Assistive Reproductive Technology Flashcards
What is infertility?
failure to conceive after regular unprotected intercourse
-within 12 months in pts < 35 yrs old
-within 6 months in pts > 35 yrs old
What happens to ovarian reserves with age?
ovarian reserves decline with age
-most important factor in female infertility is age
-as reserves decline, so do quality
How does maternal age affect IVF success?
as we move up in maternal age, there is a significant decline in live birth rate
What are the factors that may contribute to female infertility?
ovulatory disorders
tubal factors
endometriosis
cervical factors
unexplained
What are the factors that may contribute to male infertility?
sperm production issues
genetic factors
ejaculatory dysfunction
lifestyle
environmental
Why are we seeing an increase in infertility rates?
increased maternal age
starting families later
people talk about it and share
What is ovulation induction?
letrozole or clomiphene
timed intercourse
with or without “trigger” short
What is super ovulation?
ovaries are stimulated with hormones to produce follicles
goal: produce 2-4 eggs
often combined with IUI
medications used for SO and IVF are the same
-lower dose with SO
What is intrauterine insemination?
inserting the sperm directly into the uterus
sperm are prepped prior to insertion
-separated in a centrifuge
-evaluated
-washed
may done +/- super ovulation
What is intracytoplasmic sperm injection?
injecting the sperm directly into the egg
may be used for:
-low sperm count
-impaired sperm penetration
-anti-sperm antibodies
-previous IVF failure
What are the steps in IVF?
tests & diagnosis
ovarian stimulation & control
egg retrieval
sperm collection/retrieval
fertilization
transfer
pregnancy test
Describe the ovarian stimulation stage of IVF.
stimulation of ovaries with hormones to produce follicles
typical IVF stimulation lasts 8-14 days
intense monitoring:
-estrogen, progesterone, follicle development and size
What are some FSH agents?
follitropin alpha
follitropin beta
follitropin delta
What is an LH agent?
lutropin alfa
What is the purpose of the control stage of IVF?
control to prevent premature ovulation using GnRH agonists or antagonists
-so that we get egg collection at the right time (tighter control over ovulation)
What are examples of GnRH agonists?
leuprolide
nafarelin
buserelin
What are examples of GnRH antagonists?
ganirelix
cetrorelix
How do GnRH agonists work?
binding to pituitary receptors
induce release of large amounts of FSH and LH (flare-up)
increase GnRH receptors (upregulation)
prolonged use (7-10 days) = decrease in GnRH receptors and hence a decrease in gonadtropins
How do GnRH antagonists work?
competitively binding GnRH receptors to prevent endogenous pulses on the pituitary
work relatively quickly (within hours of admin) and no “flare-ups” occur
d/c rapidly results in recovery of the pituitary-gonadal axis
highly dose dependent
Which protocol is most common for ovarian stimulation?
GnRH antagonist protocol
What is a good practice tip for IVF?
patients will be given a timetable
-ask if they have one and then put a copy on file
What is a risk of ovarian stimulation?
ovarian hyperstimulation syndrome
-ovaries are over stimulated
-intensely monitored by clinic, modifications can be made
-very painful
-possibly detrimental
What is the trigger shot used for oocyte retrieval?
HCG
choriogondatrophin alpha
What is the role of the trigger shot?
matures egg and prepares for ovulation
When does oocyte retrieval occur?
34-36 hours after trigger shot
-timing is of the utmost importance
-ideally retrieve 10-12 well developed oocytes
What is luteal phase support?
progesterone to support the pregnancy
-changes endometrium from follicular to luteal phase
-helps create a ready wall for when embryo comes back
When is sperm collection ideally done?
ideally obtained day of oocyte retrieval
-collection of fresh sperm
When should fertilization occur?
18-24 hours after exposing oocyte to sperm
What happens once fertilization has occured?
embryos are transferred to a growth medium, assessed & incubated for 24 hours
When does transfer occur?
day 2 or 3 (embryo transfer)
day 5 (blastocyst transfer)
How many embryos/blastocysts are transferred?
usually 1 or 2
-3 to 4 may be transferred
What are the side effects of the medications used in IVF?
headache
mood changes
injection site discomfort, bruising
hot flashes
breast tenderness
wheal response
bloating
constipation
nausea, cramping
fatigue and exhaustion
What are the success rates of IVF?
60-70% of couples treated for infertility end up with a healthy child
Why use cryopreservation?
donor and carrier synchronization/timing issues
suboptimal uterine environment during start of ART
issues discovered during process
preservation of reproductive material
decreases future costs if lots of embryos to freeze
freeze to decrease damage of repeated procedures if retrieval required
