Fertility and preconception
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Unit 594
June 2022
This edition of check considers management of patients in the preconception period and the investigation and management of fertility concerns.
The general practitioner (GP) will often be the first point of contact for patients planning pregnancy or experiencing fertility issues. The provision of preconception care presents GPs with an opportunity to improve health outcomes for patients planning pregnancy and their children as well as a chance to introduce patients to fertility awareness methods to assist them with identifying their fertile periods.
Once a couple starts trying for a baby, 80% will conceive within 12 months, and 90% will conceive within two years if the woman is aged <40 years.
However, approximately 15% couples experience infertility. For couples experiencing infertility, approximately 25% have unexplained infertility, 30% have male factor infertility, 25% have ovulatory disorders, 20% have tubal damage and 10% have uterine or peritoneal disorders.
Gynaecological conditions associated with infertility include polycystic ovary syndrome (which affects 12–21% of women and is the most common cause of anovulatory infertility) and endometriosis (which affects one in nine women). Treatment options can include medications, surgery and assisted reproductive techniques, such as in-vitro fertilisation.
Patients may also present with miscarriage, which affects 12–15% of pregnancies, while recurrent pregnancy loss is experienced by <5% of couples.
At the end of this activity, participants will be able to:
Below is a list of the case studies found in this month's edition of check. To see how these case studies unfold and gain valuable insights into this months topic, log into gplearning to complete the course.
Penny, aged 26 years, and Caleb, aged 27 years, met at a wedding almost a year ago and have been in a relationship since shortly after. They have presented today saying that they want to start trying for a baby.
Sara, aged 28 years, is a married woman who has been trying to conceive for the past six months. She is using an app to tell her when she is ovulating, but it has not helped as her menstrual cycles are irregular (between 30 and 46 days), and she is still unsure when she is fertile. Sara is wondering if the app is giving her incorrect information.
Miremba, aged 32 years, is a disability support worker who has been married for six years to Jace, aged 40 years, a software programmer. She comes to discuss their problems with trying to have a baby. They have experienced two miscarriages, both at approximately 6–8 weeks of gestation. One of the miscarriages was complete; with the other, Miremba needed medical intervention with dilation and curettage. In the 12 months since, Miremba has become increasingly anxious as she and Jace have been trying to conceive with no success. She has started to track her periods with a phone app and has noticed that her cycle length is irregular.
Amira, aged 34 years, presents with her husband of 17 months, Rohan, aged 42 years. They have been trying to conceive since Amira stopped taking the combined oral contraceptive pill (COCP) one month before their wedding. She is fairly sure she has a regular cycle but says it has not always been exactly on the month since stopping the COCP.
Caitlin, a university postgraduate research student aged 34 years, presents to you saying that she and her partner of two years, Mostafa, aged 38 years, are trying to have a baby. She expected that she would fall pregnant as soon as they started trying to conceive and tells you she is surprised it has not happened yet.
This unit of check is approved for 10 hours of CPD activity (two hours per case). The 10 hours, when completed, including the online questions, comprise five hours’ 鲍鱼视频al Activities and five hours’ Reviewing Performance.
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Each unit of check comprises approximately five clinical cases, and the choice of cases will cover the broad spectrum of the unit’s topic. Each unit will be led by a GP with an interest and capability in the topic, and they will scope the five different cases for that unit in collaboration with the check team.