Assisted Conception Service Flashcards
How many couples experience problems with infertility?
1 in 7 heterosexual couples
How is infertility defined?
1 year of unprotected vaginal intercourse in the absence of known causes of infertility in women of reproductive age
How can occupation be relevant to history taking in terms of infertility?
People can be exposed to chemicals and toxins which decrease semen quality through their work
men who drive for long periods of time as part of their work will increase their scrotal temperature and thus decrease the quality of their semen
People who take recreational drugs are eligible for infertility treatment on the NHS. T/F?
False
A women’s BMI must be between what range in order to qualify for infertility treatment on the NHS?
18.5-30
What procedures should be undertaken initially in primary care if a couple presents with infertility?
Chlamydia and gonorrhoea swabs
BMI calculation
Enquire about rubella status
Educate on important of cervical smears
What percentage of cases of infertility does an ovulation account for?
25%
What test is carried out to see if a women is ovulating or not?
A progesterone test 7 days before the start of the next period
Antral follicles can be seen as a dark ‘string-of-pearl’ shaped ring in the uterus on ultrasound. What would constitute a normal astral follicle count?
4-16
What is the normal range for anti-mullerian hormone for women of reproductive age?
5.4pmol/l - 25pmol/l
At what point in a women’s reproductive cycle should baseline FSH and LH assessment be carried out?
First 1-3 days of the period
What is the normal ratio of FSH to LH?
FSH should be 1.5 times greater than LH
85% of cases of an ovulation are due to…?
Hypothalamic-pituitary-ovarian axis dysfunction
Only 5% of cases of an ovulation are due to…?
Ovarian failure
How is ovarian failure treated in infertile women?
Oocyte donation
How is hypothalamic-pituitary dysfunction treated in infertile women?
Lifestyle adjustment
Gonadotrophins with LH
How is hypothalamic-pituitary-ovarian axis dysfunction create din infertile women?
Gonadotrophinstrophins / letrozole / metformin
What percentage of cases of infertility does semen dysfunction account for?
30%
What is the normal pH of semen?
7.2
What is the normal concentration of sperm in semen?
15 million sperm per ml of semen
What should the total sperm count per ejaculate be?
39 million sperm
What percentage of sperm in a semen sample should be progressively mobile?
40%
How soon do samples of semen for analysis need to be received by the lab after they are produced?
1 hour
What treatments can be offered for infertility due to semen dysfunction?
IUI and ICSI
What is ICSI?
A procedure where sperm is injected directly into the cytoplasm of the egg
What is IUI?
Artificial insemination using a sperm donor
What investigations should be carried out into male fertility?
Karyotyping Check for Cystic Fibrosis Check FSH levels Semen analysis Look for blockage of urethra or ductus deferent
What percentage of cases of infertility does uterine tube dysfunction account for?
20%
What procedures can be used to investigate the uterine tubes for infertility?
Hystero contrast sonography
hysterosalpinography
laparoscopy with dye
What treatments are available for infertility due to uterine tube dysfunction?
IVF
clipping
salpingectomy
What percentage of cases of infertility do disorders of the uterus and/or peritoneum account for?
10%
When is an endometrial scratch treatment used in infertility clinics?
If there is recurrent implantation failure
What treatments can be used for infertility caused by uterine and peritoneal disorders?
Laparoscopic disthermy
Septoplasty
Endometrial scratch
What percentage of cases of infertility have no known cause?
25%
How is infertility of unknown cause treated?
IVF
A maximum of how many embryos can be inserted into the uterus of a women under the age of 40?
2
What percentage of couples who receive IVF treatment will go on to have a baby?
33%
A maximum of how many embryos can be inserted into the uterus of a woman between the age of 40 and 42?
3
When collecting eggs for IVF/ICSI treatment, a women is given a hormone injection to down regulate the normal reproductive cycle on which day of her cycle?
Day 21
Following her period, a woman will be given injections of which hormone for 8-15 days to stimulate oocyte production for IVF/ICSI treatment?
FSH
To collect oocytes for IVF treatment, a woman is given a final hCG booster injection how many hours before egg retrieval?
38 hours
How are the oocytes collected from a woman for iVF treatment?
Aspiration guided by ultrasound
How is ICSI different from IVF?
Rather than just mixing sperm and oocytes together and waiting for fertilisation to occur as in IVF, with ICSI an embryologist injects a single sperm into the cytoplasm of the oocyte.
In what year did Scotland update its provision of IVF and ICSI to allow funding for 3 cycles of IVF/ICSI for eligible couples?
2017
