ART & INFERTILITY Flashcards
What Is The Pregnancy Rate After COH/IUI For Women With An FSH >10IU/L
- 0%
- 2%
- 4%
- 6%
- 8%
- 10%
1.
Which Blood Type has the Highest Chance of success
- A
- B
- AB
- O
2.
BCL2 gene defest
lack of sperm BCL2 lead to aportive appoptosis
cryptochidism
undescended testis
Caesarean Section and subsequent Fertility
there is NO association
A Mother’s diet before she conceives has a permanent effect on her offspring’s genetics as shown by the increased presence of epigenetic markers during the year
true
Abnormal PLCZ1 Function Is Associated With Reduced, Poor Or Failed Fertilization In Normospermic Semen Profiles.
true
Abnormal PLCZ1 Function Are Associated With…
Reduced robust [Ca2+]i oscillations upon injection into eggs
Oocyte activation
PLCZ1 function could be the underlying cause of failed fertilization
PLCZ1 function should be assessed in cycles with low or failed fertilization.
Delaying the oocyte maturation trigger in IVF/ICSI Increases the Number of Mature Oocytes
true
Delaying the Oocyte Maturation Trigger In IVF/ICSI may be of benefit in:
Women with a low progesterone
In patient with low basal progesterone, delaying HCG by one day increased the number of MII by….
2.4
The Percentage of normal semen profiles is lower in HBsAg-seropositive male partners
true
The Percentage of Good Quality Embryos was Lower in Female Partners being HBsAg-Seropositive
true
The fertilization rates in groups with male or female partners being HBsAg-seropositive was significantly lower
true
but no different in Pregnancy Rates in male or female HBsAg seropositive
Live Birth Rates are Compromised when the Serum Progesterone at HCG was:
- =<0.5 ng/ml
- 0.50–0.75 ng/ml
- 0.75–1.00 ng/ml
- 1.00–1.25 ng/ml
- 1.25–1.50 ng/ml
- >1.50 ng/ml
1, 6
Uterine Peristalsis before embryo transfer affects the chance of clinical pregnancy in:
- Fresh Embryo Transfers
- Unstimulated Frozen Embryo Transfers
- Stimulated Frozen Embryo Transfers
all correct
Uterine peristalsis:
wavy movements(contractions)of sub endometrial myometrium or endometrium.
which stimulation regimen delivers a better outcome (babies/cycle) for poor responders (<4 eggs in previous cycle).
- Long down regulation agonist stimulation
- Antagonist stimulation
1.
reference????
What proportion of cases expected to achieve fertilization in a second ICSI attempt after total failed fertilization (TFF)
- 30%
- 40%
- 50%
- 60%
- 70%
- 80%
4.
reference????
In a recent study a second ICSI attempt after total failed fertilization (TFF), what was the most significant difference associated with success?
- Recover more oocytes
- Delay insemination
- Delay hCG Trigger
- Employ more than one scientist for the injection.
- nothing, just repeat the treatment plan a second time.
1.
Donors younger than 20 years of age have a lower live birth rate than donors aged 20-40 years of age.
true but not significant low
Which markers predict ovarian response in normal responders
- AMH
- Antral Follicle Count
- Basal FSH
- Age
The use of a portable CO2 incubator to transport oocytes (donor) or embryos does not appear to be detrimental
true
Letrozole is superior to Clomiphene in ovulation rates and pregnancy for women with Polycystic Ovary Syndrome PCO
TRUE
In culture mediaThe Pyruvate/Lactate Ratio has significant impact on the offspring birth weight
true
KIsspeptin-54 can induce normal ovulation and pregnancy in antagonist managed COH IVF Cycles
true
A Human Oocyte-Derived Sperm Chemoattractant is a Hydrophilic Molecule Associated with a Carrier Protein
False
Oocyte-Derived Sperm Chemoattractant ►Hydrophobic
molecule
The proportion of men with normal semen profiles after cancer treatment was:
- 75%
- 48%
- 39%
- 25%
- 9%
2
…………..gene is Critical for directing human stem cells to become PGCs
SOX17
In women with normal ovaries who have regular menstrual cycles, approximately how many days does it take for a primary follicle to develop to a mature preovulatory follicle?
