An Integrative Approach To Fertility & IVF

229 Pages·2017·21.94 MB·English

by  Andrew Orr

8/06/17
About
 Dr
 Andrew
 Orr

•  Reproduc1ve
 Medicine
 Specialist
 (Medical)

•  Women’s
 &
 Men’s
 Health
 Specialist
 (Medical)

•  Doctor
 of
 Tradi1onal
 Chinese
 Medicine

•  Naturopath

•  Nutri1onist

•  Qualified
 Chef

•  And……..
 More

2
About
 Dr
 Andrew
 Orr

My
 Mo%os

•  Leave
 No
 Stone
 LeJ
 Unturned

•  Period
 Pain
 IS
 NOT
 Normal

•  Early
 Interven1on
 Is
 The
 Key
 To
 Any
 Issue
 That

Affects
 The
 Body

•  Fer1lity
 Requires
 A
 Couple
 To
 Be
 On
 The
 Same
 Page

•  A
 Mul1modality
 Approach
 Is
 Needed
 For
 Any
 Health

Issue
 The
 Body
 Faces,
 especially
 gynaecological

•  Never
 Underes1mate
 The
 Power
 Of
 A
 Second

Opinion

3
About
 Dr
 Andrew
 Orr

• I
 have
 helped
 over
 12,000
 babies
 into
 the
 world
 with

my
 unique
 integra1ve
 medicine
 fer1lity
 program

• I
 use
 an
 integra1ve,
 mul1modality
 approach
 to
 help

fer1lity
 and
 gynaecological
 issues

• I
 have
 helped
 thousands
 of
 Men
 and
 Women
 with

Gynaecological,
 Reproduc1ve
 and
 Health
 Issues

• I
 lecture
 and
 Mentor
 to
 Health
 Care
 Professionals
 on

how
 to
 be
 be[er
 at
 trea1ng
 Gynaecology
 and

Fer1lity
 issues

4
1
8/06/17
About
 Dr
 Andrew
 Orr

5
6
About
 Dr
 Andrew
 Orr

• My
 success
 has
 been
 publicised
 on
 various
 forms
 of

media,
 including
 Channel
 9’s
 A
 Current
 Affair,
 The

courier
 Mail,
 Channel
 9’s
 Brisbane
 Extra,
 Woman’s

Day,
 New
 Idea
 and
 many
 other
 forms
 of
 media

• I
 have
 a
 team
 of
 support
 people
 and
 qualified
 health

care
 professionals
 that
 can
 assist
 me
 and
 my

pa1ent’s
 throughout
 this
 whole
 journey

• My
 pa1ents
 get
 both
 a
 medical
 and
 holis1c
 medicine

background
 to
 give
 them
 the
 best
 results
 possible

7
2
8/06/17
About
 Dr
 Andrew
 Orr

Important
 Facts
 You
 Need
 to
 Remember

•  Many
 of
 your
 pa1ents
 have
 not
 had
 the
 basics
 tested

•  Many
 of
 your
 pa1ents
 have
 had
 crucial
 things
 missed

•  Many
 of
 your
 pa1ents
 have,
 or
 s1ll
 are
 actually
 seeing

someone
 with
 substandard
 knowledge
 about
 their
 condi1on

•  Many
 of
 your
 pa1ents
 are
 underprepared
 for
 their
 journey

ahead

•  Many
 of
 your
 pa1ent’s
 will
 feel
 unheard
 and
 feel
 like
 a

number

•  Many
 of
 your
 pa1ent’s
 are
 trying
 to
 patch
 things
 as
 they
 go

•  You
 pa1ent’s
 need
 to
 know
 there
 is
 always
 someone
 who
 will

listen
 and
 help
