Infertility Update BGPERT - PowerPoint Presentation

1. Infertility UpdateBGPERTWednesday 8th February 2017Mr Nick SharpSenior Medical Director, Bath Fertility Centre

2. Bath Fertility Centre Presentation ContentsBath Fertility Centre – overviewServices availablePregnancy rates and other performance measuresNICE GuidelinesCurrent status of CCG fundingLatest techniquesQ&A

3. Bath Fertility CentrePreviouslyOpened April 199440 fresh treatment cycles in first year383 fresh cycles 2015/20165 staff in 1994 – now 32 staff1994 offered:IVFDISemen CryopreservationEmbryo Cryopreservation

4. Bath Fertility CentreCurrent350-450 Treatment cycles per yearIVFICSI (intracytoplasmic sperm injection)DITESA/PESA (testicular/percutaneous epididymal sperm aspiration)Blastocyst CultureOocyte CryopreservationDonor EggsDonor EmbryosSurrogacyTime Lapse MonitoringAssisted HatchingEndometrial Scratch

5. Bath Fertility CentreServices &Pre-Referral InvestigationsServices:Reproductive Medicine ClinicsNHS Clinics for basic investigation. Hosted at BFC on behalf of RUH.Assisted Conception For those patients whose investigations indicate assisted conception.Investigations prior to referral to Reproductive Medicine Clinic (all patients)RubellaChlamydia Serology (not swabs)FSH/LH (Day 1-3)ProlactinTSHProgesterone (Day 21 or 7 days before expected period)Semen Analysis – can arrange with BFC or RUHAMH if concerns about ovarian reserveIf assisted conception required virology screening both partners mandatory:HIVHepatitis B Core AntibodyHepatitis B Surface AntigenHepatitis C Antibody

6. Bath Fertility CentreReasons for patients undergoing treatment

7. Bath Fertility CentrePregnancy Rates  Fresh cyclesFrozen ETsUnder 3544.3%45.1%35-3728.3%33.8%38-39 22.8%45.9%40-4225.0%24.1%Clinical Pregnancy Rates per Embryo TransferJanuary – December 2016  Multiple pregnancy rate 7.9%

8. Bath Fertility CentrePregnancy Rates Pregnancy rates according to age for IVF and ICSI

9. Bath Fertility CentrePregnancy Rates  Cumulative clinical pregnancy rate per fresh cycle started (including any FETs)All patients had their first treatment cycle between May 2013-Dec 2015Age = when first started treatment

10. Bath Fertility CentreMultiple Pregnancies We have successfully reduced the incidence of multiple births without compromising pregnancy rates, and with a 94% single birth rate (national average of 83%) are the only clinic in the South West to exceed the HFEA’s target of 85% for single births during this period. The HFEA target has now increased to 90%. Biggest risk of treatment1 vs 2 vs 3 (or even more with overseas treatments)Quality not quantity

11. Bath Fertility CentreNICE GuidelinesInvestigate after 1 year, or earlier if known factors.Unexplained = 2 years trying (not 3)Three full cycles IVF or ICSI re-emphasisedFull Cycle = fresh + frozen embryos transferredWomen aged 40-42 should be offered a full cycle of IVF or ICSI (provided no previous IVF treatment)Where top quality Blastocyst – single embryo transferCryopreservation of eggs and sperm for oncology patients are not subject to eligibility criteria for NHS infertility funding

12. Bath Fertility CentreNHS FundingCriteria for NHS IVF Funding WiltshireSomersetBANESWoman aged 30-39Treatment must commence no later than 18 weeks before patient’s 40th birthdayMan aged under 55Both registered with Wilts GPWoman aged 23-39Man aged under 54Both registered with Somerset GPWoman aged 23-39Female registered with BANES GPOne partner has no childrenNeither partner has any childrenOne partner has no children 3 years (age 30-35) or2 years (age 35-40) unexplained sub fertility or identified cause of infertility e.g. azoospermia, bilateral tubal occlusion2 years stable relationship2 years unexplained subfertilityNo timescale on length of time trying to conceiveWoman's BMI 19-30Woman's BMI 19-30Woman's BMI 19-30(or 33 if known PCO) Both non smokers min 6 months with a CO readingBoth non smokers min 3 months with a CO readingBoth non smokers(no timescale)Previous sterilisation/vasectomy excludesNot eligible if more than 1 NHS or 2 self funded previous IVF/ICSI cyclesNot eligible if more than 1 NHS or 5 self funded previous IVF/ICSI cycles (considered on a case by case basis)Not eligible if more than 1 NHS or 3 self funded previous IVF/ICSI cyclesBFC applies for fundingGP applies for fundingGP applies for funding

13. Bath Fertility CentreProvision for NHS PatientsLevel of Provision for NHS Patients WILTSHIRE 1 full cycle IVF/ICSI Maximum 3 transfers 1 fresh and up to 2 frozenSOMERSET 1 full cycle of IVF/ICSI Maximum 2 transfers 1 fresh and 1 frozen (within 12 months of cryopreservation)BANES 1 full cycle of IVF/ICSI Maximum 2 transfers 1 fresh and 1 frozen

14. Bath Fertility CentreActivity DataActivity DataBath Fertility Centre January – December 2016Fresh CyclesFrozen CyclesIVF27%Total FETs41% of all cyclesICSI64%IVF/ICSI split9%NHS funded50.3%Self funded49.7%PESA5%

15. Bath Fertility CentreLatest TechniquesTime-lapse monitoring of embryosBlastocyst culture Endometrial ScratchAssisted hatchingLatest techniques

16. Bath Fertility CentreInnovative ways of funding Egg sharing Access Fertility. IVF Refund or IVF Multi-Cycle finance packages offering a substantial financial saving for patients. Details are enclosed in the GP pack Innovative ways of patients funding treatment

17. Bath Fertility CentreSummarySummaryTake Home MessagesPlease use investigation protocol prior to referral https://www.bathfertility.com/for-gpsPlease make sure that the female patients over 40 understand the limitations of treatment at that age.Please advise patients about lifestyle issues (smoking, weight) early on.