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

2. OUTLINE
Introduction
Justification
Methods
Results
Discussion
conclusion

3. 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

4. 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

5. 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

6. Male factor
Erectile dysfuntion………………………………1
Oligospermia
Azospermia
Total

7. Pituitary Ovarian axis Factor
Milky discharge from the nipples
Scanty Menstruation
No menstruation for more than 6 months
No menstruation for more than 1 year
Total

8. Ovarian factor
Polycystic ovary disease
Endometriosis
Absent ovary
Total

9. Uterine factor
Uterine fibroids
1 previous fibroid surgery
2 or more previous fibroid surgeries
Adenomyosis
Absent or atrophic uterus
Total

10. Tubal factor
One blocked tube
Both tubes are blocked
Total

11. Female age factor
29 years and less
30 years to 34 years
35 years to 39 years
40 years and above
Total

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

13. 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

14. RESULTS: Infertility Scoring
Mild
Moderate 17
Severe 09

15. 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

16. 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

17. 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.

18. 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