3 months
primary follicle-MII
The testis is enclosed in a fibrous outer capsule called the……
Tunica albuginea
The Tunica Albuginea can contract to help move sperm from the testis to the epididymis
true
the main role of the Leydig cells is to produce….
Androgens
the main function of the seminiferous tubules is to make spermatozoa
true
The testis is relatively Avascular
true
Avascular: (lack of blood vessels)
During Pregnancy, the Uterus is termed…..
Gravid
A Multiple Pregnancy is called…………..
a Multiparous Pregnancy
During foetal pregnancy, the primoidal germ cells PGCs are first seem in……….
yolk sac
The period of rapid cell division of the primordial germ cells stops prior to…………
parturition (labor)
The maximium number of oogonia are fixed prior to birth
true
The Primordial Germ Cells That Undergo a Period of Cell Division are Called….
Oogonia
Remember :
Primordial Germ Cells That Undergo a Period of Cell Division ►Oogonia
Oogonia entering the first meiotic division are called primary oocytes.
The goal of ovarian stimulation is to induce ongoing development of……..
multiple dominant follicles
Clomiphene is used to induce mono-ovulation in anovulatory women
true
Clomiphene Citrate Is an Anti-Oestrogen
TRUE
Hot Flushes are a side effect of using Clomiphene Citrate
true
used to induce ovulation in PCO women….
- Clomiphene Citrate
- Letrozole
- Metformin
3.
Letrozole NOT used in ovulation for PCO
clomiphene and metformin used together
Earle`S Balanced Salt Solution was used early in Embryo Culture
true
Early Cleavage is controlled by….
- paternal RNA
- maternal RNA
- Embryonic genome
2.
Remember:
Early Cleavage is controlled by maternal RNA
Blastocyst Growth is controlled by the Embryo Genomic Regulation.
Pyruvate is Preferred in the ……….
2pn and early cleavage
The Early Embryo is Sensitive to Glucose Concentrations
true
The Concentration of Glucose in Tubal Fluid is…..
~0.5mM
Low semen Volume may Indicate………
Epididymal Obstruction
Reddish brown colour of semen ejaculate may indicate…
Erythrocytes or inflammation
A Normal Sperm is ………….in Length
4.0 - 5.5 Um
The ability of an embryo to regulate its metabolism is directly related to its ability to implant and form a viable pregnancy
true
A rapid rise in ATPase activity occurs at:
- 4-8 cell stage
- early compaction
- morula stage
- early blastocyst stage
- Expanding stage
- Fully expanded stage
- Hatching
5.
The main consumers of ATP in the embryo are:
- Na+, K+ ATP sodium pump
- Protein synthesis
- DNA Replication
- Cell membrane synthesis
1.
The Na+, K+ ATPase Pump Exchanges
- One Na+ out of and one K+ in to a cell
- Two Na+ out of and one K+ in to a cell
- Thee Na+ out of and one K+ in to a cell
- Three Na+ out of and two K+ in to a cell
- Four Na+ out of and two K+ in to a cell
- Five Na+ out of and four K+ in to a cell
4,
Na+, K+ ATPase Pump Exchanges ⇔
3 Na+ (« out )⇔ 2 K+ (in»)
The Na+/K+ ATPase is Located……………
Basolateral region of the trophectoderm
The human Na+/K+ ATPase Pump is present in the morula but upregulated during expansion by:
- 2.3 fold
- 3.3-fold
- 4.3 fold
- 5.3 fold
2.
During blastocoel expansion, the Na+/K+ ATPase Pump Consumes
- 20% of ATP
- 30% of ATP
- 40% of ATP
- 50% of ATP
- 60% of ATP
5.
Fully Expanded Blastocyst, The Na+/K+ ATPase Pump, Activity
- Continues at the same rate
- Continues but at a significantly lower rate
- Ceases
2.
