Assisted conception Flashcards
What steps must be taken before assisted conception can commence
- female alcohol reduced to 4 units per week
- BMI 19-29
- stop smoking
- folic acid 0.4mg/day preconception - 12 weeks gestation
- check if immunised against rubella
- check smears up to date
- screen for Hep B/C and HIV
- take not of all drugs (recreational, prescribed, over counter)
What options are there for assisted conception
donor insemination intra-uterine insemination in vitro fertilisation intra cytoplasmic injection surrogacy
What are the indications for intra-uterine insemination
unexplained infertility
mild or moderate endometriosis
mild male infertility
What are the indications for IVF
unexplained fertility for more than 2 years
pelvic disease (endometriosis, tubal fibroids)
anovulatory infertility
male factor infertility
What are the steps of IVF
GnRH analogue injection Gonadotrophin hormone given HCG injection given take sperm sample and incubate collect egg and incubate implant
What is given for GnRH analogue and what side effects can it have
Buserelin
SE: hot flushes, mood swings, headache
What is given as gonadotrophin hormone, what does it do and what side effects does it have
Menopur or Gonal-F
mimics FSH - stimulates follicular growth
SE: ovarian hyperstimulation syndrome, allergic reaction
Why is HCG injection given and when is it given
to mimic LH surge
given 36 hours prior to egg collection
By what day after conception will a blastocyst be formed
Day 5!
day 1 - pronuclear stage day 2 - 4 cell day 3 - 8 cell day 4 - 16 cell (morula) Day 5 - early blastocyst Day 6 - expanded blastocyst
if patient is under 40 how many embryo’s should be takene
no more than 2
if over forty, can be as many as three in exceptional circumstances
What are the indications for intracytoplasmic injection
severe male infertility
previously failed IVF
What is a complication of assisted conception technology
OHSS
- excess follicles
- nausea, abdo pain, bloating
- breathlessness