 and
 care
 for
 them

8
Conditions Many of Your Patients Will Have Had Missed
9
•  Ended
 up
 in
 ICU-­‐Nearly
 die

•  It
 all
 ended
 up
 being
 from
 stress

•  Endured
 Chronic
 Fa1gue

•  Western
 Medicine
 wasn’t
 helping

me

•  Ended
 up
 seeking
 the
 help
 of

Chinese
 Medicine

•  Led
 me
 to
 where
 I
 am
 today

•  I
 have
 Chronic
 Asthma

•  I
 have
 Chronic
 Nasal
 Polypoid

Disease
 (Very
 similar
 to

endometriosis
 but
 in
 my
 nose

•  I
 have
 Haemochromatosis

•  My
 condi1ons
 do
 not
 define
 me

•  I
 have
 loved
 ones
 with
 Severe

Endometriosis

10
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8/06/17
Medical
 Inves1ga1ons

Medical
 Inves1ga1ons

Pathology
 Tes1ng

&

Procedures

For
 Infer1lity

Copyrights Dr Andrew Orr 2017 11
Medical
 Tes1ng-­‐Blood
 Work

1.
 Prothrombo+cs
 Studies

-­‐ Lupus
 An1coagulant

-­‐ PT

-­‐ APTT

2.

 Autoan+bodies

-­‐Cardiolipin
 IgG
 Abs

-­‐Cardiolipin
 IgM
 Abs

3.
 Autoan+bodies

-­‐An1-­‐nuclear
 Abs
 (ANA)

4.
 ESR
 (Erythrocyte
 Sedimenta1on
 Rate)

Copyrights Dr Andrew Orr 2017 12
Medical
 Tes1ng-­‐Blood
 Work

5.
 FBC
 &
 Blood
 Group
 &
 Rh

6.
 Haematology

7.
 Human
 T
 Lymphotrophic
 Viruses
 -­‐HTLV
 I/II
 (CMIA)

8.
 Cytomeglavirus
 (CMV)

9.
 Human
 Chorionic
 Gonadotrophin
 Assays

10.
 Gonadal
 Hormones

11.
 Thyroid
 Studies

-­‐(TSH,
 Free
 T3,
 Free
 T4
 plus
 Thyroid
 An1bodies)

12.
 STI’s

13.
 Hepa11s
 Serology

-­‐Hep
 B,
 HepC

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8/06/17
Medical
 Tes1ng-­‐Blood
 Work

14.
 Human
 Papilloma
 Virus
 (HPV)

15.
 HIV
 1/2
 serology

16.
 Hydroxy
 Vitamin
 D

17.
 AMH
 (An1mullerean
 Hormone)

18.
 Chromosomal
 Studies
 (Karyotype)

19.
 Cys1c
 Fibrosis
 (CFTF)
 Gene
 Muta1on

Copyrights Dr Andrew Orr 2017 14
Medical
 Tes1ng-­‐Blood
 Work

Erythrocyte
 Sedimenta=on
 Rate
 (ESR)

This
 test
 can
 be
 used
 to
 monitor
 inflammatory
 diseases
 or
 cancer.
 It
 is
 a

screening
 test,
 which
 means
 it
 cannot
 be
 used
 to
 diagnose
 a
 specific

disorder.

However,
 it
 is
 useful
 for
 detec+ng
 and
 monitoring:

Autoimmune
 disorders

Certain
 forms
 of
 arthri1s

Inflammatory
 diseases
 that
 cause
 vague
 symptoms

Tissue
 death

Tuberculosis

Adults
 (Westergren
 method):

Men
 under
 50
 years
 old:
 less
 than
 15
 mm/hr

Women
 under
 50
 years
 old:
 less
 than
 20
 mm/hr

Note:
 mm/hr.
 =
 millimeters
 per
 hour.
 Normal
 value
 ranges
 may
 vary
 slightly

among
 different
 laboratories.

