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4 RED > 10 Assisted Fertilisation Techniques > Flashcards

10 Assisted Fertilisation Techniques Flashcards

1
Q

What is observed at ovulation?

A

LH (FSH) surge

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2
Q

What does the LH surge do?

A

sitmulates oocyte maturation

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3
Q

What hormone does the corpus luteum mainly produce?

A

progesterone

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4
Q

How long is the luteal phase?

A

14 days

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5
Q

What does the luteal phase cause?

A

secretory changes to the endometrium

if there is fertilisation it can actually implant

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6
Q

What happens after 14 days of luteal phase?

A

progesterone levels reduce

endomterial breakdown and menstruation

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7
Q

The fall in oestrogen and progesterone allows for what?

A

increase in FSH from anterior pituitary gland

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8
Q

What does FSH do?

A

stimulates follicular growth

one is dominant (Graafian follicle)

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9
Q

What does the Graafian follicle produce?

A

high levels of estradiol and progesterone so there is positive feedback (LH and FSH surge)

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10
Q

At about what day does the embryo reach the endometrial cavity as a blastocyst?

A

day 5

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11
Q

At what day does the blastocyst hatch and attach to the endometrium?

A

day 6

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12
Q

What is IUI?

A

intrauterine insemination

male partner produces sperm
put in catheter loaded wth syringe
put in uterine cavity and inject

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13
Q

how do you time IUI correctly?

A

scan
urinary kits to see LH surge
inject sperm around day of ovulation

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14
Q

what are the NICE indications for IUI?

A

inability to have sexual intercourse
need sperm washing (HIV)
same sex coupls

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15
Q

What are the steps to IUI?

A

with or without ovarian stimulation
with or without hCG triggering
sprm prep and insemination
pregnancy test 2 weeks later

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16
Q

What might you use to control IUI a bit more?

A

use FSH / clomiphene to aim for 3 follicles to develop in ovaries

trigger LH surge using hCG trigger

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17
Q

Why use hCG and not LH?

A

hCG is much cheaper than LH

18
Q

What are the problems with IUI?

A

low success rate (10-20%)
multiple pregnancy (10%)
£500 each!
invasive

19
Q

What are the 9 indications for IVF?

A 
tubal disease
anovulatory
unexplained
male factor (with ISCI)
endometriosis
other fialed Tx
No eggs
no uterus
PGD
20
Q

What are the 4 key steps to IVF?

A

counselling and consenting
pituitary suppression
ovarian stimulation
hCG triggering

21
Q

What is the method and aim of pituitary suppression in IVF

A

GnRHa (antagonist)
prevents premature LH surge
to know when the woman will be ovulating

22
Q

What is the method and aim of ovarian stimulation in IVF?

A

HMG, rFSH

multi-follicular development

23
Q

What is the method and aim of hCG triggering in IVF?

A

cf LH surge

final egg maturation

24
Q

When do you retrieve the egg in iVF?

A

36 hours after hCG trigger

25
Q

What is used to guide the needle in IVF?

A

transvaginal US

26
Q

What does the needle in IVF do?

A

inserted into follicles and fluid aspirated

fluid studied to see if you can yoink an oocyte from it

27
Q

How might you tell an image of fertilisation is straight IVF?

A

there are millions of sperm surrounding it

28
Q

When is ICSI used?

A

when there is a male problem

29
Q

How do you decide which ocyte to use?

A

embryologist has to fertilise them and watch them grow for a lil bit

30
Q

Why do you give luteal support in IVF?

A

to mimic corpus luteum

give progesterone

31
Q

What is ICSI?

A

intracytoplasmic sperm injection

32
Q

When is ICSI used?

A

sperm dysfunction/failure of fertilisation in IVF

problems with sperm concentration, morphology, or motility

33
Q

Why wouldn’t you always use ICSI instead of IVF?

A

no demonstratable benefit to using ICSI if all sperm are normal

34
Q

What hurdles does blastocyst formation have to pass?

A

switching on of embryonic genome

past stages of totipotency to first differentiation

35
Q

What would you use to look at the cervix in embryo transfer?

A

speculum

36
Q

What problems are there with IVF?

A 
multiple pregnancies
OHSS
oocyte collection rissk
long-term maternal risks
£4000
invasive
37
Q

What is OHSS?

A

ovarian hyperstimulation syndrome

ovaries produce vasoactive substances causing pulmonary oedema or ascites

38
Q

Why might you use a donated oocyte?

A 
ovarian failure
premature menopause
turner's syndrome
surgical loss of ovaries
female partner carrier of inheritable disease
39
Q

Why might you use donated sperm?

A

azoospermia (testicular failure, obstructive CF)
Klinefelter’s syndrome
Microdeletions of Y
Male partner carrier of inheritable disease

40
Q

What is the HFEA?

A

Human Fertilisatoin and Embryology Authority

41
Q

How might you perform pre-implantation genetic diagnosis?

A

remove one or 2 cells from early embryo for genetic analysis

42
Q

What are you looking out for in pre-implantation genetic diagnostics?

A

CF
Huntington’s disease
Sickle cell disease
muscular dystrophies

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