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LAUNCH OF PCOS CLINICS FOR FERTILITy PATIENTS – SEPTEMBER 2011 Approximately 20% of women presenting Prof Norman is the leading expert on PCOS for fertility treatment have polycystic and infertility in Australia and was part ovarian syndrome (PCOS). As the New of the team that developed the NHMRC NHMRC Guidelines for the assessment guidelines for PCOS. The following is a and management of polycystic ovarian summary of the recommendations from syndrome are being launched this year the Guidelines. These guidelines will be Welcome to our new format Fertility SA by the PCOS Alliance and Jean Hailes published on the Jean Hailes Foundation Newsletter. It has been a wonderful Foundation for Women's Health few months; our success rates continue we would like to provide you with to be well above national and an update of the fertility options international benchmarks; patient available for women with PCOS feedback has been fantastic and we at Fertility SA.
are very excited about the launch of Most of the fertility issues faced by our specialist fertility clinics for patients women with the condition centre with Polycystic Ovarian Syndrome in around anovulation (a condition September this year. where eggs are not released from the ovaries appropriately). We hope you enjoy reading our news While some women with PCOS but if you have any suggestions for will ovulate intermittently and improving the content, please contact become pregnant spontaneously, our General Manager, Lee Battye. ovulation is often not regular and can make intercourse timing On behalf of all our fertility specialists – difficult. Ovulation kits may Dr Alex Hubczenko, Dr Louise Hull, not be effective as hormonal Prof Rob Norman, A/Prof Ossie changes associated with PCOS Petrucco, Dr Michelle Wellman and (consistently high LH levels) can me – thanks for your support.
interfere with their readings. Fertility treatments for PCOS include lifestyle modification, ovulation induction with Clomid, FSH and metformin, and where required, IVF. In September 2011, Fertility SA will support website from 28th August 2011. The dedicated infertility clinics for PCOS guidelines emphasise lifestyle management Fertility SA Consulting Clinic
patients as we believe that patients with and weight loss particularly in women with PCOS are in particular need of specialist a BMI greater than 35. No particular 345 Carrington Street gynaecological attention to manage their diet has been found to be more effective fertility treatment options. These clinics in the treatment of PCOS and the For all appointments & enquiries
will be run by Dr Michelle Wellman and recommendation is to reduce dietary energy Professor Rob Norman who have a special (caloric) intake in the setting of healthy Phone (08) 8100 2900 interest and vast experience in the fertility Fax (08) 8223 1319 management of PCOS. Continued next page.

Personalised care by leading fertility specialists monitoring these cycles in order to optimise used for women who do not respond to outcome and to reduce the risk of clomiphene. In some situations they can multiple pregnancy. be used as first line. These ovulation induction cycles often require more intense This is generally a low risk and low cost ontinued from previous page. education, supervision and monitoring to treatment. The rates of twin pregnancy A referral to a dietician may enhance the and triplets with clomiphene citrate are primary infertility care plan. 5 - 7% and 0.3%, respectively. Again, our team at Fertility SA are highly key messages for women with PCOS are experienced in the management of The incidence of ovarian hyper-stimulation that achievable weight loss goals (such these cycles.
syndrome (OHSS) is less than 1%. as 5% to 10% loss of body weight) yield Studies with clomiphene citrate have significant clinical improvements. shown an ovulation rate of 60 - 85% At least 150 minutes of exercise per week and a pregnancy rate of 30 - 50% after is recommended, and 90 minutes per 6 ovulatory cycles. week of this should be aerobic activity at moderate to high intensity (60% - 90% Case Study - Fertility SA Patient B
of maximum heart rate) .