  Copyrights Dr Andrew Orr 2017 15
Medical
 Tes1ng-­‐Blood
 Work

ESR
 (Con+nued)

Common
 autoimmune
 disorders
 include:

Lupus

Rheumatoid
 arthri1s

Very
 high
 ESR
 levels
 occur
 with
 less
 common
 autoimmune
 disorders,

including:

Allergic
 vasculi1s,
 Necro1zing
 vasculi1s,
 Giant
 cell
 arteri1s,

Hyperfibrinogenemia
 (increased
 fibrinogen
 levels
 in
 the
 blood)

Macroglobulinemia
 –
 primary
 Polymyalgia
 rheuma1ca

An
 increased
 ESR
 rate
 may
 be
 due
 to
 some
 infec+ons,
 including:

Body-­‐wide
 (systemic)
 infec1on,
 Bone
 infec1ons,
 Infec1on
 of
 the
 heart

or
 heart
 valvesRheuma1c
 fever,
 Severe
 skin
 infec1ons,
 Tuberculosis

Copyrights Dr Andrew Orr 2017 16
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8/06/17
Medical
 Tes1ng-­‐Blood
 Work

Haematology

 Blood
 Work
 (Con=nued)

Haemoglobin
  g/L 115-165

  Haematocrit

  0.35-0.47

  Red
 Cell
 Count
  10^12L 3.9-5.6

  MCV
  fL 80-100

  White
 cell
 count

  10^9L 3.5-12.0

  Neutrophils
  10^9L 1.5-8.0

  Lymphocytes
  10^9L 1.0-4.0

  Monocytes
  10^9L 0-0.9

  Eosinophils
  10^9L 0-0.6
Basophils
  10^9L 0-0.15

Platelets
  10^9L 150-400

Copyrights Dr Andrew Orr 2017 17
Medical
 Tes1ng-­‐Blood
 Work

Chromosome
 Studies

Tissue
 Submi[ed

 Blood

Number
 of
 Cells
 Analysed

 5

Number
 of
 Cells
 Counted

 15

Banding
 Studied

 Giemsa

Band
 Resolu1on

 550
 bands
 per
 haploid
 set
 (High)

Karyotype

 46,
 XX
 (Female)
 or
 46,
 XY
 (Male)

Comment

In
 men
 with
 sex
 chromosome
 aneuploidies
 such
 as
 Klinefelter
 Mosaicism
 (46,
 XY/
47,
 XXY),
 the
 injec1on
 of
 a
 sperm
 with
 a
 genotype
 of
 24,
 XX
 or
 24,
 XY
 into
 a
 23,
 X

oocyte
 will
 result
 in
 a
 47,
 XXX
 or
 47,
 XXY
 zygote.
 Indeed,

there
 is
 an
 increased
 incidence
 of
 about
 1%
 of
 sex
 chromosome
 aneuploidies
 in

offspring
 aJer
 ICSI.
 Other
 similar
 problems
 will
 arise
 if
 there
 are
 transloca1ons.

Balanced
 transloca1on
 in
 such
 men
 may
 lead
 to
 an

offspring
 with
 an
 unbalanced
 transloca1on.
 The
 most
 obvious
 example
 is
 when
 a

man
 with
 a
 Robertsonian
 transloca1on
 involving
 chromosome
 21
 produces
 a

Down
 Syndrome
 offspring.

  Copyrights Dr Andrew Orr 2017 18
Medical
 Tes1ng-­‐Blood
 Work

Blood
 Bank
 Serology

Blood
 Group

 (A,
 B,
 AB,
 O)

An1body
 Screen

 (Nega1ve
 or
 Posi1ve)

Rh

 (Posi1ve
 or
 Nega1ve)

Copyrights Dr Andrew Orr 2017 19
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8/06/17
Medical
 Tes1ng-­‐Blood
 Work

Blood
 Chemistry
 Screen

Sodium

 mmol/L

 (135-­‐145)

Potassium

 mmol/L

 (3.5-­‐5.5)

Chloride

 mmol/L

 (95-­‐110)

Bicarb

 mmol/L

 (20-­‐32)

Anion
 Gap

 mmol/L

 (5-­‐15)

Ca
 (corr)

 mmol/L

 (2.10-­‐2.55)

