Assisted Conception Techniques Flashcards

1
Q

Describe the menstrual cycle

A

Day 1- start of gradual increase in FSH driving follicular development. With this development, granulose cells form and secrete oestrogen lowering LH and FSH through negative feedback.
Day 12- oestrogen peaks, above the threshold so LH surge due to positive feedback.
36h after LH surge ovulation occurs and follicle becomes corpus luteum secreting progesterone (start of luteal phase) causing endometrium to be receptive to embryonic implantation.
Oestrogen + progesterone high = low LH and FSH
No fertilisation then corpus luteum degenerates so low oestrogen and progesterone = high LH and FSH so endometrium sheds

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2
Q

Describe the path of the egg

A

Day 1- released from ovary into uterine tube
Day 2/3- egg moves through uterine tube to be fertilised in ampulla
Day 4/5- blastocyst moves into uterine cavity
Day 5/6- blastocysts implants into wall

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3
Q

What is IUI

A

Intrauterine insemination- sperm is injected directly into the uterus

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4
Q

IUI success rate

A

5-10% - same as natural conception

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5
Q

NICE indications for IUI

A

same sex couple- sperm donation
inability to have sex due to pain or erectile dysfunction etc
male with HIV
mild male infertility, endometriosis, unexplained

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6
Q

Steps of natural cycle IUI

A

ultrasound tracks follicle growth

around day 14 sperm is injected

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7
Q

Steps of drug induced IUI

A

given GnRH analogies to suppress natural oestrogen so FSH is high to increase the no. of mature follicles. HCG trigger given to tiger ovulation as mimics the LH surge

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8
Q

What is IVF

A

In vitro fertilisation -stimulate ovaries to produce lots of eggs, harvest eggs, add/mix sperm and insert embryos into uterus for implantation

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9
Q

Indications for IVF

A
tubal disease 
anovulatory disease (PCOS)
unexplained
endometriosis - scarring of tubes, problems with implantation 
PGD
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10
Q

Steps for IVF

A
  1. counselling and consent- psychologically ready (success rate)
  2. pituitary suppression with GnRH analogues to prevent premature LH surge and ovulation
  3. ovarian stimulation with recombinant FSH for multi follicular development
  4. HCG triggering creating LH surge
  5. egg collection (transvaginal/transabdominal)
  6. insemination with sperm
  7. embryo culture
  8. embryo transfer under ultrasound guidance
  9. luteal support-given progesterone as corpus letup isn’t working no too thick endometrium
  10. 2 weeks later- pregnancy test
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11
Q

What is ICSI

A

intracytoplasmic sperm injection -problem with sperm fertilising

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12
Q

Benefits of using 5-6 day embryo culture over a shorter time frame

A

allows blastocyst to develop past significant stages-

  1. switching on embryonic genome
  2. stages of totipotency to differentiation
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13
Q

Problems with IIVF

A
  1. multiple pregnancies
  2. Ovarian hyperstimulation syndrome (OHSS)
  3. needle insertion can cause damage to bladder, bowel, blood vessels and infection
  4. congenital abnormalities and long term maternal risk
  5. very expensive
  6. very invasive
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14
Q

OHSS

A

ovarian hyperstimulation syndrome- too much FSH can cause over stimulation can cause system VC, ascites, oedema

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15
Q

PGD

A

pre-implantation genetic diagnosis

cystic fibrosis, huntingtons, sickle cell, DMD

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16
Q

PAS

A

pre-implantation aneuploidy screening

17
Q

Ethical arguments against IVF

A

same sex couples- no fertility problem so no funding
sex selection
couple splitting up before embryo transfer
fate of other embryos
should IVF be NHS funded
PGD- designer babies?