A patient with PCOS who had several Behavioural change techniques, including clomiphene citrate cycles without success motivational interviewing are advocated was referred to Fertility SA for fertility in addition to providing information and treatment. A further clomiphene citrate education. Interventions can be individual, cycle was monitored very closely with blood group or mixed mode, in a range of tests and scans. An injection to induce settings, delivered by a range of health ovulation was given at the time the follicle had developed to the correct size and timed intercourse recommended. An Case Study - Fertility SA Patient A
ongoing pregnancy resulted, much to A 43 year old patient with PCOS and a the patient's delight. BMI of 42 had had numerous cycles of Take home message: when clomiphene
IVF and ovulation induction over a 15 year does not appear to work, referral for
period of time. After review at Fertility SA, closer hormonal tracking and possible
an intensive lifestyle management plan intercourse timing should be considered.
was instituted for both partners. Another IVF cycle was planned but There has been some confusion as to the cancelled when a positive pregnancy test place of metformin in the treatment of was found. A single fetal heart was seen women with PCOS and infertility. It should on a subsequent scan. not be used as a substitute for lifestyle change. Contrary to what was initially Take home message: Lifestyle
Our nursing staff are available to answer thought, metformin appears to be more management should be applied even
any questions about these cycles and effective in restoring ovulation in women if IVF is planned. Patient spent many
provide instruction on administration with a BMI less than 30 if used alone. hundreds of thousands of dollars on
and timing of medication. It is rare for fertility treatment when correct advice
It may be effective in improving response women with PCOS not to respond to could have worked.
to Clomid in those women who may appear clomiphene resistant regardless of BMI.
The recommended first line Occasionally cycles may need to be pharmacological treatment for PCOS is Ovulation induction with gonadotropins recommenced if there is an over-response clomiphene citrate. The staff at Fertility SA (subcuticular injections of FSH, trade to medication, in order to avoid multiple have extensive experience in tracking and names Puregon or Gonal F) are generally Case Study - Fertility SA Patient C
PCOS INFORMATION SESSIONS A 26 year old anovular patient with PCOS Professor Norman and Dr Wellman will be providing an update for doctors on the new and a normal BMI was previously seen by guidelines in September 2011 and are planning a public information session for PCOS an IVF clinic who recommended IVF. fertility patients soon afterwards. She was commenced on a standard dose Professor Norman will also be conducting a general information session for PCOS of FSH, become severely hyper-stimulated patients in conjunction with the Jean Hailes Foundation and Women's and Children's and was admitted to hospital for several Hospital in October 2011. weeks without a pregnancy. She vowed never to have IVF again. At Fertility SA we Doctors seeking a specialist opinion for their PCOS patients who are not concerned with commenced ovulation induction with a very fertility issues may refer patients to Professor Norman at his clinic at the Royal Adelaide low dose of FSH seeking to develop one Hospital. Doctor Michelle Wellman is happy to provide initial advice and ongoing follicle and time intercourse without IVF management plan through her rooms in North Adelaide.
treatment. She was very happy when she became pregnant and a single fetus was seen on an ultrasound scan. Take home message: PCOS and infertility
FRANZCOG FRCPA CREI should be seen by a person with
experience in other forms of fertility
• Fertility Specialist • Fertility Specialist management and who is skilled in
• Specialist Surgical • Reproductive ovulation induction. IVF can be risky
Endocrinologist for patients with PCOS.
Often laparoscopy is performed as part of the assessment of infertility. As a number the ability of the sperm to fertilise the egg at Fertility SA, it was clear that because of of our specialists have extensive experience in vivo! However if IVF is needed, Fertility her husband's low sperm count, IVF was still in laparoscopic surgery, women with SA has an outstanding pregnancy rate in the best fertility treatment. PCOS can be advised if this is appropriate these patients.
management for them. Laparoscopic A final IVF cycle was monitored closely and ovarian drilling may also be an option in CASE STUDY- Fertility SA Patient D
several careful dose adjustments were made women who fail to respond to clomiphene. during the cycle. The ovaries responded A patient with PCOS undertook IVF This procedure may restore ovulation in up appropriately and the patient became because her partner had a low sperm count. to 60 - 80% of women with PCOS and can pregnant. In her first cycle, multiple follicles developed sometimes be offered as an alternative to and although she conceived, she developed She was monitored closely as an outpatient FSH ovulation induction or IVF.
