Assisted reproductive technologies: what the endocrinologist needs to know

A Murdoch

International Centre for Life, Newcastle upon Tyne

Summer School 5-8 July 2005
St Aidan’s College, Durham University, Durham, UK

Since the birth of the first IVF baby in 1978, it has now become accepted that there are treatments available that can help most infertile couples. In 2005, 1.6% of all births in the UK were a result of assisted conception treatment (ART). Patients who need or have used these technologies are likely to present to many other clinicians.

Before referral, both partners need to be given appropriate pre-conception advice covering both lifestyle and medical issues. It would not be appropriate to advise a poorly controlled diabetic woman to conceive and coordinated management between the endocrinologist, the obstetrician and the IVF clinicians is essential. With respect to other endocrine disorders, as long as a woman is well enough to carry a pregnancy, she is probably able to undergo ART procedures.

Not infrequently, practitioners forget that infertility involves 2 people and that both must be included in the assessment. IVF and its variations are now the first line treatments for most causes of infertility, both male and female.

Superovulation using LHRH analogues and gonadotrophins is standard in IVF treatment. The response depends little on the dose regime and reflects the underlying ovarian reserve. Age is the principal determining factor and various tests of ovarian reserve which have been used are disappointing. The best option is to advise women to have their family before the irreversible effects of ageing.

Ovarian hyperstimulation syndrome can be an alarming adverse side effect of superovulation both for the patient and the clinician. The pathogenesis of the disorder is now well described but the underlying cause is not clear. Women are managed conservatively with support primarily to prevent renal impairment and thrombosis. Although a distressing problem, it is self limiting with an expectation of full resolution. Furthermore these women have a chance of pregnancy greater than the average of 1 in 4.

The opinions expressed in this paper are those of the speaker and do not necessarily reflect the views of the Society

Revised: 28-Jul-2005