Assisted Reproduction

Question 1

What is IUI?

Answer 1

• intrauterine insemination - sperm in placed in the uterine cavity by a catheter

Question 2

What are the indications that NICE list for IUI?

Answer 2

• same sex couples
• inability to have sexual intercourse
• male with HIV
• mild male factor, mild endometriosis, unexplained infertility

Question 3

What are the steps of IUI?

Answer 3

• with or without ovarian stimulation (FSH and/or clomiphene) –> aim for no more than 3 follicles
• with or without hCG triggering (ovulation)
• sperm preparation and IUI
• pregnancy test two weeks later

Question 4

What are the problems with IUI?

Answer 4

• low success rate - 5-10% per stimulated cycle
• multiple pregnancy: 10%
• cost £500
• invasive

Question 5

What are the steps of IVF?

Answer 5

• Counselling and consenting
• Pituitary suppression with GnRH
• Ovarian stimulation via rFSH
• hCG triggering (final maturation)
• egg collection (TV or TA)
• insemination or ICSI
• embryo culturing (2, 3 or 5 days)
• embryo transfer
• luteal support
• pregnancy test after 2 weeks

Question 6

What is the appropriate timing for egg collection?

Answer 6

• oocyctes fully mature but not travelling down fallopian tube
• hCG 34-36 hours prior to egg collection

Question 7

What does ICSI stand for?

When is it used?

Answer 7

intracytoplasmic sperm injection

• used inc cases of sperm dysfunction, fertilisation failure
• cryptozoospermia (low quality sperm)
• surgical sperm retreivable
• no benefit to ICSI in cases where sperm parameters are normal and there is no history of failed fertilisation

Question 8

What are the stages from sperm and egg to hatched blastocyst?

Answer 8

Sperm + Egg
Fertilised Egg
Cleaving embryo
Hatching blastocyst
Hatched blastocyst

Question 9

Why are embryos implanted at the blastocyst stage and not earlier?

Answer 9

Development of the blastocyst passes significant hurdles:
- switching on of embryonic genome
- past stages of totipotency to first differentiation
Can then do non-invasive embryo selection. You know you have implanted embryos that are capable of development

Question 10

What are the problems with IVF?

Answer 10

• multiple pregnancies
• OHSS
• TVOR related risks: injury to bladder, bowel, blood vessels, infection
• risk of congenital abnormalities
• long-term maternal rsks
• cost: £3.5k
• very invasive

Question 11

What are the potential risks of cryopreservation?

Answer 11

• general risks include the possible transmission of infective agents via liquid nitrogen

Question 12

When can donated oocytes be used?

Answer 12

• ovarian failure
• premature menopause
• Turner’s syndrome
• surgical loss of ovaries
• female partner carrier of inheritable disease

Question 13

What is the role of the HFEA?

Answer 13

• Uk’s independent regulator overseeing the use of gametes and embryos in fertility treatment and research
• licenses fertility clinics and centres carrying out IVF, other assisted conception procedures and human embryo research
• success rates by clinics
• information provision for patients and professionals

Question 14

What is pre-implantation genetic diagnosis?

Answer 14

• removal of one or two cells from the early embryo for genetic analysis, where there is a risk of genetic disease - diagnosis may also be made from polar body analysis
• single gene disorders and balanced translocations e.g. CF, huntington’s, sickle cell, muscular dystrophies

Question 15

What is pre-implantation aneuploidy screening?

Answer 15

• removal of one or two cells for chomromsal analysis in order to select embryos with normal karyotypes

Question 16

Consider the moral and ethical arguments surrounding ART

Answer 16

• same sex couples
• donor treatment
• sex selection
• couples splitting before embryo transfer
• fate of surplus embryos
• NHS funding
• PGD - designer babies, eye colour, height
• embryo research