By Peter Braude, Alison Taylor
Written by way of a group of infertility specialists, this consultant addresses the advanced topic of subfertility. It starts with prognosis within the female and male ahead of featuring recommendation on all sorts of assisted belief in addition to counselling aid with therapy judgements.
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Additional info for ABC of Subfertility (ABC Series)
Presentation of OHSS Symptoms x Abdominal pain caused by enlarged ovaries and acute ascites x Abdominal distension secondary to enlarged ovaries and ascites x Feeling unwell, nauseated, vomiting x Bowel disturbance—can be constipation or diarrhoea x Dark, concentrated urine because of reduced renal perfusion and low urine output x Shortness of breath caused by splinting of diaphragm with marked ascites or pleural effusions x Leg and vulval oedema Timing x Early onset: within one to five days of human chorionic gonadotrophin injection, soon after egg collection and embryo transfer x Late onset: 7-14 days after embryo transfer when endogenous human chorionic gonadotrophin concentration rises after successful implantation Ultrasound scan showing an enlarged ovary (10 cm x 6 cm) and fluid in the pouch of Douglas and the uterovesical pouch Management of OHSS Grades of OHSS Mild x No need to admit x Increase oral fluid intake x Follow up at regular intervals and report if symptoms worsen Mild x Symptoms of abdominal discomfort and nausea x Ovarian enlargement between 5 cm and 12 cm Moderate x Admit to hospital and assess daily x Start thromboprophylaxis and maintain until patient is discharged x Monitor liver function, urea and electrolytes, full blood count, and clotting Severe x Strict fluid balance with input of 3 L or more.
I had to read the letter again a couple of times to satisfy myself that I hadn’t been picked up as the Desperate CPD Dodger of the Year. I then rang my colleague next door to ask if he had received any veiled threats as I had. He hadn’t, but neither had he sent in his return so far. So, was I going to be investigated for “delays in CPD returns”? I immediately opened the folder labelled “CPD” on my computer and transferred the information there on to the CPD return form, struggling a bit as usual to decide on the right category—clinical, academic, or professional.
Important objectives of counselling include encouraging people to clarify the underlying nature of a problem or difficulty, and exploring the capacity that the couple has to deal with the problem. Counselling and fertility treatment Couples often have conflicting thoughts and feelings about a proposed form of treatment. Being given the opportunity to discuss the different options available and the implications of any proposed treatment can help them reach an informed decision that is acceptable to both partners.
ABC of Subfertility (ABC Series) by Peter Braude, Alison Taylor