Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A - ObsNGynae > Assissted Reproduction + pcos > Flashcards

Assissted Reproduction + pcos Flashcards

1
Q

What is the criteria to receive ivf on the nhs?

A

Defined infertile: for at least 2 years though

Under 23-42: get 3 rounds
40-42? : get 1 round

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are conception rates in normal/fertile couples?

A

20% chance of conception in each menstrual cycle.

85% conceive in 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When counselling patients seeking IVF, what are some details you should tell them?

A

Lots of needles

6 weeks where you will require lots of appointments, you and your partner need to be available for these so must be able to take time off work or do it in a holiday.

Success rates higher for younger patients, reduces with age.
Success rates reduce with each subsequent round.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the process involved in IVF?

A
  1. Initial tests and ultrasound
  2. GnRH agonist or antagonist (start at day 21 for 2-3 weeks)
    • suppress menstrual cycle via stopping FSH and LH
  3. FSH given - ovarian stimulation
  4. LH/hCG injections - stimulate/triggers ovulation -> oocyte collection. 34-38h post injection. hCG preferred
  5. Fertilisation and culture - can use ICSI (wait 2-3/5-6 days before implantation in uterus).
    - woman goes home and takes progesterone/ injections
  6. Embryo transfer to uterus;
    • max 2 eembryos implanted
    • give progesterone for luteal phase support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the Complications of Assisted Conception?

A

Multiple pregnancy - biggest risk. women usually hAve more than 1 embryo transferred to increase success rate

Ovarian hyperstimulation syndrome

Egg collection: intraperitoneal haemorrhage and pelvic infection (<1% risk)

Pregnancy complications: risk multiple and ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is used for Luteal Phase Support in IVF?

A

this is required post egg collection:

  1. Progesterone
    - (vaginally/rectally/IM/sc — oral = unreliable)
    - to induce secretory changes within endometrium
    - most used. usally given alone
  2. hCG – increased risk of OHSS

o not widely used

  1. Oestrogen?
    o No real data to support oestrogen in luteal phase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

during egg colleciton in ivf?

A

granulosa cell / follicular cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

during IVF, when looking to trigger/induce ovulation, when could it be appropriate to use GNRH agonist as a trigger?

A

only if used GNRH antagonist to downregulate pituitary/ shut off menstrual cycle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the mutliple pregnancy rate in ivf?

A

18%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

at what stage is the embryo implanted back into uterus?

A

at the blastocyst stage

day 2 after collection (this is early)
days 2-5 depends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what type of FSH is given during IVF?

A

Urinary or synthetic/recombinant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

whats the risk of urinary fsh?

A

cjd/prion disease - if donor is a carrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is used in the Prevention of Ovulation in ivf? when are the given

A

GNRH agonist
- follicular phase. have to give 2 weeks b4 to be able to block lh surge
- due to excess stimulation, leads to reduced receptor
expression
- injection, nasal spray

GNRH antagonist

  • luteal phase
  • compete for binding with endogenous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

benefit of long protocol over short?

A

Associated with an increase in the no. of eggs

Higher clinical pregnancy rates compared to short protocols (not live birth rate)

Long protocol; involves GNRH use to switch off period and then conduct ovarian stimulation.

Short protocol; different types but injection 5-9 days before collection or no injections and collect base on natural menses cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

benefit of using antagonists over agonists?

A

reduction in OHSS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

list the methods of assisted conception?

A

IUI,
IVF + ICSI,
frozen embryo replacement,
oocyte donation

PGD - preimplantation genetic diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

list causes of infertility by prevalence?

A

Male factors-30%
Ovulatory-25%
Tubal damage-20%
Uterine-10%

Endometriosis-5-15%
Unexplained-25%
Both male and female factors-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the protocol for IUI? indication?

