DOCSLIB.ORG

Infertility Update

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Infertility Update Infertility Update George R Attia, M.D Director of IVF Program University of Texas Southwestern Medical Center at Dallas Infertility • Inability to conceive after one year of adequate unprotected intercourse (six months if the woman is over age 35) Time Required for Conception in Couples Who Will Attain Pregnancy 100 93 95 90 85 80 72 70 nt 57 60 na g 45 e 50 r P 40 % 30 25 20 10 0 1 month 2 months 3 months 6 months 1 Year 2 Year 3 ear 7% 3% 35% Male Factor 20% Tubal Factor Ov dysfunction Unexplained Others 35% 10% 10% 40% Anovulatory Tubal & Pelvic Unusual factors Unexplained 40% • Anovulation • Tubal Factor • Male • Pelvic Factor (Endometriosis, adhesion) • Unexplained • Uterine/cervical (fibroid) 10% PCOS Others 90% Ovulation • History •BBT • LH kits • Mid luteal phase Progesterone (cycle length –7) • Ultrasound • EMB (day 21-26) • Anovulation • Tubal / Pelvic Factor • Male • Unexplained • Uterine/cervical (fibroid) Tubal & Pelvic Factors • Tubal disease, PID • Tubal surgery • Pelvic adhesions • Endometriosis Tubal Factor • Tubal infertility after PID (12%, 24%, 50%) • One-half of patients who found to have tubal damage and/or pelvic adhesion have no history of antecedent disease Tubal Factor • Hysterosalpingography • Hysteroscopy / laparoscopy • Falloscopy • Anovulation • Tubal Factor • Male • Unexplained • Uterine/cervical (fibroid) Male Factor Infertility • Anatomic defects (hypospadias, Retrograde ejac.) • Genetics Causes • Trauma • Infection • Endocrine disorders •Varicocele Male Factor Infertility • Vol. > 2 ml, Conc. > 20x106, Mot. >50%, Morph. > 30%. • Total motile sperm per milliliter ( sperm per ml X percent motility) > 1o x 106 Male Factor Infertility • Screening for * Cystic fibrosis (Bilateral congenital absence of the vas) (1%-2% of infertile males) * Y chromosome microdeletion (7% - 10%) * Klinefelter’s syndrome (XXY) (1 in 500) • Anovulation • Tubal Factor • Male • Uterine/cervical (fibroid) • Unexplained • Anovulation • Tubal Factor • Male • Uterine/cervical (fibroid) • Unexplained Basic Work Up • Anovulation • Day 3 Labs (FSH, Inhibin B, Estradiol) • Mid luteal phase Progesterone • Male • Semen analysis • Tubal Factor • Uterine/cervical • Hysterosalpingogram (fibroid) • Unexplained • ??? Laparoscopy • Anovulation • Tubal Factor • Male • Unexplained • Uterine/cervical (fibroid) Hypoth / Pituitary Positive Feedback 4.LH 1. Estrogen 2.FSH 3. Estrogen Induction of Ovulation Hypoth / Pituitary Positive Feedback 4.LH 1. Estrogen 2.FSH 1. Clomid 3. Estrogen 2. Injection Medications (Gonal-f, Follistim, Repronex) Induction of Ovulation • Clomid 80% response, less invasive, cheap Low incidence of multiple • Injectable Multiple gestation Expensive • Intrauterine Insemination • Anovulation • Tubal / Pelvic Factor • Male • Unexplained • Uterine/cervical (fibroid) • Tubal Surgery • In vitro fertilization (IVF) Pregnancy Outcome After Tubal Surgery ) % 70% ( e 60% t a 50% R 40% y c 30% n a 20% n g e 10% r P 0% Mild Moderate Sever Intrauterine 70% 17% 12% Ectopic 10% 14% 4% 10 29 56 • Anovulation • Tubal Factor • Male • Unexplained • Uterine/cervical (fibroid) • Intrauterine Insemination • In vitro fertilization (IVF) • Intracytoplasmic Sperm Injection (ICSI) • Anovulation • Tubal Factor • Male • Unexplained • Uterine/cervical (fibroid) Pregnancy Rate per Cycle in Patients with Unexplained Infertility 30 30 NoTreatment 25 IUI 20 17.1 Clomiphene 15 Clomiphene & IUI 10 8.3 7.7 HMG 5.6 HMG + IUI 5 3.8 2.7 IVF 0 • Anovulation • Tubal Factor • Male • Unexplained • Uterine/cervical (fibroid) In Vitro Fertilization (IVF) Hypoth / Pituitary Positive Follisitim Feedback LH FSH Gonal-F Perganol Repronex Estradiol Start Start Start OC Lupron FSH Retrieval Transfer 3 wks 2wks 10-14 D 3 D 2 D D 1 D 21 D 35 S D SD 1 10-14 IVF Success Rate • Age • Age • Age • 40 - 60% • Cost $5500 + Medications Intracytoplasmic Sperm Injection (ICSI) Pre Implantation Genetic Diagnosis (PGD) Sex Selection (Microsort) .
