ART Flashcards
Indications for ART
Tubal damange: severe disease or failure to conceive w/in 6-12 months of tubal surgery
Endo- mod or severe disease when conception has not occurred within 12 months of ablative surgery
Male factor
PCOS - failing OI treatment or clomiphene resistant
Unexplained infertility
Other: coital dysfunction,j gamete donation, PIGD
Prognostic factors
Age 23-29
Ovarian reserve AMH >5.4, FSH <8.9
Past reproductive history
IUI indications
Unexplained infertility
Endometriosis (minimal, mild)
Mild male factor
Cervical factor infertility
Physical or psychological disability preventing penetrative intercourse
Conditions the require consideration to method of conception (sperm washing in HIV)
As part of donor insemination
Indications for IVF
Tubal disease Male factor infertility Endometriosis (other treatments unsuccessful) Unexplained infertility Ovulation disorders Egg donation of POF ICSI indication Embryo donation or surrogacy PGS or PFD indicated Fertility preservation for cancer patients and social reasons
Indications for ICSI
Severe impairment of sperm quality or number
Obstructive or non—obstructive a paper is
Previous IVF with failed or poor fertilization
Principal steps of IVF treatment cycle
Pre-treatment evaluation
Controlled ovarian stimulation using gonadotrophins and GnRH analogues (agonists or antagonists)
Monitoring follicular development using TV USS with or without serum estradiol levels
Oocyte maturation using hcg
Egg collection and sperm production or sperm recovery
Fertilization and subsequent embryo culture
Embryo transfer and cryo of extras
Luteal support through progesterone administration
Measures to predict likely ovarian response to gonadotrophin stimulation in IVF
FSH >8.9 for low response
Total AFC < or = 4 for a low response, >16 for a high response
AMH < or = 5.4 for a low response and >25 for a high response
Factors to consider in IVF
Age Ovarian reserve Pelvic pathology Hydrosalpinx Leiomyoma Endometrial polyps Endometriosis and endometrioma Prev preg history Previous unsuccessful IVF (not relevant until 4th cycle) Obesity Smoking
GnRH agonists (buserelin, naferelin)
Competitively blocks the action of GnRH, preventing the release of LH and FSH from the anterior pituitary
GnRH antagonists (certitude)
Competitively and reversibly bind to GnRH receptors in the pituitary gland, blocking the release of LH and FSH from the pituitary, thus preventing ovulation; no flare effect
Gonaotrophins
Synthetic and recombinant preparations
FSH with LH or without
Long protocol
Utilizes GnRH agonist for 2-3 weeks to desensitize the pituitary
Down regulation confirmed with thin endometrium and low oestrogen
Ovarian stimulation with continued use of GnRH agonist
Hcg administered
Oocyte collection 34-37 hours after final hcg administration
Short protocol
No downregulation stage to desensitize the pituitary
Hcg or rFSH administered in the early menstraul phase (day 2 or 3)
GnRH antagonists are administered from day5 or day 6 of stimulation and used with gonadotrophins (prevents premature leutenisation prior to follicle maturity being reached)
HCG or recombinant LH
Oocyte collection
Monitoring follicular development
ET and folllicular response check on 6th -to 8th day of tax cycle
Follicles grow by 2mm per day with steady increase in estradiol
When 3 or more follicles are > 17-18mm in diameter, give hcg to induce final egg maturation
Obstetric risks with IVF
Preterm birth LBW Neurodevelopmental deficits Congenital anomalies Perinatal mortality
Primary infertility
Couples who have not become pregnant after at least one year of having sex without using birth control methods
Fecundity by year
0 20-35%
1 10%
2 5%
3 3%
Risk factors for infertility
Age Obesity PID Endo Male infertility Ovulatory dysfunction Underweight Lack of relationship
Tubal infertility after PID
10-20%
Most single exposure chlamydia does not result in tubal disease
Subfertility w endo percentage
20-50%
10-20% of women with infertility have endo
