3.5.3 Assisted Reproductive Treatments Flashcards
Describe the assisted reproductive technique of IVF and the indications of it.
IVF – in vitro fertilization, stimulate ovulation with hCG → US guided oocyte retrieval → IVF
Indications – tubal or pelvic factor, severe male infertility
What are the characteristics of egg cryopresentation?
What are the characteristics of rFSH stimulation?
What are the characteristics of Clomiphene citrate?
What are the main causes of infertility?
Male factor - 35%
Female - 50% - Tubal/pelvic path - 35%
Anovulation/oligoovulation -15%
What are some possible uterine anomalies?
Bicornuate
Didelphys
Unicornuate
Septate
T-shaped
What are the characteristics of IVF?
Requires careful monitoring
Risk of OHSS
Embryo transfer 5 days after retrieval
Can control number of embryos transferred
What is the risk for multiple gestation with Clomid and rFSH?
Clomid - 7% twins, 0.5% triplets
rFSH - 20% twins and 5% triplets
What are some possible causes of occluded fallopian tubes?
PID - particularily chlamydia
Endometriosis
If patient doesn’t want kiddos and has PCOS what are some treatment options?
OCPs, spironolactone, mirena IUD, provera,
What happens to the rate of fetal aneuploidy by maternal age?
What are teh important characteristics of oligospermia?
How does paternal age relate to fertility?
INcrease in spermatic DNA fragmentation but no increase in aneuploidy
Greater the 40 have greater risk of autism
What is the treatment of endometriosis?
If not wanting kids
Surgical fulguration/excision of endo
Menstrual suppression
If wanting kids - IVF if tubes are blocked, consider suppression prior to cycle w/ GnRH agonist
What is recurrent pregnancy loss?
2 or more sAB (clinical losses)
What is ICSI?
Intracytoplasmic sperm injection
Describe the hormonal evaluation for a female with reproductive issues?
What does HSG give information about?
Uterine cavity, anomalies, tubal patency and presence of hydrosalpinges
What is the most common cause of teratospermia?
Varicocele
What are the characteristics of endometriosis?
What are some of the psychological impacts of infertility?
What are the characteristics of a male semen analysis?
What is the use of Hysteroscopy with laparoscopy?
Gives same information and can be therapeutic.
Can treat endometriosis, fibroids etc
Consider in patients with severe dysmenorrhea
What is the definition of infertility and what is the dependence on age?
Def - inability to conceive after one year
Age dependence - After age of 35 and treatment warrented after 6mo. After 40 many recommend referral to specialist after 3mo.
What are some possible treament options for tubal disease?
IVF
Tuboplasty
Tubal reanastamosis - if history of BTL
What are the characteristics of PCOS?
Complex ovulatory dysfunction involving the hypothalamus, pituitary, ovaries, and other tissues all contributing to an endocrine imbalance associated with hirsutism and infertility
Describe the epidemiology of infertility.
What are some possible causes of azoospermia?
What are the semen analysis parameters?
What are possible causes of motility dysfunction in male sperm?
What is fecundity?
Probability a single cycle will result in live birth
What are some possible causes for low volume of semen?
Obstruction
Absence of vas deferens
Retrograde ejaculation
Androgen deficiency
When would it be a good idea as a physician to refer a couple to a specialist for fertility issues?
What all goes into a female infertility evaluation?
How does age relate to fertility?
Women’s fertility decreases with age
After 34 - 11% infertility
At 40 - 33% infertility
At 45 - 87% infertility
Describe the assisted reproductive technique of controlled ovarian stimulation.
clomiphene and letrozole, monitor follicle growth with US and estradiol level
What are some ways to preserve fertility?
Safe sex practices
Stop smoking
EtOH in moderation
Decrease caffeine intake
Maintain healthy weight
