65: Clinical Correlation--In Vitro Fertilization

Question 1

Infertility is the inability to conceive within __ months without contraception.

Affects 10-15% of general population.

10-20% of couples have unexplained infertility = when you ___ find a specific cause for infertility on workup.

Answer 1

Infertility is the inability to conceive within 12 months without contraception.

Affects 10-15% of general population.

10-20% of couples have unexplained infertility = when you cannot find a specific cause for infertility on workup.

Question 2

Fertility can begin to decline as early as age __. Significant decline is seen @ age __ & beyond. Spontaneous pregnancy is rare after age __.

Answer 2

Fertility can begin to decline as early as age 27. Significant decline is seen @ age 35 & beyond. Spontaneous pregnancy is rare after age 45.

Question 3

Treatment of infertility =

Ovulation ____

_____ tract surgery

_____ insemination

_____ reproduction

Answer 3

Treatment of infertility =

Ovulation induction

Reproductive tract surgery

Intrauterine insemination

Assisted reproduction

Question 4

We want to bombard ovary with gonado____ in in-vitro fertilization.

Answer 4

We want to bombard ovary with gonadotropins in in-vitro fertilization.

Question 5

Arcuate nucleus contains ____ neurons

GnRH is a _____

Arcuate nucleus makes pulses of ____—this gives normacy to the pituitary ovarian axis. Stimulates gonadotrophs, FSH & LH.

LH stimulates _____ cells to produce androstendione and ________.

FSH works on ______ converting testoststerone to estradiol.

Answer 5

Arcuate nucleus contains GnRH neurons

GnRH is a decapeptide

Arcuate nucleus makes pulses of GnRH—this gives normacy to the pituitary ovarian axis. Stimulates gonadotrophs, FSH & LH.

LH stimulates theca cells to produce androstendione and testososterone

FSH works on aromatase converting testoststerone to estradiol. FSH acts upon granulosa cells.

Question 6

To _____regulate GNRH you can either use a GNRH agonist or antagonist.

With GNRH _____, the receptor becomes internalized due to very high GNRH levels. Cetrorelix.

GNRH ____ is a competitive inhibitor for the GNRH receptor & blocks FSH & LH production. Leuprolide.

Answer 6

To downregulate GNRH you can either use a GNRH agonist or antagonist.

With GNRH agonists, the receptor becomes internalized due to very high GNRH levels, & takes longer than GNRH antagonist to down regulate GNRH. Cetrorelix.

GNRH antagonist is a competitive inhibitor for the GNRH receptor & blocks FSH & LH production. Leuprolide.

Question 7

In In-vitro-fertilization they mimic LH surge by giving ____. _____ has a 6x longer half life too. It has a sialyc acid residue that makes it last longer so can be used _____ instead of using LH many times.

Answer 7

In In-vitro-fertilization they mimic LH surge by giving HcG. HCG has a 6x longer half life too. It has a sialyc acid residue that makes it last longer so can be used once instead of using LH many times.

Question 8

We transfer the ______ because it is a tougher embryo than 4 or 8 cell embryo.

Answer 8

We transfer the blastocyst because it is a tougher embryo than 4 or 8 cell embryo.

Question 9

2 _____ stage = means successful in vitro fertilization.

Answer 9

2 pronucleus stage = means successful in vitro fertilization.

A pronucleus (plural: pronuclei) is the nucleus of a sperm or an egg cell during the process of fertilization, after the sperm enters the ovum, but before they fuse. Sperm and egg cells are haploid, meaning they carry half the number of chromosomes. The male and female pronuclei don’t fuse, although their genetic material do. Instead, their membranes dissolve, leaving no barriers between the male and female chromosomes. Their chromosomes can then combine and become part of a single diploid nucleus in the resulting embryo, containing a full set of chromosomes.

The appearance of two pronuclei is the first sign of successful fertilization as observed during in vitro fertilisation, and is usually observed 18 hours after insemination or ICSI. The zygote is then termed a two-pronuclear zygote (2PN).

Question 10

You transfer more embryos to the mother as age of the mother _____.

Answer 10

You transfer more embryos to the mother as age of the mother increases.

There are also options for excess embryos like adoption, freezing, donation, discard.

Question 11

Gestational surrogacy medical indications:

• ____ absent
• Anatomically ____ uterus
• Medical ______ to pregnancy
• ______ pregnancy wastage & loss
• Repeated IVF _____ with good embryos

Answer 11

Gestational surrogacy medical indications:

• Uterus absent
• Anatomically abnormal uterus
• Medical contraindication to pregnancy
• Recurrent pregnancy wastage & loss
• Repeated IVF faliures with good embryos