ACTIVE MANAGEMENT OF INFERTILITY USING A SCORING TOOL Wada I, Ameh N, Odeku T, Hati S

OUTLINE Introduction Justification Methods Results Discussion conclusion

INTRODUCTION High prevalence of infertility Aetiology ranges from simple to complex Therapies like ART are emerging as a veritable tool Questions like WHAT THERAPY? WHEN? Timely intervention is key to success That’s the concept of ACTIVE MANAGEMENT OF INFERTILITY

OBJECTIVES Develop a couples' mode tool for individualized assessment of their infertility Apply the tool as a guide for their need or otherwise to seek ART services

MATERIALS AND METHODS A couple mode simplified questionnaire was developed Scoring system for each factor achieved using the Delphi method Grading for couple’s need for ART was low moderate severe (1- 9) (10 – 14) (15 – 91) The tool was assessed on line as well as at the gynae clinic

Male factor Erectile dysfuntion………………………………1 Oligospermia-----------------------------------2 Azospermia------------------------------------10 Total---------------------------------------------13

Pituitary Ovarian axis Factor Milky discharge from the nipples-------------------------1 Scanty Menstruation-----------------------------------------2 No menstruation for more than 6 months--------------4 No menstruation for more than 1 year--------------- 10 Total-------------------------------------------------------------17

Ovarian factor Polycystic ovary disease----------------------------2 Endometriosis ----------------------------------------4 Absent ovary-----------------------------------------10 Total----------------------------------------------------16

Uterine factor Uterine fibroids----------------------------------------------1 1 previous fibroid surgery---------------------------------2 2 or more previous fibroid surgeries--------------------3 Adenomyosis-------------------------------------------------4 Absent or atrophic uterus---------------------------------10 Total------------------------------------------------------------20

Tubal factor One blocked tube----------------------1 Both tubes are blocked---------------10 Total---------------------------------------11

Female age factor 29 years and less-------------------------------1 30 years to 34 years---------------------------2 35 years to 39 years---------------------------3 40 years and above---------------------------10 Total-----------------------------------------------16

Duration of in-fertility Less than 2 years-----------------------------1 2 years and above---------------------------- 2 Total---------------------------------------------- 3 GRAND TOTAL……………………………..91

METHODOS The tool was generated and graded by three experts in the field of invitro fertilization. The parameters were made up of causative factors for infertility The Delphi method for medical risk scoring was used to obtain the scores for each fertility challenge

RESULTS: Infertility Scoring Mild 24 Moderate 17 Severe 09

RESULTS HIGH RISK LOW RISK TOTAL POSITIVE 17 (A) TRUE POSITIVE 9 (B) FALSE POSITIVE 26 TEST POSITIVE NEGATIVE (C) FALSE NEGATIVE 24 (D) TRUE NEGATIVE TEST NEGATIVE 33 50 Test Positive: High Need for ART Test Negative: Mild Need for ART

Results contd SENSITIVITY – 17/17 X 100 = 100%, {A/(A+C) X 100} SPECIFICITY – 24/33 X 100 = 72% D/(D+B)X100 POSITIVE PREDICTIVE VALUE – 17/26x100= 65.4% A/(A+B)X100 NEGATIVE PREDICTIVE VALUE- 24/(24+0)= 100% D/(D-C)x100 ACCURACY – 17+24/50 X 100 = 82% A+D/TOTAL X100

DISCUSSION Medical practice decision is aided by scoring tools Tools like the Bishop and APGAR scores are useful tools This fertility scoring tool has a high sensitivity at 100% an accuracy value of 82%. This makes the tool a good one for active management of infertility.

Active management of labour CONCLUSION Recall: Active management of labour Active management of post partum haemorrhage These interventions have made significant impact on these conditions This tool will reduce the time wasted on irrelevant practices during evaluation of an infertile couple The tool will save time which is important in infertility management