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Reproduction and Sexual Health > Assisted Conception > Flashcards

Assisted Conception Flashcards

1
Q

before assisted conception begins what is assessed

A

alcohol-females limit to 4 units per week
weight between 19-29
stop smoking
folic acid-0.4mg pre conception, 5mg after
check for rubella immunity
cervical smears up to date, occupational factors
drugs-prescribed and OTC
screen for blood borne viruses
assess ovarian reserve

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2
Q

what treatments are available

A 
donor insemination 
intra-uterine insemination 
IVF 
Intra-cytoplasmic sperm injection -ICSI 
fertility preservation 
surrogacy
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3
Q

what are the indications or Intra Uterine Insemination

A

unexplained infertility, mild or moderate endometrisosi, mild male factor infertility

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4
Q

how is IUI carried out

A

can be in natural/stimulated cycle

prepared semen inserted into uterine cavity around the time of ovulation

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5
Q

what are the indications for IVF

A

unexplained >2 years durations
pelvic disease (endometriosis, tubal diseae, fibroids)
anovulatory infertility
male factor infertility

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6
Q

what is down regulation

A

synthetic gonadotrophin releasing hormone antagonist reduces cancellation from ovulation improves success rates
allows precise timing of oocyte recover using HCG trigger

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7
Q

side effects of down regulation

A

hot flushed and mood swings, nasal irritation, headaches

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8
Q

describe ovarin stimualiton

A

gonadotrophin hormone containing either synthetic or urinary gonadotrophins
causes follicular development

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9
Q

what are the side effects of ovarian stimulation

A

mild allergic reaction

ovarian hyperstimulaiton syndrome (OHSS)

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10
Q

what is an action scan

A

a repeat scan 72 hours later

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11
Q

what happens if there is a poor response to FSH

A

abandon treatment/ increase dose of FSH

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12
Q

what does the HCG injection do

A

mimic LH causing resumption of meiosis in oocyte, 36 hours before oocyte recovery

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13
Q

before a sperm sample is taken what must happen

A

abstinence for 72 hours beforehand

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14
Q

what is assessed iin the sperm sample

A

volume
density-numbers of sperm
motility-what proportion are moving
progression-how well they move

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15
Q

where are the oocytes collected

A

in theatre as risk of bleeding, pelvic infection, failure to obtain oocytes

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16
Q

what is the role of the embryologist

A

search through the follicular fluid
identify eggs and surrounding mass of cells
collect them into cell culture medium
incubate at 37 degrees

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17
Q

at what day is there usually transfer and cryopreservation

A

day 5

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18
Q

what helps with embryo transfer

A

progesterone suppositories for 2 weeks

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19
Q

what are the indications for ICSI

A

severe male infertility
previous failed fertilisation with IVF
preimplantation genetic diagnosis

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20
Q

if azoospermia what will happen

A

surgical sperm aspiration

can be extracted form epididymis (if obstructive) or testicular tissue if non obstructive e

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21
Q

how does ICSI work

A

each egg is strpped, sperm immobilised and single sperm injected and incubated at 37 degrees overnight

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22
Q

what are the symptoms of OHSS

A

abdominal pain/bloating
nausea/diarrhoea
breathless

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23
Q

OHSS treatment after embryo transfer

A

monitoring with scans and bloods
antithrombotic fluids, TED stockings and fragmin
analgesia
hospital admission if required