After fully Expanded Blastocyst, The Na+/K+ ATPase Pump, Activity Continues but at a significantly lower rate.
Remember:
During Expansion, the blastocyst appears to consume the major proportion of generated ATP
What are the three main stages of gestational development?
Early development
Embryonic period
Fetal period
What 5 things comprise the period of early development?
Fertilization►, Implantation►, Formation of trilaminar embryo,► Placental formation, ►Deination of body axes
What is the approximate time period of Early Development?
0-2 weeks
How sensitive to teratogenesis is the zygote during Early Development?
Not usually sensitive
What is the approximate time period of the Embryonic Period?
3-8 weeks
How sensitive to teratogenesis is the Embryo?
The embryonic period is the period of greatest sensitivity throughout the pregnancy
What is the approximate time period of the Fetal Period?
9-38 weeks
How sensitive to teratogenesis (in general) is the Fetus?
Initially more sensitive
but
sensitivity decreases as the fetal period progresses
How sensitive to teratogenesis (in general) is the Fetus?
Initially more sensitive, but sensitivity decreases as the fetal period progresses
What is the general morphology of the embryo at the beginning of the embryonic period?
Flat disc, 2 cell layers thick
What 6 structures are still highly vulnerable to teratogenesis during the Fetal period?
Brain, Eyes, Ears, Palate, Teeth, External Genitalia
What structure designates the midline of the embryo during development?
Notochord
What is a somatotopy and why is it significant?
It is a “body map” - shows how gene expression differs by region
What are the products of one round of meiosis in males and in females?
Males - 4 spermatids;
females - 1 ovum, 3 polar bodies
(note: technically only 2 are formed, 3rd formed upon fertilization)
Where is the origin of the primordial germ cells, and where to they migrate?
Epiblast -> Gut -> Genital Ridge
What are the respective male and female gametic supportive cells?
Sertoli cells (male)
follicular cells (female)
_______ cells secrete _________ (hormone) which “stimulate” primordial germ cells at puberty in males
Leydig, testosterone
During which two cellular gametogenic stages does meiosis occur in males?
Primary spermatocyte ⇒ secondary spermatocytes
and
secondary spermatocyte ► spermatid
What is required for sperm to activate, and where does this occur?
Capacitation, which occurs in the female reproductive tract
Spermiogenesis (the conversion of spermatids into mature sperm) is characterized by:
Nuclear condensation,
Loss of cytoplasm,
Formation of an acrosome,
Neck and tail formation
By week ___ of female fetal development, a population of ______ enter the first meiotic phase and become dormant until puberty
By week _12__ of female fetal development,
a population of __Oogonia enter the first meiotic phase and become dormant until puberty
What comprises the primordial follicle?
Capsule of squamous cells and follicle
What comprises the primary follicle?
Capsule of cuboidal cells and follicle
What do follicular cells secrete to prevent any further progression of the cell cycle?
follicular cells secrete OMI (Oocyte maturation inhibitor)
to► prevent any further progression of the cell cycle.
Identify the types of follicles shown
Primordial, Primary, Graafian
Ovulation is preceded (just before day 14) by a sudden large spike in what two gonadotropins?
LH & FSH
What glycoprotein coat is secreted by the follicle cells and oocyte together?
Zona pellucida
What hormone secreted by what tissue prevents the degeneration of the corpus luteum?
HCG (Chorionic gonadotropin), Secreted by Syncytio-trophoblast until the formation of Placenta
Prader-Willi syndrome
is a syndrome characterized by hypotonia, and is thought to be caused by a microdeletion on paternal chromosome 15 ► result in ( Paternal imprinting defect)
Angelman syndrome
A syndrome characterized by:
lack of speech, weakness in all four extremities, and uncontrollable bouts of laughter, and is thought to be caused by≈
a microdeletion on maternal chromosome 15
Note:(if paternal chr 15 deletion ►Prader-Willi syndrome)
Turner syndrome
XO; Is syndrome characterized by short webbed neck, cubitus valgus, and lymphedema?
