Assisted Conception

Question 1

What can cause infertility?

Answer 1

male factor 
tubal disease
PCOS 
endometriosis 
unexplained

Question 2

What are the types of assisted conception?

Answer 2

surrogacy 
IUI (intrauterine insemination)
IVF
ICSI 
DI (donor insemination)

Question 3

Who gets assisted conception (not infertile)?

Answer 3

fertility preservation
homosexual couples
pre implant genetics
blood born viruses

Question 4

Who qualifies for assisted conception?

Answer 4

regular unprotected sex, 12 months - start investigating
regular unprotected sex, 24 months and haven’t found an explanation - treatment
if an explanation found in those 12 months and its obvious they aren’t going to get pregnant naturally - start treatment

Question 5

What tests do they do before starting assisted conception?

Answer 5

check woman is ovulating - progesterone levels 7 days before end of cycle e.g. day 21 of 28 day cycle
semen analysis
hysterosalpingogram - tubal disease?

Question 6

What are regular periods very indicative of?

Answer 6

ovulation

Question 7

What are the criteria for IVF?

Answer 7

2 yrs regular unprotected sex 
female <4 units alcohol/week 
BMI 19-29 for both 
smoking cessation 
rubella negative 
up to date smear 
no STIs
screen for BBVs - doesn't mean you can't have it - do ICSI
folic acid 0.4mg

Question 8

What decides which assisted conception is used?

Answer 8

ovarian reserve - anti mullerian hormone

Question 9

What is step 1 of IVF?

Answer 9

down regulate - 'quiet ovary'
synthetic GnRH (gonadotrophin releasing hormone) 
ovary starts producing follicles and all of them get bigger - as opposed to normally just the primary follicle

Question 10

How do you assess step 1 of IVF?

Answer 10

transvaginal USS - predicts how many eggs will be released on ovarian stimulation

Question 11

What is step 2 of IVF?

Answer 11

ovarian stimulation - HCG injection –> follicular development

Question 12

What is step 3 of IVF?

Answer 12

egg retrieval - 36 hours after stimulation

male produces sperm sample

Question 13

What is step 4 of IVF?

Answer 13

fertilisation - all eggs they collect in a petri dish

Question 14

What is step 5 of IVF?

Answer 14

transfer - day 5 after egg retrieval (blastocyst stage)
1embryo (max. is 2 - risk of multiple pregnancies)
give progesterone - luteal support

Question 15

When do you do a pregnancy test?

Answer 15

16 days

Question 16

What is 1 cycle of IVF?

Answer 16

All the embryos from first egg retrieval (10-30)

Question 17

When is ICSI used?

Answer 17

problem with the sperm

Question 18

What is the only difference between ICSI and IVF?

Answer 18

manually inject sperm into the egg

Question 19

What are the risks of IVF?

Answer 19

increased risks of pregnancy 
ovarian hyperstimulation syndrome 
multiple pregnancy 
no eggs retrieved 
surgical risks - bleeding, infection, damage to local structures

Question 20

What is ovarian hypertimulation syndrome?

Answer 20

if it looks like over 20 eggs will be retrieved
abdo pain, SOB, N and V
give fluids and hydration

Question 21

When does ovarian hyper stimulation syndrome become an emergency?

Answer 21

if embryos are put straight back in to the woman - too much for body to handle