Assisted conception Flashcards by Sheryl O'Hare

Definition

Any treatment which involves gametes outside of the body

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Why is demand increasing?

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

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

Up to 3 cycles

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

False

- it can be used for same sex couples

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What is the role of a surrogate ?

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

True

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Female alcohol limit before treatment

Less than 4 units per week

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Male alcohol limit before treatment

Less than 14 units per week

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Smoking guidance before treatment

Stop smoking (including e-cigarettes)

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Weight guidance before treatment

Aim for BMI between 19 and 29

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

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

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Recreational drugs guidelines before treatment

Must be abstinent from recreational drugs for at least 1 year

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Name 5 forms of ACT available

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

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Indications for intra-uterine insemination

Sexual problems
Same sex relationships
Abandonded IVF

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intra-uterine insemination - method

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

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IVF - indications

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

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

Try IVF

IVF - method

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

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

IVF - semen guidance

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

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

For 72 hours

IVF - overview of treatment stages

Down regulation
Ovarian stimulation
Oocyte collection
Fertilisation
Transferring embryos and cryopreservation

IVF treatment - 1. down regulation

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

IVF treatment - 1. down regulation - side effects

Menopausal side effects
- hot flushes, mood swings
Headaches

IVF treatment - 2. Ovarian stimulation

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

IVF treatment - 3. oocyte collection

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

IVF treatment - 4. fertilisation

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

IVF treatment - 5. transferring embryos

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

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

Routinely: 1 | Exceptional circumstacnes: 3

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

16 days later take a pregnancy test

ICSI - method

Obtain sperm Sperm can then be injected into the egg Surgical sperm aspiration may be needed if - azoospermia

ICSI - where should you aspirate sperm from if obstructive?

Epididymis

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

Testicular tissue

ICSI - indications

Severe male factor infertility | Previous failed IVF

ICSI - procedure

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

Donor insemination - indications

Azoospermia or very low count

What should be attempted first - ICSI or donor insemination?

ICSI | - do donor insemination if ICSI fails

Complications of assisted conception treatment

Multiple pregnancy Ectopic pregnancy Ovarian hyper-stimulation syndrome

Complications of ACT - multiple pregnancy

Aim to resolve this by - transferring at blastocyst stage - only transferring one embryo into mothers womb

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

Due to taking too much hormone medication