subfertility Flashcards
GTGs and SIPs
risk of miscarriage 30-34y
15%
risk of miscarriage 35-39y
24%
risk of miscarriage 40-44y
51%
risk of miscarriage >45y
93%
risks for mothers >35yo
Stillbirth, ectopic, miscarriages, GDM, placenta previa, placental abruption, PIH, C/S
best test of ovarian reserve
AMH
% of IVF cycles using electively frozen eggs
<2%
risks of elective egg freezing
- Age –> PET, GDM, C/S
- OHSS
- Procedural –> bleeding, infection, VTE
10 frozen egg cumulative live birth rate <35yo
42.8%
10 frozen egg cumulative live birth rate >36yo
25.2%
commonest treatment related adverse outcome of IVF
multiple pregnancies
risks of multiple pregnancies
PIH PTL PPH OVB GDM
rate of multiple pregnancies in ART (2009 vs. 2014)
24% vs. 15.9%
incidence of mild OHSS
33%
combined incidence of moderate-severe OHSS
3.1-8%
After OHSS, risk of PET
21.2%
after OHSS, risk of PTL
36%
risk factors for OHSS
previous OHSS
PCOS
increased AFC or AMH
Multiple pregnancy
Protective factor against OHSS
use of GnRH antagonists
Criteria for critical OHSS
- tense ascites or hydrothorax
- Hct >0.55
- WBC >25
- Oliguria/anuria
- VTE
- ARDS
risk of miscarriage 25-29y
11-12%
risk of miscarriage 20-24y
9-11%
% of congenital CMV neonates symptomatic at birth
10-15%
% of shoulder dystocias complicated by brachial plexus injuries
2.3-16%
% of brachial plexus injuries with permanent damage
<10%
incidence of chronic pelvic pain after ONE episode PID/TOA
12%
incidence of chronic pelvic pain after TWO episodes of PID/TOA
30%
incidence of chronic pelvic pain after THREE episodes of PID/TOA
67%
raised AFP in 2nd trim screen
FGR placental abruption female demise >24/40 PTL spont misc
raised bHCG and inhibin A 2nd trim screen
PTL PIH PET IUFD FGR
low estriol 2nd trim screen
oligo
IUFD
SGA/LBW
spont misc
low PAPP-A 1st trim screen
PET LBW PIH PTL Miscarriage
low bHCG 1st trim screen
spont misc
LBW
combined test for downs
PAPP-A
bHCG
Nuchal translucency
quadruple test
AFP
bHCG
estriol
inhibin A
risk of ovarian failure after bilateral ovarian endometrioma cystectomy
2.4%
intraop complication rate for DIE
2.1%
total postop complication rate for DIE
- 9%
9. 5% minor, 4.6% major
recurrence rate of DIE at 2 years following surgery
5-25%
ovarian conservation at TAH for endometriosis - risk of recurrent pain
6x greater
ovarian conservation at TAH for endometriosis - risk of reoperation
8.1x greater
according to NICE, what % of couples will conceive in 1 year
80%
according to NICE, what % of couples will conceive within 2 years (cumulative rate)
> 90% (of those who did not conceive, half will do so in the second year)
incidence of miscarriage following ART (singleton)
15-20%
incidence of ectopic pregnancy following ART
2-8%
OR of stillbirth following ART
2.4
PTL after ART (singleton)
11.2% (may be iatrogenic)
OR of placenta previa following ART
3.76