Klinefelter’s syndrome
A Syndrome characterized male genetically by a 47, XXY genotype?
What is the process of a sperm fertilizing a secondary oocyte, starting with the first ovum barrier, ending with the final meiotic division?
Sperm penetrates corona radiate► Sperm binds to zona pellucida► Plasma membranes of sperm and oocyte fuse► Oocyte releases lysosomal enzymes, inducing the zona reaction (causes binding sites on the zona pellucida to change)► Both replicate their DNA► Final polar body released by meiotic division
What is the physical boundary for the secondary oocyte/zygote until blastocyst formation?
ZP
Most contraceptive pills are either ________________, or an analogue thereof.
P
Stone baby
A lithopedion or stone baby, is a rare phenomenon which occurs most commonly when a fetus dies during an abdominal pregnancy,
Stone baby: calcified embryo. Pelvic/abdominal CT scan most likely to reveal it
Define placenta previa
Implantation occurs at the cervix
Define placental accreta
Placenta penetrates too deeply (syncytiotrophoblast invasion)
Define placental abruption
Separation of placenta from the endometrium
What are the two layers formed within the embryoblast, and their defining features?
Epiblast: outside layer, high columnar cells adjacent to amniotic cavity;
Hypoblast: inside layer, small cuboidal cells adjacent to blastocyst cavity
What are the two layers of the trophoblast, and their defining features?
Cytotrophoblast (maintains cellularity) and Syncytiotrophoblast.
(lose individual cellularity, becomes a multinucleated cell)
What 2 cavities are formed in the second week of development?
Amnion and yolk sac
What two layers does the extraembryonic mesoderm split into?
Somatopleure and Splanchnopleure
What layer within the embryoblast forms the amniotic cavity?
Epiblast
What is polyhydramnios, and what kind of developmental problems might it indicate?
Too much amniotic fluid > 2L,
may indicate⇒ problem with Gastrointestinal GI system
What is oligohydramnios? What kind of developmental problems might it indicate? Result in?
Low volume of amniotic fluid <0.5L. May indicate problem with urinary system. May result in poor limb development
What large cavity surrounds the embryoblast and fills the trophoblast?
Chorionic cavity
What structure is indicated in day 13
formation of Exraembryonic membranes
notice the formation of Somatopleuric layer and
extraembryonic mesoderm.
and Splanchnopleuric layer cover the Yolk sac
What is the function of the syncytiotrophoblast?
Invade endometrium,►Erode maternal tissue,► Secrete hCG
What is the name of the cavities that form in the syncytiotrophoblast? What are they there for?
Trophoblastic lacunae
which accept blood being “dumped” in from maternal sinusoids
What are primary villi?
Cellular columns originating from the embryo, penetrating into and surrounded by the syncytium
At what point do primary stem villi become secondary stem villi?
Day 16, when the extraembryonic mesoderm extends into them
At what point do secondary stem villi become tertiary stem villi?
End of week 3, when they have formed blood vessels that connect to forming fetal blood vessels
Which parent’s genome contributes more to the formation of the trophoblast?
paternal genomes (Father)
Genomic Imprinting
Differential modification and/or expression of homologous alleles or chromosome regions depending upon the parent from whom it was derived
Hydatidiform mole
Hydatidiform mole is a rare complication of pregnancy characterized by the abnormal growth of trophoblasts (paternal imprinting origin)
Caused by fertilization of an empty oocyte. Zygote begins to develop, but never forms embryoblast (just trophoblast)
A patient presents with nausea and vaginal bleeding in her first trimester of pregnancy.
⇒Physical examination reveals a uterus that is enlarged for her gestational age►, and bloodwork shows► abnormally high levels of hCG.
What does the primitive pit indicate?
Midline of body Forms on cephalic end
What morphologically characterizes the prechordal/cloacal plate, and what do these sites indicate?
Ectoderm and endoderm in direct contact with each other, no mesoderm. These sites indicate the location of development of the mouth and the anus, respectively
What are the 4 important characteristics of the notochord for development?