Phosphate

 mmol/L

 (0.8-­‐1.5)

Urea

 mmol/L

 (2.5-­‐7.0)

Uric
 Acid

 mmol/L

 (0.15-­‐0.40)

Crea1nine

 umol/L

 (45-­‐85)

eGFR

 (>59)

Copyrights Dr Andrew Orr 2017 20
Medical
 Tes1ng-­‐Blood
 Work

Blood
 Chemistry
 Screen
 (Con=nued)

Random
 Glucose

 mmol/L

 (3.6-­‐7.7)

Total
 Protein

 mmol/L

 (64-­‐81)

Albumin

 g/L

 (37-­‐48)

Globulin

 g/L

 (20-­‐39)

Bilirubin

 umol/L

 (3-­‐15)

Alk
 Phos

 U/L

 (20-­‐105)

AST

 U/L

 (10-­‐35)

ALT

 U/L

 (5-­‐30)

Gamma
 GT

 U/L

 (5-­‐35)

LDH

 U/L

 (120-­‐250)

Chol

 mmol/L

 (3.9-­‐5.5)

Haemolysis
 Index

 (0-­‐40)

Copyrights Dr Andrew Orr 2017 21
Medical
 Tes1ng-­‐Blood
 Work

Syphilis
 Serology

Syphilis

 (CMIA)
 Screen

 Nega1ve
 or
 Posi1ve

Comments

If
 treponemal
 an1bodies
 detected
 or
 not

This
 result
 may
 indicate

1.  No
 exposure
 to
 T.pallidum

2.  Very
 early
 primary
 syphilis.
 If
 risk
 factors
 exist
 a
 further
 sample
 should
 be

tested
 in
 2-­‐3
 weeks

3.  A
 swab
 if
 mucocutaneous
 lesions
 for
 the
 detec1on
 of
 T.pallidum
 DNAby

PCR
 may
 be
 posi1ve
 before
 an1body
 produc1on
 commences

Repeat
 antenatal
 syphilis
 screening
 for
 high
 risk
 subjects
 should
 be

considered
 at
 28-­‐32
 weeks
 gesta1on
 and
 at
 delivery

  Copyrights Dr Andrew Orr 2017 22
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8/06/17
Medical
 Tes1ng-­‐Blood
 Work

Chlamydia
 Serology

Chlamydia
 trachoma=s

PCR
 (Polymerase
 Chain
 Reac=on)
 tes1ng
 is
 the
 diagnos1c
 technique

rou1nely
 used
 by
 Capital
 Pathology
 to
 detect
 Chlamydia
 trachoma1s.

Chlamydia

Rou1ne
 screening
 for
 serum
 chlamydial
 an1bodies
 has
 been
 advocated
 by

many
 as
 it
 is
 a
 well
 known
 STI
 that
 causes
 tubal
 disease
 and
 PID.
 If
 the

serology
 was
 posi1ve,
 the
 chances
 of
 pregnancy
 with
 IVF
 were
 significantly

reduced.

A
 posi1ve
 test
 creates
 its
 own
 emo1onal
 problems
 for
 the
 couple
 since
 the

majority
 of
 Chlamydia
 transmission
 in
 our
 society
 is
 intercourse
 related.

Some
 units
 have
 abandoned
 the
 rou1ne
 tes1ng
 because
 the
 aggrava1on
 of

a
 posi1ve
 result
 outweighs
 the
 unproven
 value
 of
 its
 treatment.

Copyrights
 Dr
 Andrew
 Orr
 2017
  23

Medical
 Tes1ng-­‐Blood
 Work

Human
 T
 Lymphotrophic
 Viruses
 -­‐HTLV
 I/II
 (CMIA)

HTLV

 I/II
 (CMIA)

 Posi1ve
 or
 Nega1ve

Comments

This
 assay
 does
 not
 dis1nguish
 between
 an1bodies
 to
 Human
 T-­‐Lymphotropic

virus
 type
 1
 (HTLV-­‐1)
 and
 HTLV-­‐II.