Load more

Recommended publications
  • Polycystic Ovary Syndrome, Oligomenorrhea, and Risk of Ovarian Cancer Histotypes: Evidence from the Ovarian Cancer Association Consortium
    Published OnlineFirst November 15, 2017; DOI: 10.1158/1055-9965.EPI-17-0655 Research Article Cancer Epidemiology, Biomarkers Polycystic Ovary Syndrome, Oligomenorrhea, and & Prevention Risk of Ovarian Cancer Histotypes: Evidence from the Ovarian Cancer Association Consortium Holly R. Harris1, Ana Babic2, Penelope M. Webb3,4, Christina M. Nagle3, Susan J. Jordan3,5, on behalf of the Australian Ovarian Cancer Study Group4; Harvey A. Risch6, Mary Anne Rossing1,7, Jennifer A. Doherty8, Marc T.Goodman9,10, Francesmary Modugno11, Roberta B. Ness12, Kirsten B. Moysich13, Susanne K. Kjær14,15, Estrid Høgdall14,16, Allan Jensen14, Joellen M. Schildkraut17, Andrew Berchuck18, Daniel W. Cramer19,20, Elisa V. Bandera21, Nicolas Wentzensen22, Joanne Kotsopoulos23, Steven A. Narod23, † Catherine M. Phelan24, , John R. McLaughlin25, Hoda Anton-Culver26, Argyrios Ziogas26, Celeste L. Pearce27,28, Anna H. Wu28, and Kathryn L. Terry19,20, on behalf of the Ovarian Cancer Association Consortium Abstract Background: Polycystic ovary syndrome (PCOS), and one of its cancer was also observed among women who reported irregular distinguishing characteristics, oligomenorrhea, have both been menstrual cycles compared with women with regular cycles (OR ¼ associated with ovarian cancer risk in some but not all studies. 0.83; 95% CI ¼ 0.76–0.89). No significant association was However, these associations have been rarely examined by observed between self-reported PCOS and invasive ovarian cancer ovarian cancer histotypes, which may explain the lack of clear risk (OR ¼ 0.87; 95% CI ¼ 0.65–1.15). There was a decreased risk associations reported in previous studies. of all individual invasive histotypes for women with menstrual Methods: We analyzed data from 14 case–control studies cycle length >35 days, but no association with serous borderline including 16,594 women with invasive ovarian cancer (n ¼ tumors (Pheterogeneity ¼ 0.006).
    [Show full text]
  • Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009†
    Human Reproduction, Vol.24, No.11 pp. 2683–2687, 2009 Advanced Access publication on October 4, 2009 doi:10.1093/humrep/dep343 SIMULTANEOUS PUBLICATION Infertility The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009† F. Zegers-Hochschild1,9, G.D. Adamson2, J. de Mouzon3, O. Ishihara4, R. Mansour5, K. Nygren6, E. Sullivan7, and S. van der Poel8 on behalf of ICMART and WHO 1Unit of Reproductive Medicine, Clinicas las Condes, Santiago, Chile 2Fertility Physicians of Northern California, Palo Alto and San Jose, California, USA 3INSERM U822, Hoˆpital de Biceˆtre, Le Kremlin Biceˆtre Cedex, Paris, France 4Saitama Medical University Hospital, Moroyama, Saitana 350-0495, JAPAN 53 Rd 161 Maadi, Cairo 11431, Egypt 6IVF Unit, Sophiahemmet Hospital, Stockholm, Sweden 7Perinatal and Reproductive Epidemiology and Research Unit, School Women’s and Children’s Health, University of New South Wales, Sydney, Australia 8Department of Reproductive Health and Research, and the Special Program of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland 9Correspondence address: Unit of Reproductive Medicine, Clinica las Condes, Lo Fontecilla, 441, Santiago, Chile. Fax: 56-2-6108167, E-mail: [email protected] background: Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide.
