Clinical Notes

Female Evaluation Prior to IVF

By

Osama Abdalmageed Assistant Lecturer of Obstetric & Gynecology, Assiut University,

Assiut, Egypt

Research Fellow, American Center for Reproductive Medicine, Cleveland, Ohio

Case Scenario

Amy, 35 years old, referred for you for her interest in having IVF baby!

Points to be covered:

1- Introduction: Causes of infertility and their impacts on IVF.

2- Impact of age on IVF outcomes.

3- Ovarian reserve evaluation.

4- Uterine cavity assessment.

Introduction Causes of infertility

6

7

18

3 1

16

13

Common diagnosis frequency in SART data, 2013

Tubal factor Ovulatory dysfunction DOR Endomeriosis Uterine factor Male f Unknown

Female Age (a)

Female Age (b)

Female Age (c)

Female Age (d)

Female Age (e)

1-Age is the most important prognostic factor in pregnancy outcome in IVF.

2-The risk of miscarriage increases with advancement of maternal age (Counsel, Aneuploidy screening and PGD??)

Ovarian Reserve Evaluation

Ovarian Reserve Evaluation (a)

Def. of ovarian reserve:

Ovarian Reserve Evaluation (b)

Ovarian Reserve Evaluation (c)

Testing for ovarian reserve:

Biomarker

• Basal FSH

• Basal Estradiol

• AMH

• Inhibin B

• CCCT

Ultrasound

• AFC

• Ovarian Volume

Ovarian Reserve Evaluation (d)

1- Basal FSH

Basal Evaluation (When?)

Elevated if poor ovarian reserve.

(Value?)

Limited reliability (Why?)

Ovarian Reserve Evaluation (e)

2- Basal Estradiol

Basal Evaluation (When?)

Normal range. (Value?)

Can not used alone (Why?)

High basal E2 and low basal FSH (?)

Ovarian Reserve Evaluation (f)

3- AMH:

When(?)

Value (?)

Clinical Significance(?)

Ovarian Reserve Evaluation (g)

4- Inhibin B

?

Value (?)

ACOG(?opinion)

Ovarian Reserve Evaluation (h)

5- CCCT

Result (?)

ACOG (opinion?)

CD 3

• FSH measurement

CD 5-9

• CC 100mg/day

CD 10

• FSH measurement

Ovarian Reserve Evaluation (i)

6- AFC

When(?)

interpretation

Reliability

Ovarian Reserve Evaluation (j)

7- Ovarian volume

D1*D2*D3*0.52

Interpretation

Ovarian Reserve Evaluation (k)

1- AMH and AFC are the most predictive tests for ovarian reserve. 2-FSH+basal E2 can be used for prediction of ovarian reserve 3-Inhibin B and CCCT should not be used in the evaluation of ovarian reserve

Uterine Cavity Assessment

10% of the female factor infertility.

50% of the recurrent implantation failure are due to abnormal uterine finding.

Uterine Cavity Assessment (a)

HSG

TVUS

SIS

3D US

Hysteroscopy

Again!

Amy, 35 years old, referred for you for her interest in having IVF baby!