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Reproduction > Assisted Conception > Flashcards

Assisted Conception Flashcards

1
Q

what is assisted conception treatment

A

any treatment which involves the gametes outside the body

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2
Q

how may couples need ACT

A

50% of the 1 in 6 couples that have infertility assessments

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3
Q

why is the demand in ACT rising

A 
increasing parental age
increasing chlamydia 
male factor infertility 
increasing range of ACT options 
improved success rate
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4
Q

how long should patients be waiting for IVF

A

less than 12 months

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5
Q

what are the indications for ART (aka ACT)

A 
endometriosis
male factor infertility 
tubal disease 
multiple male and female factors 
unexplained 
ovulatory disorder 
multiple female factors 
same sex/ single couples 
transgender referrals 
fertility preservation (cancer, transgender, social reasons) 
avoiding transmission of BBVs
pre-implantation diagnosis of inherited disorders
treatment with surrogacy when absent/ abnormal uterus
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6
Q

what is ICSI

A

intra cytoplasmic sperm injection

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7
Q

what is IVF

A

in vitro fertilisation

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8
Q

what must the patients do before starting ART

A

limit alcohol to 4 units per week
BMI 19-29
advise to stop smoking
folic acid 0.4mg/day preconception- 12 weeks gestation (5mg if increased risk of NTD/ obese)
rubella screen + immunisation
cervical smears
avoid exposure to hazards
drugs (prescribes, OTC, recreation) review
screen for BBV (hep b/c and HIV)
assess ovarian reserve (antral follicle count or AMH)
counselling

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9
Q

why is it important to assess ovarian reserve

A

predicts ovaries response to the treatment, helps prevent overstimulation

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10
Q

what are the types of ARTreatments available

A 
donor insertion 
intra uterine insemination 
intra-cytoplasmic sperm injection 
fertility preservation 
surrogacy
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11
Q

what are the indications for an intra uterine insemination (IUI)

A 
sexual problems (cant achieve penetrative intercourse) 
same sex relationships
discordant BBV/ abandoned IVF
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12
Q

what is the method of IUI

A

can be in natural or stimulated cycle (inject gonadotrophins to stimulate cycle)

prepared semen inserted into uterine cavity around time of ovulation

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13
Q

what are the indications for in vitro fertilisation (IVF)

A 
unexplained (>2 years) infertility 
pelvic disease (endometriosis, tubal disease, fibroids) 
anovulatory infertility (after failed ovulation induction) 
failed intra uterine insemination (after 6 cycles)
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14
Q

what causes the dominant follicle to be released

A

LH surge

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15
Q

what is the tonic phase of follicular development

A

primary and secondary follicles develop into antral follicles

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16
Q

what is the growth phase of follicular development

A

antral follicles 35 mm to pre ovulatory follicle

this stage is dependent on gonadotrophins

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17
Q

what do gonadotrophins cause in early follicular phase

A

synchronised growth of all follicles

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18
Q

what is down regulation in IVF

A

when a synthetic GnRH analogue/ agonist is given
reduces LF and FSH secreted from pituitary - switches off ovaries
this ensures eggs are not released from the follicles before they are collected
allows precises timing of oocyte recovery using HCG trigger

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19
Q

what SEs can down regulation cause

A

hot flushes and mood swings
nasal irritation
headaches

20
Q

what does a down regulation (baseline) scan look for in IVF

A

hopefully no follicle development, no cysts and thin endometrium

21
Q

what is the first stage in IVF

A

down regulation injections- allows better control of follicle development

22
Q

what step follows the baseline (down regulation scan) in IVF

A 
ovarian stimulation via gonadotrophins 
self administered (injections)
causes follicular development
23
Q

what do the post stimulation scan do in IVF

A

measures follicle size and thickness of endometrium

allows planning/ timing of HCG injection

24
Q

what does the hCG injection do in IVF

A

mimic LH causing meiosis to begin again in the oocyte

25
Q

when is the hCG injection given in IVF

A

36 hours before oocyte recovery

26
Q

what are the prerequisites for semen collection

A

abstinence for 72 hours beforehand

needs to be analysed within 1 hour

27
Q

what is assessed in sperm analysis

A

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

28
Q

how is sperm prepared in IVF

A

remove seminal plasma and concentrate

29
Q

what are the risks of oocyte collection

A

bleeding
pelvic infection
failure to obtain oocytes
injury to bowel/bladder

30
Q

what is formed immediately after fertilisation

A

two pronuclei

31
Q

at what stage is the embryo transferred/ cryopreserved (IVF)

A

blastocyst stage

32
Q

how many embryos are tranferred into patient (IVF)

A

normally 1 (up to three but in exceptional circumstances)

33
Q

what is done after embryo transfer (IVF)

A

luteal support progesterone suppositories for 2 weeks

pregnancy test 16 days after oocyte recovery

34
Q

what are the indications for intra cytoplasmic sperm injection

A

severe male factor infertility
previous failed fertilisation with IVF
preimplantation genetic diagnosis

35
Q

what is required if there is azoospermia

A

surgical sperm aspiration (extracted from epididymis if obstructive or testicular tissue if non obstructive)

36
Q

how many sperm are injected to egg in ICSI

A

one

37
Q

what temp are embryos incubated at

A

37 degrees

38
Q

what syndrome is a possible complication of ART

A

ovarian hyperstimulation syndrome:

39
Q

what causes clots and ascites in ovarian hyperstimulation syndrome

A

LH causes fluid shift

40
Q

how do you prevent ovarian hyper stimulation syndrome

A

low dose protocols

use of antagonist

41
Q

what is the treatment of ovarian hyper stimulation syndrome

A

before embryo transfer:

  • elective freeze
  • single embryo transfer

treatment after embryo transfer:

  • monitoring with scans and bloods
  • reduce risk of thrombosis (fluids, TED stockings, fragmin)
  • analgesia
  • hospital admission if requiring IV fluids/ more intensive monitoring/ paracentesis
42
Q

how many ARTs result in multiple pregnancies

A

10%

43
Q

which ART has highest risk of ectopic pregnancy

A

IVF

44
Q

what are the surgical risk of sperm retrieval

A

haematoma

infection

45
Q

what risks during pregnancy are increased in ART

A

miscarriage
prematurity
growth retardation
congenital abnormalities

46
Q

what is the overall IVF success rate

A

35%

Reproduction (51 decks)

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