Samples
 with
 a
 posi1ve
 screen
 result
 are
 referred
 for
 confirma1on
 by
 Western
 Blot

and
 PCR,
 Detectable
 an1bodies
 to
 HTLV
 I/II
 may
 not
 develop
 un1l
 4-­‐6
 months
 aJer

exposure
 and
 repeat
 serum
 should
 be
 tested
 if
 symptoms
 persist.

HTLV-­‐I
 has
 been
 iden1fied
 as
 a
 cause
 of
 human
 T-­‐cell
 leukemia/lymphoma
 and

tropical
 spas1c
 paraparesis.
 HTLV-­‐II
 is
 closely
 related
 to
 HTLV-­‐I
 but
 has
 not
 been
 linked

to
 human
 illness.

Both
 viruses
 can
 be
 transmi[ed
 through
 blood
 transfusions,
 sexual
 contact,
 from

mother
 to
 child
 through
 breasreeding
 and
 injec1on-­‐drug
 use.

Copyrights Dr Andrew Orr 2017 24
Medical
 Tes1ng-­‐Blood
 Work

Hepa==s
 Serology

HepB
 surface
 an1gen

 Posi1ve
 or
 Nega1ve

HepC-­‐IgG
 an1body

 Pos1ve
 or
 Nega1ve

Comments

Hepa11s
 c
 IgG
 may
 not
 appear
 for
 up
 to
 (6)
 months
 aJer
 primary
 infec1ons

If
 this
 is
 acute
 phase
 serum,
 suggest
 repeat
 at
 a
 suitable
 interval
 in
 60-­‐90
 days

(range
 45-­‐180
 days)
 post
 exposure
 is
 indicated

Copyrights Dr Andrew Orr 2017 25
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8/06/17
Medical
 Tes1ng-­‐Blood
 Work

Rubella
 Serology

Rubella
 IgG
 (EIA)

 <50

 IU/ml

-­‐Nega1ve:

 <5.0

 IU/ml

-­‐Grayzone:

 <5.0-­‐9.9

 IU/L

-­‐Low
 Posi1ve:

 <10-­‐20

 IU/L

-­‐Posi1ve:

Comments

Rubella
 IgG
 an1body
 detected
 or
 not
 protected

If
 detected
 suggests
 past
 exposure
 or
 response
 to
 immuniza1on

If
 not
 detected
 suggests
 no
 level
 of
 protec1on
 or
 immunity
 and
 immuniza1on

should
 be
 looked
 at

Copyrights Dr Andrew Orr 2017 26
Medical
 Tes1ng-­‐Blood
 Work

HIV
 1/2
 Serology

HIV
 Ag/Ab

 Posi1ve
 or
 Nega1ve

Comments

HIV-­‐1/HIV-­‐2
 an1gen/an1body
 assay
 performed
 on
 Abbo[
 Architect

Approximately
 50-­‐90%
 of
 pa1ents
 report
 signs
 and
 symptoms
 sugges1ve
 of

primary
 HIV
 infec1on
 at
 the
 1me
 of
 seroconversion,
 which
 mostly
 occurs
 at

10-­‐14
 days
 aJer
 exposure
 (range
 3
 days
 to
 10
 weeks).
 Onset
 of
 symptoms

oJen
 coincides
 with
 the
 detec1on
 of
 HIV
 an1gen/an1bodies
 although

tes1ng
 can
 be
 nega1ve
 for
 up
 to
 3
 weeks
 aJer
 symptoms
 develop.
 Nega1ve

results
 performed
 less
 than
 12
 weeks
 aJer
 exposure
 should
 be
 repeated
 at

least
 12
 weeks
 aJer
 exposure
 to
 exclude
 transmission

Copyrights Dr Andrew Orr 2017 27
Medical
 Tes1ng-­‐Blood
 Work

Pro-­‐Thrombo=c

 Studies

Lupus
 An1coagulant

 Detected
 or
 not

detected

PT
 (Prothrombin
 Time)