Anatomic midline,
CNS development,
Vertebral column development
, Nucleus pulposis formation
What disorder causes an organ or organs to be formed outside the body? What development error causes this?
Gastroschisis - caused by anterior wall defect (failure to completely enclose splanchnic/somatic mesoderm)
Define situs inversus
One or more organs on the opposite site of the body from “normal”
Holoprosencephaly
Holoprosencephaly (HPE) is the failure of the prosencephalon, or forebrain, to develop normally.► Failure in producing proper midline for facial structure.
(can be mild, moderate, or severe)
result from mutations of sonic hedgehog (shh) gene
In cases of holoprosencephaly, defects of facial structures are typically secondary to defects of the:
- A. Pharynx
- B. Oral cavity
- C. Forebrain
- D. Eyes
- E. Hindbrain
c.
Cleft lip results from lack of fusion of the:
A. Nasomedial and nasolateral processes
B. Nasomedial and maxillary processes
C. Nasolateral and maxillary processes
D. Nasolateral and mandibular processes
E. Nasomedial and mandibular processes
B.
NOTE:
The medial nasal process (nasomedial) on the inner side of each nasal pit merge into the intermaxillary segment and form the upper lip, crest, and tip of the nose. The medial nasal processes merge with the maxillary prominences. The lateral nasal process from each side merge to form the alae of the nose.
The facial nerve (cranial nerve VII) supplies muscles derived from which pharyngeal arch?
A. First
B. Second
C. Third
D. Fourth
E. Sixth
B.
. Meckel’s cartilage is a prominent structure in the early formation of the:
A. Upper jaw
B. Hard palate
C. Nasal septum
D. Soft palate
E. Lower jaw
E.
Meckel’s cartilage is a piece of cartilage from which the mandibles (lower jaws)
A woman who averaged three mixed drinks a day during pregnancy gave birth to an infant who was mildly retarded and who had a small notch in an upturned upper lip and a reduced olfactory sensitivity. What is the basis for this constellation of defects?
These defects could be a manifestation of fetal alcohol syndrome.
They could represent a mild form of holoprosencephaly, which in this case would relate to defective formation of the forebrain (prosencephalon).
The defects in olfaction and in the structure of the upper lip could be secondary effects of a primary defect in early formation of the prosencephalon
What is sirenomelia, and what is it caused by?
Called “mermaid syndrome”, caudal dysgenesis - not enough mesoderm to make lower extremeties. Caused by oligohydramnios
Sirenomelia, which is also known as mermaid syndrome, is an extremely rare congenital developmental disorder characterized by anomalies of the lower spine and the lower limbs.
Sacrococcygeal teratoma
Sacrococcygeal teratoma (SCT) is a tumor that develops before birth and grows from a baby’s coccyx — more commonly known as the tailbone. It is the most common tumor found in newborns, occurring in 1 out of every 35,000 to 40,000 live births.
What is the significance of the neural ectoderm?
Signaled by the notochord to become the neural plate; forms the CNS
When do the cranial and caudal neuropores close?
Cranial: day 24-25;
caudal: day 26-27
What 3 major derivatives form from neural crest cells?
Parasympathetic ganglia of CN 3, 7, 9, 10
Sensory ganglia of CN 5, 7, 8, 9, 10
Autonomic and dorsal root ganglia
Surface ectoderm will give rise to what 5 major structures?
EpidermisAnterior pituitaryTooth enamelInternal earPhakic lens
What are the 3 “rod and sheet-like” mesodermal derivates and what systems will they form?
Paraxial mesoderm -
axial skeleton, skeletal muscle, part of the dermisInediate mesoderm -
urinary and part of genital systemLateral plate mesoderm -
gives rise to splanchnic and somatic mesoderm
Somites
Somites
(“Bricks” of mesoderm),
later form⇒ skeletal muscle
external genitalia can be distinguished as male or female at week?
week 9
primary ovarian follicles formed and testes descend during week ……..?
Weeks 17-20
surfactant beginning to be secreted in the lungs?
