Spire Healthcare Group Plc · LSE:SPI
Spire Healthcare — Investor Presentation (February 2011)
62 slides from Spire Healthcare's investor presentation, Feb 12, 2011
Slide 1: Patient information evening: General guide to infertility
Patient information evening General guide to infertility Anil Gudi & Amit Shah Consultants, Homerton Fertility Centre
Slide 2: Homerton Fertility Centre
= ——_—— ei | ‘Horton Fertility Centre - aye as pean
Slide 3: Definition
Definition • Inability to conceive after 2 years of unprotected SI • Affects 10% of couples • 84% conceive after 1 year of trying • 92% conceive after 2 years
Slide 4: Things to do before you see your GP
Things to do before you see your GP Stop smoking and adopt a healthy life style Your BMI (Body mass index) should be less that 30 Check this online and if necessary loose weight Stop using any recreational drugs
Slide 5: Consultation with the GP
consultation with the GP • Ask if the hospital offer you the full range of fertility treatments-very few do. If you go to the local hospital, you may have to wait till you get referred to the specialist hospital • Attend as a couple if that applies to you • Do organize your tests asap with your GP a
Slide 6: Relationship
Relationship • Couple? • Cohabiting for 1 year • Different address but meet 4 times a week? Etc • If you are a couple then stick to an address
Slide 7: Consultation with the GP
consultation with the GP • please ask for an early referral if any pre existing conditions that lower the fertility for both male and female and if you are over 35years. • please do not feel guilty about infertility and use your family, friends and support groups • Infertility creates stress, ask fo
Slide 8: Information you should provide
information you should provide • any previous surgery in the pelvic area for the females • any previous surgery on the testes and hernia operations etc. • general health issues • smoking/alcohol/drugs history
Slide 9: Age and fertility
Age and fertility pact of age • Advancing age decrease of oavarian reserve • Fertility deceases after 35 years • 20% of young women have decreased ovarian reserve
Slide 10: Age and miscarriage rate
conception Knudsen 1991 ge (Years) Total Number of Miscarriage pregnancies Rate 0-24 350,395 9% 5-29 414,149 11% 0-34 235,049 15% 5-39 93940 25% 0-44 25132 51%
Slide 11: Basic tests
basic tests • female hormone profiles to assess the ovarian reserve • female ultrasound scan to look at the uterus and the ovaries • male sperm test • virology and infection screen • assessment of the fallopian tubes
Slide 12: Normal menstrual cycle
Normal menstrual cycle
Slide 13: Female reproductive anatomy
Uterus Fallopian Internal os Cervix - External os Y , Vagina 2 — Labium
Slide 14: Natural conception
NATURAL CONCEPTION
Slide 15: Referral
Referral • Couples trying for >1 year of unprotected SI or earlier • History of predisposing factors
Slide 16: Causes of infertility
Causes of infertility • Tubal Infertility- Blocked tubes • Ovulatory infertility- Polycystic ovaries • Uterine factors – fibroid and adhesions • Male factor- low sperm count • Endometriosis • Unexplained
Slide 17: Tubal infertility
Tubal infertility Damaged tubes nfection/endometriosis
Slide 18: Ovulatory infertility: Polycystic ovaries
Ovulatory Polycystic ovaries
Slide 19: Polycystic ovaries
Polycystic ovaries • Hormonal imbalance • Long cycles • Hair growth/facial hair • Infertility • obesity
Slide 20: Uterine factors
Uterine factors broids fibroids
Slide 21: Endometriosis
Endometriosis • Pain during period,.sexual intercourse • Seen in 25% of women trying to get pregnant • Takes a long time to diagnose since lack of specialists
Slide 22: Endometriosis
Endometriosis
Slide 23: Fibroids
SUBSEROSAL (Pedunculated SUBSEROSAL ——— INTRAMURAL SUBMUCOSAL
Slide 24: Unexplained infertility
Unexplained infertility • 30% of infertility • Cause is often not known • Or Cause is not found ??? • 40% of unexplained infertility show endometriosis (Missed earlier) and treatment improves fertility
Slide 25: Tests
Tests • Ovarian reserve • Tubal check • Ultrasound (To check ovaries and uterus) • Sperm test
Slide 26: Basic tests
basic tests • female iron levels and hemoglobinopathy checks • rubella immunity check • smear test updates
Slide 27: The Aging Ovary
The Aging Ovary irth Birth 1-2 million germ cells Menarche 300,000 follicles 35-37 years 10,000 - 25,000 follicles 50 years 1,500 follicles Menopause +3 years
Slide 28: Live Birth Rate and Ovarian Ageing
Live Birth Rate and Ovarian Ageing 16 % 12 live births / cycle 8 4
Slide 29: Tests for ovarian reserve
Tests for ovarian reserve • FSH released from the brain • Makes the ovary produce an egg • Depends on the reserve • Increases when closer to menopause • Ovarian reserve decreased in 20% of women with normal FSH!!