 (10-­‐16
 seconds)

APPT
 (Ac1vated
 Par1al
 Thromboplas1n
 Time)

 (24-­‐40
 seconds)

Factor
 V
 Leidens
 Deficiency

 (1.6-­‐1.8)

Comments

Prothrombin
 Time
 is
 a
 blood
 test
 that
 measures
 how
 long
 it
 takes
 blood
 to
 clot.
 A

prothrombin
 1me
 test
 can
 be
 used
 to
 check
 for
 bleeding
 problems.
 PT
 is
 also
 used

to
 check
 whether
 medicine
 to
 prevent
 blood
 clots
 is
 working

Factor
 V
 Leiden
 thrombophilia
 is
 an
 inherited
 disorder
 of
 blood
 clotng.
 Factor
 V

Leiden
 is
 the
 name
 of
 a
 specific
 gene
 muta1on
 that
 results
 in
 thrombophilia,
 which

is
 an
 increased
 tendency
 to
 form
 abnormal
 blood
 clots
 that
 can
 block
 blood
 vessels.

Results
 >1.9
 are
 normal.
 Heterozygotes
 for
 Factor
 V
 Leiden
 usually
 have
 results
 <1.5.

A
 result
 of
 1.6
 to
 1.8
 may
 be
 associated
 with
 heterozygosity
 for
 Factor
 V
 Leiden.

Copyrights Dr Andrew Orr 2017 28
9
8/06/17
Medical
 Tes1ng-­‐Blood
 Work

Autoan=bodies

An1-­‐nuclear
 Abs
 (ANA)

 Nega1ve
 or
 Posi1ve

 (Titre

 <
 1:80)

Comments

ANA
 in
 SLE
 (Systemic
 Lupus
 Erythematosus)

The
 main
 indica1on
 for
 ANA
 is
 as
 a
 screen
 test
 in
 suspected
 SLE
 where
 it
 will

be
 posi1ve
 in
 95%
 of
 cases.
 A
 nega1ve
 ANA
 makes
 SLE
 unlikely.
 A
 posi1ve

ANA
 requires
 follow–up
 by
 an1–DNA,
 which
 has
 a
 much
 higher
 specificity
 for

SLE,
 and
 ENA
 to
 check
 specificity
 of
 the
 an1body.

Copyrights Dr Andrew Orr 2017 29
Medical
 Tes1ng-­‐Blood
 Work

Autoan=bodies
 (con=nued)

ANA
 in
 other
 autoimmune
 disorders

Rheumatoid
 arthri1s
 30%

Sjogren’s
 syndrome
 60%

Limited
 scleroderma
 (CREST)
 50%

Diffuse
 scleroderma
 (systemic
 sclerosis
 80%

Mixed
 connec1ve
 1ssue
 disease
 (MCTD)
 80%

Polymyosi1s
 30%

Autoimmune
 liver
 disease
 <
 10%

Some
 drugs
 cause
 posi=ve
 ANA
 and
 some=mes
 a
 lupus–like
 illness

The
 clinical
 manifesta1ons
 of
 drug–related
 SLE
 are
 mild
 and
 subside
 within
 six

weeks
 of
 drug
 withdrawal.

Copyrights Dr Andrew Orr 2017 30
Medical
 Tes1ng-­‐Blood
 Work

Cardiolipin
 an=bodies
 (
 aCL,
 ACA
 )

Cardiolipin
 IgG
 Abs

 U/mL

 (<20)

Caridolipin
 IgM
 Abs

 U/mL

 (<20)

Comments

Specimen:
 Serum
 –
 Gel

High
 levels
 of
 the
 IgG
 an1body
 are
 found
 in:

An1phospholipid
 syndrome

SLE

Other
 autoimmune
 disorders

Recurrent
 Pregnancy
 Loss

In
 some
 healthy
 people.

Copyrights Dr Andrew Orr 2017 31
10