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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
Q

what are the steps of IVF treatment

A

down regulation, ovarian stimulation, oocyte retrieval, embryo transfer and luteal support

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26
Q

what is the current success rate for IVF

A

35%

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27
Q

what is a chorionic haematoma

A

pooling of blood between endometrium and embryo due to separation

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28
Q

what happens on day 1 of menstrual cycle

A

menstruation

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29
Q

what are the FSH levels like in the first 4 days of a womans cycle

A

in the first 4 days FSH levels are high

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30
Q

what stimulates spermatogenesis

A

FSH stimulates spermatogenesis together with testosterone

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31
Q

what hormone stimulates testosterone secretion

A

LH

32
Q

what does testosterone do to GnRH and LH

A

testosterone decreases release of GnRH and LH

33
Q

what does GnRH do and what is it under control from

A

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
Q

what does LH act on

A

leydig cells-regulate testosterone secretion

35
Q

FSH

A

acts on Sertoli cells to enhance spermatogenesis

regulates by negative feedback from inhibin

36
Q

is production of LH and FSH cyclical in males

A

no

37
Q

what is testosterone derived from

A

it is a steroid hormone derived from cholesterol

38
Q

where is testosterone produced

A

in leydig cells

39
Q

what are inhibin and activin secreted by

A

sertoli cells

40
Q

what do inhibin and activing do

A

feedback on FSH (inhibin inhibits and activing stimulates)

41
Q

which part of oocyte do spermatozoa bind to

A

zona pellucida

42
Q

what are spermatocytes derived form

A

immature germ cells called spermatogonia

43
Q

are primary spermatocytes haploid or diploid

A

diploid

44
Q

are secondary spermatocytes haploid or diploid

A

haploid

45
Q

what do secondary spermatocytes form after meiosis II

A

2 spermatids

46
Q

what is the function of seminal vesicles

A

produce semen into ejaculatory duct, supply fructose, secrete prostaglandins (stimulates motility), secrete fibrinogen (clot precursor)

47
Q

what is the function of the prostate gland

A

produce alkaline fluid (neutralises vaginal acidity), produces clotting enzymes to clot semen within female

48
Q

what is the function of the bulbourethral glands

A

secrete mucus to act as lubricant

49
Q

is erection under parasympathetic or sympathetic control

A

parasympathetic (point)

50
Q

is ejaculation under parasympathetic or sympathetic control

A

sympathetic (shoot)

51
Q

what is the genetic abnormality in Kleinfelters syndrome

A

XXY

52
Q

what are some of the endocrine causes of male infertility

A

pituitary tumours-acromegaly, cushings disease, hyperprolactinaemia
Kallmans syndrome
anorexia
thyroid disorders-hyper or hypothyroidism
diabetes
steroid abuse

53
Q

why does Kallmans syndrome cause infertility

A

(it is a form of hypogonadotrophic hypogonadism)

failure in production or LH and FSH because of impairment of the hypothalamus to release GnRH

54
Q

what is the normal testicular volume

A

12-25 mls

55
Q

how is testicular volume monitored

A

using an orchidometer

56
Q

what is measured in semen analysis

A 
volume 
density-numbers of sperm 
motility 
progression-how well they move 
morphology
57
Q

what are some of the extrinsic factors for abnormalities in semen analysis

A 
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
Q

if semen analysis was abnormal what would you do

A

repeat semen analysis 6 weeks later

59
Q

if semen analysis still abnormal what would you do

A

endocrine profile
chromosome analysis
cystic fibrosis screening
depending on results-testicular biopsy, scrotal scan

60
Q

if obstructive finding what would be the endocrine features

A

normal LH, FSH and testosterone

61
Q

what would be the clinical features of an obstructive problems

A

normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent

62
Q

if non obstructive with low testicular volume, reduced secondary sexual characterists and vas deferens presenent what would you expect endocrine results to be

A

High LH, FSH and low testosterone

63
Q

what is intra uterine insemination

A

semen sample prepared to produce concentrated sperm sample

inseminated into uterine cavity around time ovulation

64
Q

what is the indication for IUI

A

mildly reduced sperm count

65
Q

what is the indication for ICSI

A

very low sperm count

66
Q

how does ICSI work

A

sperm injected into stripped oocyte obtained during IVF

67
Q

what is the indication for surgical sperm aspiration

A

azoospermia

68
Q

how does surgical sperm aspiration work

A

sperm aspirated surgically and then injected into oocyte ICSI

69
Q

what is the first step of IVF

A

GnRH antagonists (ovaries are asleep) then get period and get bloods done on day 2 and transvaginal ultrasound to look for ovarian cysts

70
Q

after the period what step is next in IVF

A

give GnRH injectable for 7-10 days to stimulate the follicles in the ovary

71
Q

what is given prior to ovulation

A

HcG

72
Q

how much after the HcG shot are the eggs retrieved

A

about 34-36 hours

73
Q

how are the eggs that are retrieved fertilised

A

semen sample provided from that day from the partner, incubated with egg then PGD-pick the best looking egg from them for implantation

74
Q

what hormone is given after the implantation of the embryos

A

progesterone

75
Q

when is a pregnancy test ordered after IVF

A

can do a serum pregnancy test about 9-12 days after

Reproduction and Sexual Health (24 decks)

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