severe over hyperstimulation syndrome in early pregnancy by her own doctor at If women do not respond to these requiring admission to a public hospital, IV both Fertility SA's consulting rooms and at more simple treatments or there are fluid therapy, catheterisation and drainage St Andrews Hospital but did not develop other infertility factors, IVF may be an of ascites (an abdominal fluid collection). hyperstimulation syndrome. A single live appropriate course of treatment. Caution Unfortunately the pregnancy miscarried. fetus was identified at an 8 week however needs to be exercised as women pregnancy scan. Another IVF cycle was cancelled because with PCOS are at significantly increased of over response, then in a third IVF cycle Take home message: For women
risk of ovarian hyper-stimulation syndrome.
there were some difficulties obtaining with PCOS that require IVF, careful
For this reason, even if there appears to be medical advice and the dose was initially monitoring, continuity of care and
an abnormal semen analysis, more simple too low, then increased to a level that again specialist medical input is required during
and safer techniques are often better used resulted in an over response of the ovaries an IVF cycle and in early pregnancy,
first line. The best test of male fertility is and a cancelled cycle. After seeking advice to minimise hyperstimulation.

Personalised care by leading fertility specialists Our success rates for the period ending 31st March 2011 are shown in the opposite graph. This demonstrates clearly that our success rates are outstanding by comparison to national and international benchmarks. However, success rates do not tell the whole story and for some patients, the dream of having a baby will not become a reality. For this reason, we hold regular in-house education meetings, learn about the latest innovations at national and international conferences, run several research projects and promote the use of new techniques and technologies to ensure that we remain at the cutting edge of Clinical heart beat developments to help enhance the prospects of pregnancy for our patients.
GENERAL MANAGER'S UPDATE from the desk of Lee Battye ESHRE CONFERENCE, STOCkHOLM Professor Norman gave a plenary lecture to 4,000 participants at the European Society Consulting locations –
for Human Reproduction and Embryology (ESHRE). ESHRE is one of the two premier For patients' convenience, organisations on IVF and reproduction. Dr Alex Hubczenko consults from Calvary Central District Hospital, 25-37 Jarvis Rd, Professor Norman's speech was entitled "Redefining success of assisted reproductive Elizabeth Vale every fortnight and Dr Ossie technology: how do we assess the best results?" In it, he pointed out that success is more than Petrucco holds consultations for country claiming high pregnancy rates - live birth, fresh and frozen results, a low multiple rate and patients periodically at various locations high patient satisfaction are also important. in South Australia and Darwin. He defined the PERFECT clinic as one with high pregnancy rates, the best trained Dr Jodie Semmler and Dr Michelle gynaecological specialists, a high investment in education and research, a strong focus on Wellman also consult from their respective patient care, emotional engagement, outstanding controlled quality systems and truth in private rooms in North Adelaide. all aspects of patient care, results, effective treatments and marketing. Fertility SA has All of our specialists also consult from our set its standards to be among the very few elite units in the world to achieve all these rooms at 345 Carrington St, Adelaide. goals and has a clear plan to excel in all these areas. PATIENT SATISFACTION SURVEyS New brochure – Some of you may have
already seen our new brochure for patients.
If you would like more brochures or any
We have been thrilled with feedback from our patients, with 92% of patient responses other materials, please contact myself or rating our overall service as good or excellent and 94% of respondents saying they would Janet McBride on (08) 8100 2900.
recommend our clinic to a friend or family member. Welcome - We are delighted to be
Patient comments mainly centre on the friendly, supportive and personalised service welcoming Jo Patterson and Jane Gard we provide and many patients have contrasted this to the "production line" they have to our nursing team, Rochelle Owens to experienced elsewhere. We are aiming to improve this even further and to this end we our admin team and Meghan Inge to our have recently been gathering feedback from referring doctors as well. laboratory team. Sadly, one of our lovely We understand that occasionally we may not meet our desired service levels however fertility nurses Rosie Bell will be leaving and if you have an experience that you would like to share, please contact me later this year to return to Victoria and on (08) 8100 2900.
she will be greatly missed by all of us.

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