Weeks 21-25
Lungs are capable of breathing CNS capable of controlling breathing and body temperature Hematopoeisis shifts to bone marrow at ……week
(week 28)
“finishing period
Weeks 35-38; final preparations of tissues important to transition to the outside world
What are the major sites of embryonic hematopoeisis during what time periods?
Weeks 1-12: yolk sac
Weeks 12-30: liver
Weeks 12-24: spleen
Week 30: bone marrow
What embryonic layers must be penetrated in order to perform an amniocentesis?
Chorion (syncytiotrophoblast, cytotrophoblast, extraembryonic mesoderm) and amniotic sac
An amniocentesis is performed in the third trimester of pregnancy, revealing elevated levels of alpha fetoprotein. What disorder might be the cause? Why? What causes this disorder?
Spina bifida - incomplete posterior wall closure (neural tube defect) would result in leakage of alpha fetoprotein into the amnion
All but the first ___ somitomeres give rise to ___________. Regardless of this, all somitomeres eventually give rise to _________ tissue.
All but the first 7 somitomeres give rise to somites Regardless of this,
all somitomeres eventually give rise to muscle tissue
Somites and somatomeres arise from what?
Paraxial mesoderm
What contributes to the development of the nucleus pulposus? The annulus fibrosus?
Notochord, Sclerotome
The muscle of the head arises from _———?
Somitomeres
The muscle of the torso and limbs arises from ___________
Hypomeres (Somites)
The dermomyotome eventually splits into what two layers?
Dermotome and myotome
The cells of the myotome split into two parts. What parts are they and what is their relative positioning?
Dorsal epimere and ventral hypomere
What are the events that lead to differentiation of myotome into muscle fibers?
Myotome cells become myoblasts elongate, migrate, and fuse, forming myotubes Contractile filaments appear in cytoplasm–>Muscle fiber
The epimere gives rise to what two things?
Dorsal ramii, deep back muscles
The hypomere gives rise to several various structures originating from a ventral or lateral region. What is the innervation of these structures?
All innervated by ventral rami
Define myotome fusion and give an example
Muscles innervated by more than one spinal cord level - rectus abdominus
Define myotome splitting and give an example
One spinal cord level or segment innervating more than one muscle
Longitudinally - trapezius and sternocleidomastoid Tangentially - intercostals and obliques
Define Poland anomaly
Congenital absence of pectoralis major
Poland anomaly is an underdevelopment or absence of the chest muscle on one side of the body and webbing of the fingers of the hand on the same side
What is unusual about rectus sternalis?
Not present in most of the population: considered a congenital anomaly/variation
HemiScoliosis
As the spine forms before birth, part of one vertebra (or more) may not form completely. When this occurs, the abnormality is called a hemivertebra
What is spina bifida occulta?
Spina bifida is a type of neural tube defect. The neural tube is the structure that eventually develops into the baby’s brain and spinal cord
What is a chordoma? Where do they develop?
Chordoma is a slow growing cancer of tissue found inside the spine. Chordoma can happen anywhere along the spine.
It is most often found near the tailbone (called a sacral tumor)
or where the spine meets the skull (called a clival tumor). Chordoma is also called notochordal sarcoma.
elevated alpha-fetoprotein levels
a neural tube defect such as
spina bifida, a condition in which the bones of the spine don’t close around the spinal cord, or
anencephaly, a condition in which the brain does not develop properly.
What symptoms are seen with Hirschprune’s disease? What causes this?
Hirschsprung’s (HIRSH-sproongz) disease is a condition that affects the large intestine (colon) and causes problems with passing stool. The condition is present at birth (congenital) as a result of missing nerve cells in the muscles of the baby’s colon
What are the two ways that bones are derived? Give an example of each.
Intramembranous ossification - most flat bones of the skull, most of the clavicle Endochondral ossification - most limb bones
process of endochondral ossification
The following stages are:
(a) Mesenchymal cells differentiate into chondrocytes.
(b) The cartilage model of the future bony skeleton and the perichondrium form.
(c) Capillaries penetrate cartilage. Perichondrium transforms into periosteum.
