Assisted Conception Treatment

Question 1

What is ACT?

Answer 1

any treatment that involves gametes outside of the body

Question 2

Why are demands for ACT rising?

Answer 2

increase in parental age
increase in clamidya
male factor infertility
increasing range of ACT
increase in sucess rates

Question 3

What pre treatment measures must be taken for ACT?

Answer 3

limit alcohol to 4 units per week
BMi 19-29 optimal for both males and females
stop smoking
0.4mg a day folic acid pre conception -> 12 weeks gestation
immunise to rubella
screen for blood borne viruses - hep B/C, hIV
assess ovarian reserve - antral follicle count or AMH

Question 4

What are the avaliable ACTs?

Answer 4

Donor insemination - IUI
Surrogacy
IVF
Fertility prevention
ICSI

Question 5

When is IUI - intra uterine insemination - used?

Answer 5

sexual problems
same sex relationship
discordant blood bourne virus
abandoned IVF

Question 6

What is the process of IUI?

Answer 6

prepared semen is inserted into the uterine cavity around the time of ovulation
can be in a natural or stimulated cycle

Question 7

When is IVF indicated?

Answer 7

unexplained inability to concieve (>2 yrs trying)
pelvic disease - endometriosis, tubual disease, fibroids
anovulatory infertility - after failed ovulation induction
failed intra uterine insemination - after 6 cycles

Question 8

What is the method of IVF?

Answer 8

1. down regulation using synthetic GnRH analogue, allows precise timing of oocyte recovery due to being able to detect HCG levels. Scan then performed
2. ovarian stimulation by self administered GnRH injctions, late at night - causes follicular development
3. oocyte collection - done in theatre
4. fertilisation
5. embryo is transferred and cryropreserved, progesterone is given for luteal support

Question 9

When should a preganancy test be taken after IVF?

Answer 9

16 days afer oocyte recovery

Question 10

When is the embryo transferred in IVF?

Answer 10

day 5 - blastocyst stage

Question 11

What are the side effects of the GnRH analogues?

Answer 11

mood swings
hot flushes
headaches
nasal irritation

Question 12

What conditions must the semen be in for IVF?

Answer 12

abstinence for 72 hours

Question 13

When is Intra Cytoplasmic Sperm injection (ICSI) indicated?

Answer 13

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

Question 14

What is the method for ICSI?

Answer 14

each egg is stripped and the sperm is immobilised
a single sperm is injected and it is incubated at 37 degrees overnight

if azoospermia need to do a surgical sperm aspiration

• from epididymis if obstruction
• from testicular tissue if non obstructive

Question 15

What are some of the complications of ACT?

Answer 15

ovarian hyperstimulation syndrome
multiple pregnancy
ectopic pregnancy

Question 16

What is the presentation of ovarian hyperstimulation syndrome?

Answer 16

affects 1% of patients
mild - severe
abdo bloating and pain
ovarian size up to >12cm
can cause thromboembolism and resp distress syndrome

Question 17

How common is multiple pregnancy with ACT?

Answer 17

10%

Question 18

How do you reduce risk of multiple pregnancy with ACT?

Answer 18

move to blastocyst transfer
improved cryropreservation
increase in single embryo transfer

Question 19

How common is ectopic pregnancy with IVF?

Answer 19

2-3x increase