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Y3 Reproductive > Assisted Conception, Ethics & TOP > Flashcards

Assisted Conception, Ethics & TOP Flashcards

1
Q

How many couple in the UK have fertility problem?

A

1 in 6

half of these receive some form of Tx

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2
Q

Name 5 methods of assisted conception

A 
IVF
Intra-uterine insemination
ICSI
Donor insemination
Surrogacy
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3
Q

How long must a couple have been ‘trying’ to qualify for ACT?

A

2 years

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4
Q

What BMI range must both partners be in to qualify for ACT?

A

18.5-30

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5
Q

What are the lifestyle components of the criteria for ACT?

A

Neither partner smokes for pre 3 months + during ACT
Females must drunk <4 units / wk
Abstain drugs 1 yr

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6
Q

If 1 partner has a biological kid, can a couple still qualify for ACT?

A

Yes

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7
Q

If 1 partner has been sterilised in the past, can a couple still qualify for ACT?

A

No

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8
Q

What infections must you screen for in the assessment for ACT?

A

HIV
HCV
HBV
Rubella immunity

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9
Q

When must you take folic acid for ACT?

A

Pre 12 wk
+
1st 12wk

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10
Q

How many cycles of ACT can a couple receive on the NHS?

A

3

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11
Q

Method of intrauterine insemination:

prepared ______ inserted into _______ at time of ______

A

Method of intrauterine insemination:

prepared SEMEN inserted into UTERINE CAVITY at time of OVULATION

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12
Q

What is the success rate of IVF?

A

35%

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13
Q

What is the success rate of ICSI?

A

35%

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14
Q

Method of IVF:

  1. give woman synthetic ____ and perform _____ on male.
  2. ___ hours before oocyte recovery inject ____.
  3. Collect ____ in theatre.
  4. Incubate ____ at ___ degrees in culture medium.
  5. Transfer _____ on day ____ or cryopreservation.
A

Method of IVF:

  1. give woman synthetic GnRN and perform SPERM ANALYSIS on male.
  2. 36 hours before oocyte recovery inject HCG.
  3. Collect EGGS in theatre.
  4. Incubate EGGS at 37 degrees in culture medium.
  5. Transfer BLASTOCYST on day 5 or cryopreservation.
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15
Q

What is test in semen analysis?

A

Vol
No.
Motility
Progression

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16
Q

On what day after insertion should you perform a pregnancy test in IVF?

A

Day 16

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17
Q

How is azoospermia classified?

A

Obstructive and non-obstructive

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18
Q

What procedure is indicated in obstructive azoospermia?

A

Surgical sperm aspiration from testis

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19
Q

What procedure is indicated in non-obstructive azoospermia?

A

Surgical sperm aspiration from epididymis

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20
Q

In donor insemination, at what time is the semen inserted into the uterus?

A

Time of ovulation

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21
Q

What conditions of pregnancy are more common in assisted conception?

A

Ectopic pregnancy
Multiple pregnancy
Ovarian hyper-stimulation synd
Misscarriage

22
Q

What is done to prevent ovarian hyper-stimulation synd in ACT?

A

Single embryo transfer at a cycle

23
Q

What is the management of ovarian hyper-stimulation synd?

A

Fluids (thrombosis prophylaxis)
TED stocking
Fragmin

24
Q

Does a fetus have legal rights?

A

No

25
Q

Is sex selection in assisted conception legal?

A

Illegal unless serious medical condition related to gender

26
Q

Is an embryo with 2 genetic mothers legal?

A

Only approved to Tx serious mitochondrial diseases

27
Q

Is embryo research legal in the UK?

A

Yes, up to 14 days (when primitive streak appears)

28
Q

Is preimplantation tissue typing legal in the UK?

A

Only for stem cell Tx of sibling w serious/life-threatening condition

29
Q

What guidelines are used to asses capacity to consent in under 16 year olds?

A

Fraser guidelines

Guilick competence

30
Q

At what age should you always report underage sex?

A

Under 13 years

31
Q

Can 2 14 year old consent to sex?

A

Assess consent on individual basis - potentialy

32
Q

What are the emergency grounds for termination of pregnancy?

A

Save mums life or prevent grave permanent physical/ mental injury

33
Q

If someone under 16 requests termination of pregnancy, do you have to tell their parents?

A

No, advise them to do so

34
Q

A doctor can conscientiously object to termination of pregnancy. T or F

A

Partially true, cannot object to emergency abortion

35
Q

If a doctor conscientiously objects to termination of pregnancy, what must they do?

A

Explain to patient themselves and arrange for another Dr. to take role

36
Q

Who must assess a request for TOP for it to be made?

A

2 qualified medical practitioners must deem justified

37
Q

What are the 2 main methods of TOP?

A

Medical and surgical

38
Q

What antibiotic is given as prophylaxis to surgical methods of TOP?

A

Metron

39
Q

What is the gestation limit to TOP and what are the exceptional circumstances?

A

Social reason - 23wk 6 day

Fetal anomaly - any wk

40
Q

What is involved in the method of medical TOP?

A

PO mifepristone anti-progesteren

After 24-48hr VAG/PO prostaglandin induce contractions

41
Q

What are the methods of surgical TOP?

A

Vacuum aspiration and dilatation plus evacuation

42
Q

How many weeks gestation can vacuum aspiration TOP be performed?

A

6-12wk

43
Q

What drug is given in the surgical method of TOP to prime the cervix?

A

VAG prostaglandin

44
Q

How many weeks gestation can vacuum aspiration + dilatation TOP be performed?

A

13-24wk

45
Q

Name the prostaglandins used in TOP

A

VAG misoprostol

PO gemeprost

46
Q

What increases the likeliness of haemorrhage in TOP?

A

Further gestation

47
Q

Following TOP in rhesus -ve women, how many hours after is anti-D injected?

A

72hours

48
Q

How long after TOP is a pregnancy test performed

A

(urine) pregnancy test after 2-3wk

49
Q

How long after TOP can oral contraception be initiated?

A

Immediately

50
Q

How long after TOP can combined transdermal patch be initiated?

A

Immediately

51
Q

How long after TOP can the depot be injected?

A

Not immediately - how long??

52
Q

How long after TOP can the implant be inserted?

A

Immediately

Y3 Reproductive (28 decks)

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