Assisted Reproductive Technology Flashcards
Ovulation induction (OI) refers to…
Inducing ovulation with medications, and having timed intercourse based on menstrual cycle
Clomiphene, letrozole
Super ovulation (SO) refers to…
Ovaries stimualted with hormones to produce follicles - goal to produce 2-4 eggs
Often combined with IUI +/- normal intercourse
Intrauterine insemination (IUI) refers to…
Inserting sperm directly into the uterus - sperm prepper priot to insertion
May be done +/- superovulation
Intra-cytoplasmic sperm injection refers (ICSI) to…
Injecting sperm directly into the egg
ICSI may be used for…
Low sperm count
Impaired sperm penetration
Anti-sperm antibodies
Previous IVF failure
Stage 1a of IVF is…
+ briefly describe
Stimulation of ovaries with hormones, to produce follicles
Factors that are intensely monitored during IVF stimulation include…
Levels of estrogen + progesterone
Follicular development and size
These are the drugs used to induce stimulation…
FSH + LH formulations
No Dosed in units based on what body needs + their response
Sources of hormones are typically either ____ or ____.
Urinary or recombinant
Differences between urinary and recombinant sources of hormones is that…
Urinary sources are a combo of FSH and LH - recombinant sources are separate components
Also likely to see a physical response from urinary sources (wheal)
Stage 1b of IVF is…
Control - prevent premature ovulation using GnRH agonists/antagonists
GnRH agonists include…
Leuprolide
Nafarelin acetate
Buserelin
GnRH antagonists include:
Ganirelix
Cetrorelix
Recall that GnRH agonists work by…
Binding to pituitary receptors, to induce release of large amounts of FSH + LH (Flare-up). Prolonged use ~7-10 days results in down-regulation of GnRH receptors, decreasing gonadotropins
GnRH antagonists work by…
Competitively binding GnRH receptors to prevent endogenous pulses on pituitary. Work relatively quickly and no “flare-up” occurs
Discontinuation rapidly results in recovery of pituitary-gonadal axis
Some protocols for stage 1b IVF include…
GnRH antagonist protocol
GnRH agonist short protocol
GnRH agonist long protocol
Long protocol is less common due to flare-up
Considerations for choosing a specific IVF control protocol includes…
Previous experience
Good or poor responder
Risk of hyperstimulation or premature ovulation
Number of injections
A good practice point when assisting a patient with their control protocol is…
Ask if they have a timetable for reference
A risk of ovarian stimulation is ____, which is when…
Ovarian hyperstimulation syndrome (OHSS) - ovaries are over stimulated, and presence of many follicles can lead to enlargement of the ovary.
Very painful, possibly detrimental (ovary burst)
Intensely monitored by clinic, and modifications to protocol will be made
Risk of OHSS is correlated with…
Number of eggs received
Stage 2 of IVF is…
Oocyte retrieval
Oocyte retrieval requires this medication…
“Trigger” shot - HCG
Matures egg, prepares for ovulation
“Loosens” up follicles
Oocyte retreival occurs ____ after the trigger shot.
34-36 hours
After oocyte retrieval, luteal phase support is done which consists of…
Progesterone to support pregnancy (Local OK)
Changes endometrium from follicular to luteal phase, makes nice environment for embryo
Stage 3 of IVF is…
Sperm collection/retrieval
Fresh sperm
Collection of fresh sperm is ideally obtained…
On the day of oocyte retrieval
Needs to be separated and evaluated
Retrieval of sperm may be required due to…
Obstructive/non-obstructive reasons
Neurological issues
Retrograde ejaculation
Stage 4 of IVF is…
Fertilization + Culture
Fertilization should occur within ____ after exposing oocyte to sperm
18-24 hours
Once fertilization has occurred, embryos are…
Transferred to a growth medium, assessed and incubated for 24 hours
Stage 5 of IVF is…
Transfer
IVF transfer occurs on…
Day 2 or 3 (embryo transfer)
Day 5 (Blastocyst transfer)
Dependent on factors such as previous pregnancies, maternal age, medical history…
