExamination Instruction Consider for highrisk patients Breast SelfAwareness Recommended Age 40 years and older annually Practice Bulletin, ACOG, August 2011

ENDOMETRIAL CANCER SCREENING • Most common gynecologic cancer Risk Factor Relative Risk • No screening tool. Longterm high dose HRT 10-20 • Red flags: postmenopausal bleeding Tamoxifen 3-7 • Diagnosis: PCOS or estrogen producing tumor >5 • Endometrial biopsy or D&C Obesity 2-5 • Transvaginal ultrasound Nulliparity 3 ACOG practice bulletin, August 2005

OVARIAN CANCER SCREENING • Lifetime risk of 1/70 • No evidence that screening leads to earlier detection or improved survival • Diagnostic tests: CA 125 and transvaginal ultrasound ACOG, July 2007

PRE-CONCEPTION SCREENING • Folic acid 0.4mg (or 4mg with a history of open neural tube defects) • Risk factor-based genetic screening/ counselling • Optimize medical conditions (HTN, DM) • Domestic violence screening • Avoid alcohol, tobacco, radiation, and illegal drugs • Weight reduction • Vaccinations (Rubella, influenza) ACOG Committee opinion, 9/2005

TESTING FOR OVARIAN RESERVE • ASRM, 2005 Speroff, 2005

THE INFERTILE COUPLE DEFINITION For women ≤ 35: No conception after 1 year of unprotected intercourse For women >35: No conception after 6 months of unprotected intercourse Only 43% seek medical care Age (years) Infertility rates (%) 15-24 4 25-34 13 35-44 30 Age and infertility. Science 1986;233:1389-94

CAUSES OF INFERTILITY- COUPLES 5% 10% 35% 15% Tubal and pelvic pathlogy Male factor Ovulatory dysfunction Unexplained Unusual problems 35% Speroff, 2005

CAUSES OF FEMALE INFERTILITY 10% 10% 40% Ovulatory dysfunction Tubal and pelvic disease Unexplained Unusual problems 40% Speroff, 2005

STANDARD FERTILITY WORK-UP • Assessment of male factor infertility: semen analysis • Assessment of ovulation: history, BBT, day 21 progesterone • Assessment of uterus/endometrium and ovaries: transvaginal ultrasound • Assessment of tubal patency: hysterosalpingogram or laparoscopy • Assessment of endometriosis: laparoscopy ASRM Fact sheet 2005

INFERTILITY MANAGEMENT • Timed intercourse • Ovulation induction • Intrauterine insemination (+/- ovulation induction) • In-vitro fertilization (IVF) • Intracytoplasmic sperm injection (ICSI)

Add a comment

Related presentations

Related pages

Management of the Infertile couple in a Primary Care ...

1.management of the infertile couple in a primary care setting part two milie nwoye md shape army medical clinic march 27th 2014 milie.nwoye@gmail.com
Read more

Evaluation and Management of the Infertile Couple | GLOWM

Evaluation and Management of the Infertile Couple: ... the role of all primary care physicians to ... care must be well organized in either setting.
Read more

5. Management of the infertile couple in tertiary care, part 2

Management of the infertile couple in tertiary care, part 2. ... on modern management of infertile ... fertility treatment on primary care ...
Read more

Attitudes to and management of fertility among primary ...

Attitudes to and management of fertility among primary health care ... the management of an infertile couple ... in a primary care setting.
Read more

Management of Infertility within Primary Health Care ...

Management of Infertility within Primary Health ... and family planning program in primary health care setting. ... infertile couple: ...
Read more

Patient and professional views of open access ...

... organise within the primary care setting, ... primary care can organise the HSG. It's part of the first ... and management of the infertile couple.
Read more

Initial Evaluation and Treatment of Infertility in a ...

Initial Evaluation and Treatment of Infertility in a Primary-Care Setting. ... The infertile couple: ...
Read more

Supporting the couple with Conception Challenges

Supporting the couple with Conception ... NPs in the primary care setting to assist them in ... A primary care approach to the infertile couple.
Read more