IVF updateDr Gregory Jenkins

VMO Norwest Private HospitalVMO Sydney West AHS

Accredited Specialist Genea

IVF update• Maternal age and AMH• Maternal obesity• Sperm DNA fragmentation• IVF cycles• Current success rates

Overview- female age and fertility

Rising female age and fertility

• Concept of ovarian reserve (egg number & quality)

• FSH rises (> 15 significant)• AMH (Anti-Mullerian Hormone) falls– Normal range varies with age– Close correlation with egg numbers at IVF– Predictor of poor outcome– Also predicts women at risk of ovarian hyperstim

• Fast track to IVF

Maternal obesity & fertility

• BMI> 30 50% reduction. BMI >35 further 50% reduction

• Anovulation main reason. • Weight in ovulating women is an independent

factor too• 5% weight loss can restore ovulation• “Fitness for fertility program”• Need high dose folic acid (5mg)

Maternal obesity & pregnancy

• Miscarriage, Fetal abnormality, GDM, pre-eclampsia, DVT, CS and most other obs complications

• Maternal obesity is the #1 preventable cause of stillbirth in the developed world

• Need to normalise BMI to eliminate excess risk

Sperm

• Count, motility and morphology• BUT there is also the DNA within the sperm• SCIT – measures degree of DNA fragmentation

as a % (DFI)• > 30% is abnormal• Assoc with 7x reduction in IVF success rate• Menevit/daily ejaculations/TESA

PeriodGnRH Down Regulation (Lucrin)

FSH Stimulation

HCG Trigger

Day 0 Day 21 Day 35 Day 47

IVF cycle – long

Dr A Lighten: June 09

OCP

Period

GnRH Antagonist

FSH Stimulation

HCG Trigger

Day 2-4 +9 days+5 days

IVF cycle - short

Dr A Lighten: June 09

Fertilisation Day 2 Day 3

Day 4Day 5Blastocyst

Day 5Blastocyst

Questions?