    [Show full text]
  • Diagnostic Evaluation of the Infertile Female: a Committee Opinion
    Diagnostic evaluation of the infertile female: a committee opinion Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all relevant factors with initial emphasis on the least invasive methods for detection of the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of the infertile female, and it replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:302–7). (Fertil SterilÒ 2015;103:e44–50. Ó2015 by American Society for Reproductive Medicine.) Key Words: Infertility, oocyte, ovarian reserve, unexplained, conception Use your smartphone to scan this QR code Earn online CME credit related to this document at www.asrm.org/elearn and connect to the discussion forum for Discuss: You can discuss this article with its authors and with other ASRM members at http:// this article now.* fertstertforum.com/asrmpraccom-diagnostic-evaluation-infertile-female/ * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace. diagnostic evaluation for infer- of the male partner are described in a Pregnancy history (gravidity, parity, tility is indicated for women separate document (5). Women who pregnancy outcome, and associated A who fail to achieve a successful are planning to attempt pregnancy via complications) pregnancy after 12 months or more of insemination with sperm from a known Previous methods of contraception regular unprotected intercourse (1).
    [Show full text]
  • Changes Before the Change1.06 MB
    Changes before the Change Perimenopausal bleeding Although some women may abruptly stop having periods leading up to the menopause, many will notice changes in patterns and irregular bleeding. Whilst this can be a natural phase in your life, it may be important to see your healthcare professional to rule out other health conditions if other worrying symptoms occur. For further information visit www.imsociety.org International Menopause Society, PO Box 751, Cornwall TR2 4WD Tel: +44 01726 884 221 Email: [email protected] Changes before the Change Perimenopausal bleeding What is menopause? Strictly defined, menopause is the last menstrual period. It defines the end of a woman’s reproductive years as her ovaries run out of eggs. Now the cells in the ovary are producing less and less hormones and menstruation eventually stops. What is perimenopause? On average, the perimenopause can last one to four years. It is the period of time preceding and just after the menopause itself. In industrialized countries, the median age of onset of the perimenopause is 47.5 years. However, this is highly variable. It is important to note that menopause itself occurs on average at age 51 and can occur between ages 45 to 55. Actually the time to one’s last menstrual period is defined as the perimenopausal transition. Often the transition can even last longer, five to seven years. What hormonal changes occur during the perimenopause? When a woman cycles, she produces two major hormones, Estrogen and Progesterone. Both of these hormones come from the cells surrounding the eggs. Estrogen is needed for the uterine lining to grow and Progesterone is produced when the egg is released at ovulation.
    [Show full text]
  • Too Much, Too Little, Too Late: Abnormal Uterine Bleeding
    Too much, too little, too late: Abnormal uterine bleeding Jody Steinauer, MD, MAS July, 2015 The Questions • Too much (& too early or too late) – Differential and approach to work‐up – Does she need an endometrial biopsy (EMB)? – Does she need an ultrasound? – How do I stop peri‐menopausal bleeding? – Isn’t it due to the fibroids? • Too fast: She’s hemorrhaging—what do I do? • Too little: A quick review of amenorrhea Case 1 A 46 yo G3P2T1 reports her periods have become 1. What term describes increasingly irregular and heavy her symptoms? over the last 6‐8 months. 2. Physiologically, what Sometimes they come 2 times causes this type of per month and sometimes there bleeding pattern? are 2 months between. LMP 2 3. What is the months ago. She bleeds 10 days differential? with clots and frequently bleeds through pads to her clothes. She occasionally has hot flashes. She also has diabetes and is obese. Q1: In addition to a urine pregnancy test and TSH, which of the following is the most appropriate test to obtain at this time? 1. FSH 2. Testosterone & DHEAS 3. Serum beta‐HCG 4. Transvaginal Ultrasound (TVUS) 5. Endometrial Biopsy (EMB) Terminology: What is abnormal? • Normal: Cycle= 28 days +‐ 7 d (21‐35); Length=2‐7 days; Heaviness=self‐defined • Too little bleeding: amenorrhea or oligomenorrhea • Too much bleeding: Menorrhagia (regular timing but heavy (according to patient) OR long flow (>7 days) • Irregular bleeding: Metrorrhagia, intermenstrual or post‐ coital bleeding • Irregular and Excessive: Menometrorrhagia • Preferred term for non‐pregnant bleeding issues= Abnormal Uterine Bleeding (AUB) – Avoid “DUB” ‐ dysfunctional uterine bleeding.