Slide 30: Ovarian reserve – which test
Ovarian reserve – which test • Other tests • AMH • INHIBIN B • Antral follicle count (Ultrasound) • Response in previous treatments
Slide 31: Tests for tubes
Tests for tubes Laparascope Pubic bone Endometriosis Urethra Fallopian tube Ovary Uterus Rectum Vagina
Slide 32: Tubal test
Tubal test • Detects if tubes are • Laparoscopy detects blocked cause and of any adhesions or • More specific endometriosis
Slide 33: Ultrasound
Ultrasound • Internal ultrasound • Allows closer look at the womb and ovaries
Slide 34: Sperm analysis
Sperm analysis • Sperm test • Can be arranged from GP surgery • Simple test to know if any problems • 25% of infertility is due to male factor
Slide 35: Treatment
Treatment
Slide 36: BMI - Body mass index
BMI- Body mass index • NICE guidelines- less than or equal to 30 to offer treatment • higher BMI has shown to significantly lower the live birth rates • also makes treatments riskier and the pregnancy high risk with increase miscarriages, preterm births and birth defects along with increased risk to
Slide 37: Smoking
smoking • can affect your chances by its impact on the egg and sperm quality • ideally stop
Slide 38: Alcohol
alcohol • minimise it and if possible stop it • females- less than 6 units per week • males-less than 10 units per week • no binge drinking
Slide 39: Drugs
drugs • stop it • could cause significant impact on the success • may raise serious issues of welfare of child along with alcohol and smoking
Slide 40: Treatment for PCOS
Treatment for PCOS • Ovulation with Clomiphene • Tablets taken from day 2 to Day 6 Releases FSH from anterior pituitary Often enough to reset the cycle of events The release of even small amounts of FSH into the system often induces ovulation
Slide 41: Clomiphene ovulation rates
Clomiphene 1 Tablet 46% will ovulate 2 Tablets 21% will ovulate 3 Tablets 8% will ovulate Rostami-Hodjegan 2004, meta-analysis of 13 studies > 3 Tablets No benefit Not beneficial in ovulating women
Slide 42: When tablets fail?
When Tablets fail? • Ovarian drilling to lower hormones • Injections of hormones to stimulate the ovaries
Slide 43: Insemination
SB FEGE WO We | ew FO OF insemination
Slide 44: Assisted conception: Intrauterine insemination
Assisted conception Intrauterine insemination
Slide 45: Intrauterine insemination
Intrauterine insemination • Ovaries stimulated by gonadotrophins • Tubes should be open and sperm count normal • Success around 10 to 12%
Slide 46: IVF - In vitro fertilisation
IVF- IN VITRO FERTILISATION • Stimulating the ovaries to get more eggs • Mixing/injecting sperm and eggs • Helping the fertilized egg (Embryo) to develop • Transfer the embryo into the uterus
Slide 47: Long protocol
Long protocol 1
Slide 48: Short protocol
Short protocol
Slide 49: IVF
IVF
Slide 50: Fertilisation: ICSI
Fertilisation F ICSI
Slide 51: Embryo transfer
Embryo transfer
Slide 52: At the Clinic
At the Clinic • Ask for the waiting times • Ask for success rates for your problem and age • Success varies according to patients treated
Slide 53: At the Clinic
At the Clinic Huge difference from a normal gynaecologist and fertility expert Fertility is a specialized branch Search, choose the right clinic. You can ask for referral to the main (Tertiary centre)
Slide 54: IVF cycles and patients by region
AS Se EVE Iw Vy PCYyIVil 1 eggs. INCLUDES natural cycles, PGD cycles or cycles where both fresh and frozen embryos were used in the same cycle Patients Cycles on ae Number = Number % cycles in 2006 eee Midlands 4 2,473 7.1% 3,103 7.0% 564 160 1 725 of England 4 2,266 6.5% 2,835 6.4% 509 159 1 669 on
Slide 55: East London Funding criteria
East London Funding criteria
Slide 56: Criteria
Criteria • Women aged 23-39 at time of treatment • BMI 18-30 • Neither partner sterilised • No living children in the relationship and not more that 4 between the couple in previous ralationship • Registered with Gp for 1 year • Cohabiting and in stable relationship for 1 year
Slide 57: Not eligible for NHS treatment
Not eligible for NHS treatment • Same sex relationship • Many PCTs will not fall in line with parliamentary changes • East london PCTs treat • Single women • No NHS funding
Slide 58: Not eligible for NHS funding
Not eligible for NHS funding • You can write to the PCT, if you feel that you have been treated unfairly get the GP to write too for appeal . • Most NHS units can offer self funded fertility treatment
Slide 59: Infertility Network
Infertility Network The leading patient organisation in the UK
Slide 60: What does Infertility Network have to offer?
What does Infertility Network have to offer? • Free phone support line – 0800 008 74 • Professional advice line • Volunteer helplines • Quarterly magazine • Electronic newsletter • Regional network and branches • Local Support Groups • Fantastic Interactive Website
Slide 61: www.infertilitynetworkuk.com
www.infertilitynetworkuk.com • Forums on many different topic • Chatrooms • Factsheets free to download • Funding for Fertility – provision is in your area outlining NHS • Latest news section • Online bookstore • Branches have their own section
Slide 62: Infertility Network outcome
outcome For those with fertility problems For those facing involuntary childlessness For families following assisted conception
Spire Healthcare Group — Investor Presentation (February 2011) on 6ix