An overview of assisted reproductive technology procedures 2018 TOG Flashcards
In 2015, what was the birth rate per embryo transferred?
21.5%
In 2015, what proportion of babies were as a result of IVF?
2.1%
In ovary, what is the impact of LH and FSH?
LH - theca cells - androgens (from cholesterol)
FSH - granulose cells - converts androgen to oestrogen - growth & proliferation of endometrium
In testes, effect of LH and FSH?
LH - Leydig cells - testosterone
FSH - Sertoli cells - increase spermatogonial number/matuatino into spermatocytes
In female where is progesterone produced? What is its function?
From corpus luteum
Endometrial decidualisation
Steps in assisted reproduction cycle>
- Pretreatment adjuvant strategies (W)
- Pituitary downregulation (W)
- Controlled ovarian hyperstimulation (W)
- Final follicular maturation trigger (W)
- Oocyte (W) and sperm retrieval (M)
- Embryology process (IVF/ICSI)
- Monitoring of embryos
- Intrauterine embryo transfer (W)
- Luteal phase support (W)
For which patients does NICE recommended hormonal pre-treatment?
Those undergoing GnRH antagonist down regulation to secedule ART treatment
For which patient does pretreatment with GnRH agonist for 3-6 months increase odd of clinical pregnancy? By how much?
Endometriosis associated infertility
4 fold increase
Which conditions need pretreatment with surgery?
Hydrosalpinx - salpingectomy
Uterine septum - hysteroscopic septoplasty
Intramural fibroid - distorting cavity or >50mm - myomectomy
Submucous fibroid - myomecotmy
Polyp - polypectomy
Intrauterine adhesion - adhesionlysis
Superficial Endometritis - Lap
Deep infilitrating - Sx relief only
Endometrioma - only if >50mm
2 main class of drug used for pituitary down regulation?
GnRH agonist (-relin) - inital flare then down regulation
GnRH antagonist
Graph showing different pituitary down regulation protocols
Its there a difference in birth rate with women wit stomal ovarian reserve between GnRH agonist/antagonsit. Difference in rate of OHSS
No difference in birth rate
Higher is of OHSS with agonist (do not use if predicted over-responder)
Which gonadotrophins can be used for controlled ovarian stimulation?
Human menopausal gonadotrophin
Recombinant gonadotrophin
Which markers can be used to produced ovarian response to controlled ovarian stimulation
AMH
AFC
Early follicular stage FSH
If expected over response?
Minimise OHSS risk
GnRH antagonist + minimal FSH stimulation
If expected normal response?
Maximise succes rate
GnRH agonist + standard Tx
If expected under responder?
Minimise Tx burden
GnRH anttagnoist + Max FSH stimulation
How is controlled ovarian stimulation monitored?
TVUS - unclear how often to perform. Most pre treatment, 1 week after stimulation and after maturation trigger
How is final follicular maturation trigger achiecbed?
Pituitary downregualtioned stopped.
Drug given to mimic LH surgery - urinary hCG/ recombinant hCG or LH
If high risk of OHSS what can be given as trigger
GnRH agonist
How is oocyte retrival performed
TVUS with conscious sedations
To obtain sperm from masturbation, how long should abstain from sexual activity before?
2-5 days
What surgical procedures can be performed to obtain sperm are 1st line if obstructive azoospermia?
Percutaneous epididymal sperm aspiration
Microsurgical epididymal sperm aspiration
What surgical procedures can be performed to obtain sperm are 1st line if non-obstructive azoospermia?
Testicular sperm extraction
Microsurgical testicular sperm extraction
Which procedures can be performed by local anaesthetic
Percutaneous epididymal sperm aspiration
Testicular sperm extraction
All other GA
How long after oocyte retrieval are sperm mixed with oocyte, how many sperm?
4-6 hours
25000-50000 soerm
Indications for ICSI
Severe male factor infertility
Surgically retrieved sperm for azoospermia
Previous failed or poor fertilisation
Fertilisation of cryopreserved oocytes
How are embryos evaluated
blastomere number, evenness and fragmentation using light microscopy
When can the embryo be transferred?
Day 2-3 (2-8 cells)
Day 5-7 (64 cell/blastocyst state)
Most common luteal phase support?
Progesterone (vaginal)
When should pregnancy test be perfromed
2 weeks after oocyte retrival
When is 1st scan performed?
Undertaken at 7 weeks from +ve hCG (unless previous ectopic and should be offered earlier)