A

Select & wash sperm with best motility and concentrate it

Put sperm into uterus via transvaginal catheter usually 24h before ovulation is meant to occur or TRiggered to occur

Eggs:
1. Allow natural release
stimulated:
2. Give Clomid: inc FSH = nice big follicles
3. Give FSH: superovulation
  can then trigger release

indication: unexplained infertility, Cervical factors
Sexual factors, Male Factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

risks of IUI?

A

multiple pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the indications of PGD?

A

Couples at risk of having children with serious genetic diseases can have
unaffected embryos transferred to the uterus, eliminating the need for prenatal diagnosis and termination of
pregnancy

Applicable if they are carriers or have risk of certain conditions;
BRCA, sickle cell, thalassaemia, x-linked etc

21
Q

some contraindications for IUI?

A

Requires regular ovulatory cycles (…PCOS…)

Still requires patent tubes (hydroslapinx etc)

22
Q

what are some requirements for ivf?

A

need normal ovarian reserve;

AMH (anti-mullerian hormone)

TVUS - Antral follicle count

FSH-early follicular

23
Q

Dfference between long and short protocol?

A

long started in luteal phase

short started in follicular phase

24
Q

what are the indications for ICSI?

A

Insufficient motile sperm

25
Q

indications for oocyte donation?

A

Ovarian failure
Older age
Genetic disease

26
Q

what method would you suggest for this woman with:

Uterine abnormality or absence
Poor health e.g. renal failure
Use of teratogenic drugs

A

surrogacy

27
Q

list some causees of infertility?

A

Tubal damage:
PID, Endometriosis, surgery/sterilisation -> adhesions

Cervical:
infectoin -> reduced mucus for sperm travel
cone biopsy

28
Q

if diagnosed male factor infertility what method to recommedn them to use?

A

IVF + ICSI

29
Q

How is a woman/couple investigated for cause of infertility?

A
  1. History

In no particular order:

Male: semen analysis (WHO criteria)

Female:
Ovarian reserve testing; AMH, AFC etc
Menstrual cycle regularity - day 21 progesterone

Hysterosalpingography (HSG) +- contrast -> if no established cause. screens tubal occlusion

Laparoscopy and dye - if established cause, will look for tubal occlusion as well as established issue

30
Q

if a woman has an ovulatory disorder, what hormone should you measure?

A

Prolactin

31
Q

list some causes of absent or abnormal sperm?

A

Smoking & drugs eg steroids

Varicocele - 25%

Antisperm antibody 5% - after vasectomy reversal

Infection: epididymitis
Mumps orchitis

Testicular abnormalities e.g. Klinefelter’s
(XXY)

Kallmann’s syndrome

Hyperprolactinaemia

Congenital absence of vas deferens

32
Q

what is the role of lh and fsh in the male?

A

LH  Leydig cells  testosterone production

o FSH + testosterone  sertoli cells  synthesis and transport of sperm

33
Q

what are the symptoms of OHSS?

A 
Hypovolaemia
 Electrolyte disturbances
 Ascites
 Thromboembolism
 Pulmonary oedema
 Death

SO theyre wet but extravascularly rather than intravascular

34
Q

management of OHSS?

A 
Hospitalisation required for
 Restoration of intravascular volume
 Electrolyte monitoring
 Analgesia
 Thromboprophylaxis
 Drainage of ascetic fluid
35
Q

What are some signs of ovulation in a normal menstrual cycle?

A

Vaginal spotting, Vaginal Discharge or pelvic pain (‘mittelschmertz’)

body temperature increases by 0.5C in luteal phase - due to prog

Only real proof though is : Conception

36
Q

TVUS appearance of multiple (12 or more) small (2-8mm) follicles in an enlarged (>10ml vol) ovary is indicative of?

A

PCOS

37
Q

what is the GREATEST cause of anovulatory infertility?

A

PCOS

38
Q

list the 3 criteria for PCOS?

