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Year 2 - Reproduction, Nephrology and Urology > Artificial Reproductive Technology > Flashcards

Artificial Reproductive Technology Flashcards

1
Q

When is infertility clinically diagnosed?

A

After one year of unprotected vaginal intercourse in the absence of known causes of infertility in a women of reproductive age

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2
Q

Name five things needed for fertilisation

A 
Ovary
Fallopian tubes
Sperm
Healthy uterus 
Peritoneum
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3
Q

What things should you ask a woman when taking a history?

A 
Age of female 
Parity - how many times she has been pregnant 
Periods - regularity
Smear - has she been having the tests?
Past, personal and family history
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4
Q

What questions should you ask a man when taking a history?

A 
Age
Occupation - can affects sperm quality
PPF
Injuries
Children from previous relationships - ART only given if the couple have no children under the age of 16 living in the house with the
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5
Q

What lifestyle questions would you ask both parents?

A 
Smoking
Alcohol
Recreational drugs
STIs - ever had, not just currently 
Driving 
Toxins/radiation
Tight garments
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6
Q

What investigations are initially carried out in primary practice?

A

Rubella status
Chlamydia/gonorrhoea swabs
BMI - too far over/underweight affects fertility
Cervical smear

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7
Q

What are the most common causes of infertility?

A 
Ovary problems
Sperm count
Fallopian tubes
Uterine and peritoneal disorders 
Unexplained
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8
Q

How common is an ovulatory disorder?

A

25% of the cases of infertility

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9
Q

How it an ovarian fertility problem tested for?

A
  • Progesterone levels measured on day 21 of the woman’s cycle (assuming she is regular, so it’s taken a few times over the course of a week if the woman has irregular periods)
  • count the antral follicles (4-16, look black on an US scan)
  • anti-mullerian hormone measured
  • FSH/LH/prolactin/SHBG/testosterone measured (between days 1 and 3 of the cycle)
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10
Q

WHO classifies aovulation in three categories, what are they?

A 
Hypothalamic-pituitary failure (10%)
HPO axis dysfunction (85%)
Ovarian failure (5%)
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11
Q

How can a failure of the hypothalmic-pituitary be caused, and how is it treated?

A

Because of lifestyle
- too much dieting
- too much exercise
And treated with pulsatile hormones (GnRH)

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12
Q

How can a failure of the HPO-axis be caused, and how is it treated?

A 
It can be caused by
- weight
- polycystic ovary syndrome
It's treated by 
- weight loss
- synthetic oestrogen and gonadotropins
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13
Q

How can a failure of the ovary be caused, and how is it treated?

A

It can be caused by
- turners syndrome
- other hormonal imbalances
And it is treated with oocyte donation

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14
Q

How many cases of infertility does a problem with the sperm occur in?

A

30%

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15
Q

Name some of the things you expect to find in a normal semen analysis

A 
Volume = at least 1.5mls
pH = 7.2
Concentration = 15 million per ml
Number of sperm = 39 million per ejaculate 
Motility = 25-30%
Viability = 50% are alive 
Morphology = 4% normal forms
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16
Q

Do you need to check for antibodies in the semen?

A

No

17
Q

Which 5 things do urologists do when there is a problem in the semen analysis?

A 
Examine epididymis - for blockages
Check for cystic fibrosis
Check for Y chromosome deletion
Check the karyotyping
Test FSH levels
18
Q

When is ICSI performed?

A

Intra-cytoplasmic sperm injections are done when FSH levels are below 10.

19
Q

Where are sperm surgically removed from for ICSI?

A

The testes of epidermis are the site if SSR.

20
Q

How many of the cases of infertility do problems with the uterine tubes cause?

A

20%

21
Q

Which ways can the uterine tubes be imaged, so as to assess whether they are the cause of infertility?

A
  • HyCoSy - hystro-contrast sonography (US)
  • HSG - hysteroalpinogram (X-Ray)
  • laparoscopy and dye test (best for an image, can cause infection and bleeding)
22
Q

What are the possible treatments for someone who has a blockage of the uterine tubes?

A
  • Selective salpingography- only when the problem is in the proximal uterine tube
  • IVF
  • Clipping/salpingectomy - removal of a very full/blocked uterine tube that could wash an agh away after IVF
23
Q

How many of the cases of infertility does uterine or peritoneal problems cause?

A

10%

24
Q

What are some of the possible causes of uterine/peritoneal disorders?

A
  • endometriosis
  • uterine abnormalities (unicornuate, partial bicornuate)
  • endometrial defects
25
Q

How many cases of infertility remain unexplained?

A

25%

26
Q

How are infertility cases treated when the cause is not known?

A

With IVF

27
Q

What are the criteria a couple has to meet before they can undergo IVF treatment?

A
  • living together at the same address for two years
  • they can’t have any kids under the age of 16 living with them (adopted, previous relationships)
  • couple can’t have any major medical illnesses, smoke, drink or take drugs
28
Q

How are eggs removed from a women in order to undergo IVF?

A
  • she is given hormones to stimulate her ovaries for 1-2 weeks
  • a needle is then inserted into the ovary, some of the fluid is removed and examined for eggs
29
Q

How is the fertilisation procedure during IVF undertaken?

A
  • the egg is put in a test tube with 25 sperm and left for 16 hours
  • fertilised zygotes are then cultured for 5 days bearer being replaced in the uterus
30
Q

When is ICSI performed?

A

When the male has a low sperm count

31
Q

The ICSI procedure is the same as IVF except for what?

A

A single spree from the man is taken and injected directly into the egg

32
Q

What are the problems with ICSI?

A

Can still fail due to incomplete fusion if the egg and sperm, and lack of implantation in the endometrium

33
Q

What is IUI and when is it used?

A
  • Intrauterine injection
  • performed when the couple are using donor sperm, have difficulty in sex or the make is HIV positive
  • the woman has to be fertile
34
Q

How is IUI performed?

A

36-40 hrs after ovulation the washed sperm are injected straight into the uterus, through a catheter through the cervix

35
Q

What other treatments may be possible for any of these fertility problems?

A 
Synthetic oestrogen
Oocyte donation 
Selective salpingography 
Endometrial burning
Weight loss
Synthetic GnRH or gonadotropins
36
Q

Why would a couple need counselling for infertility problems?

A

Effect on relationships
Effect on family and work
Stress

37
Q

What forms of counselling can couples receive?

A 
Acupuncture
Yoga
Reflexology
Personal counselling
Weight loss/gain
Smoking cessation
38
Q

What special circumstances could be involved in infertility?

A 
Same sex couples
Surrogacy 
Oocyte donor
Egg sharing
PGD
Recurrent implantation failure
39
Q

How many heterosexual couples experience infertility problems?

A

1 in 7

Year 2 - Reproduction, Nephrology and Urology (14 decks)

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