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24
Q

what are all ART activities licensed by

A

Human Fertilisation and Embryo Authority

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25
what are the steps of IVF treatment
down regulation, ovarian stimulation, oocyte retrieval, embryo transfer and luteal support
26
what is the current success rate for IVF
35%
27
what is a chorionic haematoma
pooling of blood between endometrium and embryo due to separation
28
what happens on day 1 of menstrual cycle
menstruation
29
what are the FSH levels like in the first 4 days of a womans cycle
in the first 4 days FSH levels are high
30
what stimulates spermatogenesis
FSH stimulates spermatogenesis together with testosterone
31
what hormone stimulates testosterone secretion
LH
32
what does testosterone do to GnRH and LH
testosterone decreases release of GnRH and LH
33
what does GnRH do and what is it under control from
GnRH is released from hypothalamus in bursts every 2-3 hours stimulates anterior pituitary to produce LH and FSH under negative feedback control from testosterone
34
what does LH act on
leydig cells-regulate testosterone secretion
35
FSH
acts on Sertoli cells to enhance spermatogenesis | regulates by negative feedback from inhibin
36
is production of LH and FSH cyclical in males
no
37
what is testosterone derived from
it is a steroid hormone derived from cholesterol
38
where is testosterone produced
in leydig cells
39
what are inhibin and activin secreted by
sertoli cells
40
what do inhibin and activing do
feedback on FSH (inhibin inhibits and activing stimulates)
41
which part of oocyte do spermatozoa bind to
zona pellucida
42
what are spermatocytes derived form
immature germ cells called spermatogonia
43
are primary spermatocytes haploid or diploid
diploid
44
are secondary spermatocytes haploid or diploid
haploid
45
what do secondary spermatocytes form after meiosis II
2 spermatids
46
what is the function of seminal vesicles
produce semen into ejaculatory duct, supply fructose, secrete prostaglandins (stimulates motility), secrete fibrinogen (clot precursor)
47
what is the function of the prostate gland
produce alkaline fluid (neutralises vaginal acidity), produces clotting enzymes to clot semen within female
48
what is the function of the bulbourethral glands
secrete mucus to act as lubricant
49
is erection under parasympathetic or sympathetic control
parasympathetic (point)
50
is ejaculation under parasympathetic or sympathetic control
sympathetic (shoot)
51
what is the genetic abnormality in Kleinfelters syndrome
XXY
52
what are some of the endocrine causes of male infertility
pituitary tumours-acromegaly, cushings disease, hyperprolactinaemia Kallmans syndrome anorexia thyroid disorders-hyper or hypothyroidism diabetes steroid abuse
53
why does Kallmans syndrome cause infertility
(it is a form of hypogonadotrophic hypogonadism) | failure in production or LH and FSH because of impairment of the hypothalamus to release GnRH
54
what is the normal testicular volume
12-25 mls
55
how is testicular volume monitored
using an orchidometer
56
what is measured in semen analysis
``` volume density-numbers of sperm motility progression-how well they move morphology ```
57
what are some of the extrinsic factors for abnormalities in semen analysis
``` completeness of sample period of abstinence condition during transport time between production and assessment natural variation between samples health of man 3 months before production ```
58
if semen analysis was abnormal what would you do
repeat semen analysis 6 weeks later
59
if semen analysis still abnormal what would you do
endocrine profile chromosome analysis cystic fibrosis screening depending on results-testicular biopsy, scrotal scan
60
if obstructive finding what would be the endocrine features
normal LH, FSH and testosterone
61
what would be the clinical features of an obstructive problems
normal testicular volume normal secondary sexual characteristics vas deferens may be absent
62
if non obstructive with low testicular volume, reduced secondary sexual characterists and vas deferens presenent what would you expect endocrine results to be
High LH, FSH and low testosterone
63
what is intra uterine insemination
semen sample prepared to produce concentrated sperm sample | inseminated into uterine cavity around time ovulation
64
what is the indication for IUI
mildly reduced sperm count
65
what is the indication for ICSI
very low sperm count
66
how does ICSI work
sperm injected into stripped oocyte obtained during IVF
67
what is the indication for surgical sperm aspiration
azoospermia
68
how does surgical sperm aspiration work
sperm aspirated surgically and then injected into oocyte ICSI
69
what is the first step of IVF
GnRH antagonists (ovaries are asleep) then get period and get bloods done on day 2 and transvaginal ultrasound to look for ovarian cysts
70
after the period what step is next in IVF
give GnRH injectable for 7-10 days to stimulate the follicles in the ovary
71
what is given prior to ovulation
HcG
72
how much after the HcG shot are the eggs retrieved
about 34-36 hours
73
how are the eggs that are retrieved fertilised
semen sample provided from that day from the partner, incubated with egg then PGD-pick the best looking egg from them for implantation
74
what hormone is given after the implantation of the embryos
progesterone
75
when is a pregnancy test ordered after IVF
can do a serum pregnancy test about 9-12 days after

Reproduction and Sexual Health (24 decks)

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