    [Show full text]
  • Oligo-Anovulation Is Not a Rarer Feature in Women with Documented Endometriosis
    Oligo-anovulation is not a rarer feature in women with documented endometriosis Pietro Santulli, M.D., Ph.D.,a,b Chloe Tran, M.D.,a Vanessa Gayet, M.D.,a Mathilde Bourdon, M.D.,a,b Chloe Maignien, M.D.,a Louis Marcellin, M.D.,a,b Khaled Pocate-Cheriet, M.D.,b Charles Chapron, M.D.,a,b and Dominique de Ziegler, M.D.a a Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hopitaux^ de Paris (AP-HP), Hopital^ Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Universite Paris Descartes, Sorbonne Paris Cite; and b Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016, Universite Paris Descartes, Sorbonne Paris Cite, Paris, France Objective: To study the prevalence of oligo-anovulation in women suffering from endometriosis compared to that of women without endometriosis. Design: A single-center, cross-sectional study. Setting: University hospital-based research center. Patient (s): We included 354 women with histologically proven endometriosis and 474 women in whom endometriosis was surgically ruled out between 2004 and 2016. Intervention: None. Main Outcome Measure(s): Frequency of oligo-anovulation in women with endometriosis as compared to that prevailing in the disease-free reference group. Results: There was no difference in the rate of oligo-anovulation between women with endometriosis (15.0%) and the reference group (11.2%). Regarding the endometriosis phenotype, oligo-anovulation was reported in 12 (18.2%) superficial peritoneal endometriosis, 12 (10.6%) ovarian endometrioma, and 29 (16.6%) deep infiltrating endometriosis. Conclusion(s): Endometriosis should not be discounted in women presenting with oligo-anovulation.
    [Show full text]
  • Clinical Practice Guideline for Treatment Options for Menorrhagia
    Clinical Practice Guideline for Treatment Options for Menorrhagia Menorrhagia is defined as heavy blood loss during menstruation for several consecutive cycles. This condition can be related to a number of underlying conditions (e.g. fibroids, polyps, hormonal imbalance, anovulation, adenomyosis, endometrial hyperplasia) or idiopathic in nature (often referred to as dysfunctional uterine bleeding). Women with certain bleeding conditions or who take certain medications can also have heavy menstrual bleeding. (e.g. von Willebrand disease, having a low platelet count, taking a blood thinner such as Warfarin.) The objective definition of Menorrhagia is monthly blood loss that exceeds 80 ml or lasts greater than 7 days. In a normal menstrual cycle, a woman loses an average of 2 to 3 tablespoons (35 to 40 milliliters) of blood over four to eight days. Symptoms of Heavy or Prolonged Menstrual Bleeding Women with heavy or prolonged menstrual bleeding typically have one or more of the following: Soak through a pad or tampon every one or three hours on the heaviest days of the period Have bleeding for more than seven days Need to use both pads and tampons at the same time due to heavy bleeding Need to change pads or tampons during the night Pass blood clots larger than 1 inch (about 2.5cm) Iron deficiency anemia Diagnosis of Heavy or Prolonged Menstrual Bleeding Testing can include: Blood tests to look for anemia, iron levels, thyroid disease, or a bleeding disorder. A pelvic ultrasound (usually through the vagina), which can detect endometrial polyps and fibroids Endometrial biopsy Hysteroscopy Several minimally invasive techniques are available to treat this condition: 1).
