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Reproduction SOH > Assisted conception > Flashcards

Assisted conception Flashcards

1
Q

Definition

A

Any treatment which involves gametes outside of the body

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2
Q

Why is demand increasing?

A

Increasing parental age before starting a family
Increasing chlamydia
Male factor infertility
More assisted conception treatment options available

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3
Q

How many cycles of IVF or ICSI are eligible couples offered?

A

Up to 3 cycles

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4
Q

Assisted conception treatment cannot be used for same sex couples. True or false?

A

False

- it can be used for same sex couples

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5
Q

What is the role of a surrogate ?

A

Someone who can carry the baby if the patient doesn’t have a uterus

  • e.g. if they have had a hysterectomy
  • if they are male
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6
Q

Assisted conception treatment can be used to avoid transmission of blood borne viruses between patients. True or false?

A

True

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7
Q

Female alcohol limit before treatment

A

Less than 4 units per week

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8
Q

Male alcohol limit before treatment

A

Less than 14 units per week

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9
Q

Smoking guidance before treatment

A

Stop smoking (including e-cigarettes)

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10
Q

Weight guidance before treatment

A

Aim for BMI between 19 and 29

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11
Q

If a patient is trying to conceive but they are not immune to rubella, what do you do?

A

Immunise patient and tell them to avoid trying to conceive for 1 month

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12
Q

Recreational drugs guidelines before treatment

A

Must be abstinent from recreational drugs for at least 1 year

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13
Q

Name 5 forms of ACT available

A 
Donor insemination
Intra-uterine insemination
In-vitro fertilisation (IVF) 
Intra-cytoplasmic sperm injection (ICSI) 
Fertility preservation - freezing
Surrogacy
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14
Q

Indications for intra-uterine insemination

A

Sexual problems
Same sex relationships
Abandonded IVF

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15
Q

intra-uterine insemination - method

A

Monitor when woman is about to ovulate. Directly insert prepared semen into patients uterine cavity around the time of ovulation

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16
Q

IVF - indications

A 
When trying for 2 years but can't conceive 
Pelvic disease
- endometriosis
- tubal disease
- fibroids 
Anovulatory infertility
17
Q

If there is failed intra-uterine insemination after 6 cycles, what is the next step?

A

Try IVF

18
Q

IVF - method

A

Egg removed from ovaries and fertilised with sperm in a lab.

Fertilised egg is returned to the woman womb to grow and develop

19
Q

IVF - semen guidance

A

Semen must be produced within 1 hour of when it is required

20
Q

IVF - male must abstain from producing semen how long before it is needed?

A

For 72 hours

21
Q

IVF - overview of treatment stages

A
  1. Down regulation
  2. Ovarian stimulation
  3. Oocyte collection
  4. Fertilisation
  5. Transferring embryos and cryopreservation
22
Q

IVF treatment - 1. down regulation

A

Synthetic GnRH analogue or agonist is used (BUSERELIN)

  • give at day 21 of cycle
  • aim to suppress menstrual cycle which allows precise timing of ovulation
23
Q

IVF treatment - 1. down regulation - side effects

A

Menopausal side effects
- hot flushes, mood swings
Headaches

24
Q

IVF treatment - 2. Ovarian stimulation

A

Start on high dose gonadotrophin stimulation (FSH or hMG injection) to encourage ovaries to produce more eggs than usual.
US scan
- should be lots of follicles in the ovaries
- thickened endometrium

25
Q

IVF treatment - 3. oocyte collection

A

Needle inserted into ovaries to collect eggs and transport them to a cell culture medium incubated at 37 degrees

26
Q

IVF treatment - 4. fertilisation

A

Eggs are mixed with sperm for a few days to allow fertilisation to take place

27
Q

IVF treatment - 5. transferring embryos

A

At blastocyst stage, the best quality embryo is transferred into the womb of the female

28
Q

IVF treatment - how many embryos should be transferred back into the female?

A

Routinely: 1

Exceptional circumstacnes: 3

29
Q

IVF treatment - what is done after the embryo is transferred back into the patients womb

A

16 days later take a pregnancy test

30
Q

ICSI - method

A

Obtain sperm
Sperm can then be injected into the egg

Surgical sperm aspiration may be needed if
- azoospermia

31
Q

ICSI - where should you aspirate sperm from if obstructive?

A

Epididymis

32
Q

ICSI - where should you aspirate sperm from if non-obstructive?

A

Testicular tissue

33
Q

ICSI - indications

A

Severe male factor infertility

Previous failed IVF

34
Q

ICSI - procedure

A

Collected sperm is mobilised
Single sperm is injected into stripped egg
Incubate at 37 degrees overnight

35
Q

Donor insemination - indications

A

Azoospermia or very low count

36
Q

What should be attempted first - ICSI or donor insemination?

A

ICSI

- do donor insemination if ICSI fails

37
Q

Complications of assisted conception treatment

A

Multiple pregnancy
Ectopic pregnancy
Ovarian hyper-stimulation syndrome

38
Q

Complications of ACT - multiple pregnancy

A

Aim to resolve this by

  • transferring at blastocyst stage
  • only transferring one embryo into mothers womb
39
Q

Complications of ACT - ovarian hyper stimulation syndrome - why does this occur

A

Due to taking too much hormone medication

Reproduction SOH (50 decks)

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