Artificial Reproductive Technology Flashcards
When is infertility clinically diagnosed?
After one year of unprotected vaginal intercourse in the absence of known causes of infertility in a women of reproductive age
Name five things needed for fertilisation
Ovary Fallopian tubes Sperm Healthy uterus Peritoneum
What things should you ask a woman when taking a history?
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
What questions should you ask a man when taking a history?
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
What lifestyle questions would you ask both parents?
Smoking Alcohol Recreational drugs STIs - ever had, not just currently Driving Toxins/radiation Tight garments
What investigations are initially carried out in primary practice?
Rubella status
Chlamydia/gonorrhoea swabs
BMI - too far over/underweight affects fertility
Cervical smear
What are the most common causes of infertility?
Ovary problems Sperm count Fallopian tubes Uterine and peritoneal disorders Unexplained
How common is an ovulatory disorder?
25% of the cases of infertility
How it an ovarian fertility problem tested for?
- 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)
WHO classifies aovulation in three categories, what are they?
Hypothalamic-pituitary failure (10%) HPO axis dysfunction (85%) Ovarian failure (5%)
How can a failure of the hypothalmic-pituitary be caused, and how is it treated?
Because of lifestyle
- too much dieting
- too much exercise
And treated with pulsatile hormones (GnRH)
How can a failure of the HPO-axis be caused, and how is it treated?
It can be caused by - weight - polycystic ovary syndrome It's treated by - weight loss - synthetic oestrogen and gonadotropins
How can a failure of the ovary be caused, and how is it treated?
It can be caused by
- turners syndrome
- other hormonal imbalances
And it is treated with oocyte donation
How many cases of infertility does a problem with the sperm occur in?
30%
Name some of the things you expect to find in a normal semen analysis
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
Do you need to check for antibodies in the semen?
No
Which 5 things do urologists do when there is a problem in the semen analysis?
Examine epididymis - for blockages Check for cystic fibrosis Check for Y chromosome deletion Check the karyotyping Test FSH levels
When is ICSI performed?
Intra-cytoplasmic sperm injections are done when FSH levels are below 10.
Where are sperm surgically removed from for ICSI?
The testes of epidermis are the site if SSR.
How many of the cases of infertility do problems with the uterine tubes cause?
20%
Which ways can the uterine tubes be imaged, so as to assess whether they are the cause of infertility?
- HyCoSy - hystro-contrast sonography (US)
- HSG - hysteroalpinogram (X-Ray)
- laparoscopy and dye test (best for an image, can cause infection and bleeding)
What are the possible treatments for someone who has a blockage of the uterine tubes?
- 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
How many of the cases of infertility does uterine or peritoneal problems cause?
10%
What are some of the possible causes of uterine/peritoneal disorders?
- endometriosis
- uterine abnormalities (unicornuate, partial bicornuate)
- endometrial defects
How many cases of infertility remain unexplained?
25%
How are infertility cases treated when the cause is not known?
With IVF
What are the criteria a couple has to meet before they can undergo IVF treatment?
- 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
How are eggs removed from a women in order to undergo IVF?
- 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
How is the fertilisation procedure during IVF undertaken?
- 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
When is ICSI performed?
When the male has a low sperm count
The ICSI procedure is the same as IVF except for what?
A single spree from the man is taken and injected directly into the egg
What are the problems with ICSI?
Can still fail due to incomplete fusion if the egg and sperm, and lack of implantation in the endometrium
What is IUI and when is it used?
- 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
How is IUI performed?
36-40 hrs after ovulation the washed sperm are injected straight into the uterus, through a catheter through the cervix
What other treatments may be possible for any of these fertility problems?
Synthetic oestrogen Oocyte donation Selective salpingography Endometrial burning Weight loss Synthetic GnRH or gonadotropins
Why would a couple need counselling for infertility problems?
Effect on relationships
Effect on family and work
Stress
What forms of counselling can couples receive?
Acupuncture Yoga Reflexology Personal counselling Weight loss/gain Smoking cessation
What special circumstances could be involved in infertility?
Same sex couples Surrogacy Oocyte donor Egg sharing PGD Recurrent implantation failure
How many heterosexual couples experience infertility problems?
1 in 7