    [Show full text]
  • Evaluation of the Infertile Female
    REVIEW ARTICLE Indian Journal of Clinical Practice, Vol. 31, No. 1, June 2020 Evaluation of the Infertile Female GARIMA KACHHAWA*, ANJU SINGH* ABSTRACT Infertility is defined as failure to conceive after 1 year of regular unprotected intercourse and is estimated to affect 10-15% of couples worldwide. Evaluation of the female partner is started if she fails to achieve pregnancy after 12 months or more of regular unprotected intercourse. This article provides a comprehensive review of the evaluation of a woman with infertility. We discuss the history and physical examination, evaluation of ovulatory function, tubal and peritoneal factors, uterine factors, cervical factors and ovarian reserve testing in detail. Keywords: Female infertility, ovulatory dysfunction, uterine factors, tubal and peritoneal factors, cervical factors, ovarian reserve test, basal body temperature nfertility is defined as failure to conceive after 1 year HISTORY AND EXAMINATION of regular unprotected intercourse. It affects 10-15% of couples worldwide. Female factor is responsible Both the partners should be made aware of underlying I causes of infertility, components of basic evaluation and for infertility in 35-40% of couples. Among females, the major causes of infertility include ovulatory encouraged for simultaneous testing. dysfunction (30-40%), tubal and peritoneal pathology Diagnostic evaluation should begin with thorough (30-40%), cervical factor (3%), uterine factor (rare) and history and physical examination. History taking of unexplained (10%) (Fig. 1). infertile partner must include the following: Usually, we start evaluation of female partner if she fails  Duration of infertility and results of any previous to achieve pregnancy after 12 months or more of regular evaluation/treatment unprotected intercourse.
    [Show full text]
  • Anovulation and PCOS
    Anovulatory Infertility and PCOS ESHRE, Kiev 2010 Adam Balen MD, FRCOG Professor of Reproductive Medicine Leeds Teaching Hospitals, UK Disclosures: Medical advisor to Ferring, Organon SP Causes of Anovulatory Infertility Learning Objectives 1. To understand the causes of anovulation 2. Knowledge of the correct diagnostic tests 3. Effective assessment and diagnosis to plan appropriate ovulation induction therapy Hypothalamus GnRH Pituitary FSH LH Oestradiol, inhibins Progesterone……. LH FSH theca cells granulosa cells testosterone aromatase oestradiol oocytte Two cell – two gonadotrophin theory of oestrogen synthesis The Menstrual Cycle pmol/l 350 80 300 70 250 60 50 200 40 nmol/l 150 & 30 100 20 50 10 IU/L 0 0 0 2 4 6 8 10121416182022242628 E2 FSH LH P4 Causes of Anovulatory Infertility Group I: weight loss, systemic illness Hypothalamic/ Kallmann’s syndrome pituitary failure hypogonadotrophic hypogonadism Hyperprolactinaemia Hypopituitarism Group II: PCOS h/p dysfunction Group III: Premature ovarian failure (POF) Ovarian failure Resistant ovary syndrome (ROS) Causes of Anovulatory Infertility Group I: weight loss, systemic illness Hypothalamic/ Kallmann’s syndrome pituitary failure hypogonadotrophic hypogonadism Hyperprolactinaemia Hypopituitarism Group II: PCOS h/p dysfunction Group III: Premature ovarian failure (POF) Ovarian failure Resistant ovary syndrome (ROS) Causes of Anovulatory Infertility Group I: weight loss, systemic illness 5% Hypothalamic/ Kallmann’s syndrome pituitary failure hypogonadotrophic hypogonadism Hyperprolactinaemia Hypopituitarism Group II: PCOS 90% h/p dysfunction Group III: Premature ovarian failure (POF) 5% Ovarian failure Resistant ovary syndrome (ROS) Investigations 1. FSH, LH, oestradiol 2. Prolactin / TFTs 3. Testosterone (SHBG) 4. AMH...... 5. GTT, lipid profile 6. Ultrasound scan 7. Semen analysis 8.