A

PCO on USS
Irregular periods (>35 days apart)
Hirsuitism - clinical or biochemical features

Diagnosis using Rotterdam Criteria for PCOS (at least 2 of the following)
o Oligo/anovulation (> 2 years)
o Clinical or biochemical features of hyperandrogenism
o Polycystic ovaries on ultrasound (> 12 in one ovary measuring 2-9 mm in diameter)

39
Q

aetiiology of pcos?

A

Disordered LH production and peripheral insulin resistance with compensatory raised insulin levels

 LH and insulin   ovarian androgen production

  insulin   adrenal androgen production and reduce sex hormone binding globulin   free androgen
levels

  intraovarian androgens  excess small ovarian follicles + irregular/absent ovulation

  peripheral androgens  acne / excess hair growth

  body weight   insulin   androgen levels

40
Q

what ivx would you do for PCOS?

A 
Bloods
o FSH
increased in POF
reduced in Hypothalamic disease
o Prolactin
o TSH
o Serum testosterone - high
o LH - high
high LH:FSH ratio (3:1 - fsh itself may be normal)

 TVUS - >12 follicles, increased stroma /size of ovary. See past card
 Other
o DM screening

41
Q

complications of PCOS?

A

50% develop T2DM in later life
 30% develop GDM
sub fertility

42
Q

what is the management of pcos?

A

Diet and exercise
Normalisation of weight

 COCP - if amenorrhoea/dysfunctional uterine bleeding.
good if planning pregnancy. low dose

 Metformin
 Co-cyprindol (dianette) - for acne + hirsutism +
contraceptive
 Eflornithine = topical antiandrogen for facial hirsutism

Subfertility:
Weight loss
Clomifine - SERM. Anti estrogen blocks receptors in hypothal and pituitary

Surgery:
Laparoscopic ovarian drilling - if undesponsive to medical rx

43
Q

list causes of anovulation?

A

Hypothalamic hypogonadism

  • anoxeria, excess exercise
  • can cause pcos

Kallmans syndrome
- gnrh releasing hormones dont develop

Pituitary :
A. Hyperprolactinaemia - suppresses gnrh
- cabergoline (dopamine agonists)
B. Sheehans

Ovarian
Premature ovarian failure
Gonadal dysgenesis
Luteinised unruptured follicle syndrome
PCOS
44
Q

what is gonadal dysgenesis in the female? biological presentation?

A

46XX

Streak ovaries are present with non-functional tissues unable to produce the required sex steroid oestrogen

Low levels of oestrogen
FSH/LH high

this is NOT turners

45
Q

chracterise progesterone levels in oligo/amenorrhoeic cycles.

A

for women with symptoms of oligo-amenorrhoea, progesterone will remain low throughout the menstrual cycle

so not much of a fuss whether it is day 21 or not

46
Q

what does laparoscopic ovarian dirlling involve ?

A

Under general anaesthetic, your doctor will make a small cut in your lower tummy and pass a long, thin microscope called a laparoscope through into your abdomen.

The ovaries will then be surgically treated using heat or a laser to destroy the tissue that’s producing androgens.

helps to restore hormonal imbalance and improve ovulation

47
Q

how does metformin help in PCOS?

A

usually used if BMI >25

not licenced for pcos but used off label

improves insulin sensitivity - hence reduces circulating androgen levels, and improves weight

reduced circulating androgen levels menas LH surge can occur to allow ovulation

48
Q

why does pcos cause anovulation?

A

Despite the high levels of LH, the increased circulating androgens suppress the LH surge (which is required for ovulation to occur).

Follicles develop within the ovary, but are arrested at an early stage (due to the disturbed ovarian function) – and they remain visible as “cysts” within the ovary.

49
Q

how does clomiphene work?

A

it blocks hypothalamic estrogen receptors

this blocks negatve feedback of oestrogen

this increases GnRH hence FSH,LH production

so clomiphene given between day 2-6 (5 day course) of cycle =

more FSH allows follicle maturation

LH surge can then stimulate ovulation

A - ObsNGynae (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions