ART Flashcards
methods of ovulation induction (6)
- Clomiphene citrate (PCOS)
- Aromatase inhibitors (PCOS)
- Gonadotrophins; low dose FSH (hypothalamic/pituitary causes, PCOS)
- Pulsatile GnRH (hypothalamic amenorrhoea)
- Dopamine agonists (hyperprolactinaemia)
- Laparoscopic ovarian drilling
clomiphene citrate MOA
SERM: binds to hypothalamic oestrogen receptors and inhibits -ve feedback
letrozole MOA
aromatase inhibitor: blocks conversion of androstenedione + testosterone to oestrogen
laparoscopic ovarian drilling MOA
destroys ovarian stroma to reduce androgen production
complications of laparoscopic ovarian drilling (2)
adhesions
ovarian failure
induction of ovulation vs superovulation
induction of ovulation: restore physiological single follicle ovulation
superovulation: multiple follicle development for IVF
give gonadotrophins: recombinant FSH (rFSH) or human menopausal gonadotrophins (hMGs)
complications of superovulation (2)
multiple pregnancy
OHSS: ovarian hyperstimulation syndrome (life-threatening condition: fluid build-up → dehydration)
Insulin sensitising/lowering drugs in treatment of PCOS (4)
Metformin
Thiazolidinediones
d-chiro-inositol
Diazoxide
current methods of embryo selection (3)
- morphology
- time-lapse
- PGS
how is embryo transfer performed
embryos aspirated into catheter and inserted into uterus under ultrasound guidance
factors for selection of embryos for transfer (3)
- fragmentation
- apoptotic bodies
- stage of development (4 cells by day 2, blastocyst by day 5
possible causes of fragmentation (4)
- apoptotic bodies
- abnormal cytokinesis and adhesions
- cytoskeleton abnormalities
- membrane abnormalities
indications for intra-uterine insemination (4)
- those who cannot/would find it very difficult to have vaginal intercourse e.g. clinically diagnosed physical disability or psychosexual problem
- those using partner or donor sperm
- those who require sperm washing where man is HIV positive
- those in same-sex relationships
stages in process of IVF (7)
- Pituitary downregulation:
GnRH agonist (2 weeks) → initial surge of LH/FSH, receptor internalisation → “temporary menopause” (→ hot flushes, emotional lability etc.)
OR GnRH antagonist → immediate downregulation (acts more quickly) - Ovarian stimulation: supraphysiological levels of FSH → recruitment of multiple follicles
- Ovulation trigger: hCG injection → maturation of eggs & ovulation (after ~37 hours)
- Egg collection: transvaginal, laparoscopically if not possible
- Fertilisation: intra-cytoplasmic sperm injection (ICSI)
- Embryo culture (for 5 days) and transfer
- Luteal support: need progesterone to maintain endometrium
indications for IVF (4)
- azoospermia
- bilateral tubal occlusion
- 2 years unexplained infertility
- woman must be aged 23-42 years
- > offer up to 3 IVF cycles