    [Show full text]
  • Understanding Amenorrhea and PCOS
    UCSF Essentials of Primary Care August 7, 2015 Squaw Creek, CA Understanding Amenorrhea and PCOS Michael Policar, MD, MPH Professor of Ob, Gyn, and Repro Sciences UCSF School of Medicine [email protected] Disclosure • I am a litigation consultant to a law firm contracted with Bayer Healthcare relating to the Mirena IUD 1 Amenorrhea: Definitions • Primary Amenorrhea – Absence of menarche by • 16 yo with sexual development – ASRM: 15 yo or >5 years after breasts develop • 14 yo without sexual development • Secondary Amenorrhea – No vaginal bleeding for at least • Three cycle lengths OR six months – ASRM: oligomenorrhea with < 9 menses/ year ASRM: American Society of Reproductive Medicine Presentation Approach to Amenorrhea • Most common diagnoses early in workup • Minimize potentially unnecessary tests and office visits • Separate evaluation schemes for – Spontaneous secondary amenorrhea – Post‐surgical amenorrhea – Primary amenorrhea – Progestin‐induced failure to withdraw 2 Reproductive Hormonal Axis HYPOTHALAMUS Hypothalamic GnRH Amenorrhea ANTERIOR PITUITARY Pituitary FSH Amenorrhea LH OVARY Ovarian Estradiol (E2 ) Failure Progesterone (P) ENDOMETRIUM Outflow Failure Amenorrhea: Causes • Hypothalamic amenorrhea • Pituitary amenorrhea • Ovarian failure • Outflow tract failure • Anovulatory amenorrhea • Pregnancy induced amenorrhea 3 2o Amenorrhea: Hypothalamic Amenorrhea • Athlete's amenorrhea – Critical ratio of muscle to body fat exceeded – Despite exercise, risk osteoporosis (and fracture) • Female athlete triad: disordered eating,
    [Show full text]
  • Abnormal Uterine Bleeding in the Adolescent Patient
    ADOLESCENT GYNECOLOGY Abnormal Uterine Bleeding in the Adolescent Patient Nirupama K. DeSilva, MD Common Clinical Scenario: A 14-year-old fe- due to an immature hypotha- FOCUSPOINT male presents to your office with the complaint lamic-pituitary-ovarian (HPO) of menses “every 2 weeks” for the past few axis, causing anovulatory cy- months. She states that her periods started at cles and irregular bleeding.4 age 13, and after her first period she did not Before the diagnosis of imma- have another menses for 3 months. After her sec- ture HPO axis can be assumed, Many patients ond menstrual cycle, her periods started “hap- more serious disorders must complain of pening all the time.” She notes that menses be ruled out (Table).5,6 While menstrual problems sometimes come once a month, sometimes “skip there are numerous etiologies a month,” and lately have been coming twice a for abnormal uterine bleeding that actually fall month. Her menses last for 5 days, during which in the adolescent, this article within normal she changes 3 pads per day. She is in good will concentrate on the evalua- variations. health, with no medical problems or history of tion and management of DUB surgeries. Urine pregnancy test is negative. in the adolescent female. enstrual disorders are among the EVALUATION most common complaints of adoles- When an adolescent presents cents. This is in part because adoles- with the complaint of DUB, she should be asked cents and their families often have detailed questions about her menstrual history, Mdifficulty understanding what normal cycles or including the age at menarche and the timing, patterns of bleeding are and in part because duration, and quantity of her uterine bleeding.
    [Show full text]
  • CP.MP.55 Assisted Reproductive Technology
    Clinical Policy: Assisted Reproductive Technology Reference Number: CP.MP.55 Coding Implications Last Review Date: 12/20 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Diagnostic infertility services to determine the cause of infertility and treatment is covered only when specific coverage is provided under the terms of a member’s/enrollee’s benefit plan. All coverage is subject to the terms and conditions of the plan. The following discussion is applicable only to members/enrollees whose Plan covers infertility services. Infertility is defined as the condition of an individual who is unable to conceive or produce conception during a period of 1 year if the female is age 35 or younger or during a period of 6 months if the female is over the age of 35. For purposes of meeting the criteria for infertility in this section, if a person conceives but is unable to carry that pregnancy to live birth, the period of time she attempted to conceive prior to achieving that pregnancy shall be included in the calculation of the 1 year or 6 month period, as applicable. Assisted Reproductive Technologies (ART) encompass a variety of clinical treatments and laboratory procedures, which include the handling of human oocytes, sperm or embryos, with the intent of establishing pregnancy. The following services are considered medically necessary when performed solely for the treatment of infertility in an individual in whom fertility would naturally be expected and when meeting the accompanying ART criteria in the Policy/Criteria section. Females: 1.
    [Show full text]