Clinical overview of IVF Flashcards
What is oligospermia?
reduced sperm concentration
What is asthenospermia?
Reduced sperm motility
What is teratospermia?
Low morphology of sperm
What is azoospermia?
No sperm in ejaculate :(
In what circumstance might you collect sperm from a patients urine?
retrograde ejaculation
What is PESA?
percutaneous epididymal sperm aspiration (removal of sperm from epididymis via aspiration needle)
What is TESE?
testicular sperm extraction
In what case would you need to use TESE?
When the cause of azoospermia means that there is not even any sperm in the epididymis.
What factors are considered when planning a controlled ovarian hyperstimulation protocol?
age, ovarian reserve, body weight, antral follicle count
How can you measure ovarian reserve?
baseline FSH, LH and AMH levels (2-3 day of period)
What is the FSH threshold concept?
in IVF, an increased level of FSH is given for a longer period of time than in a natural cycle. This can cause a premature LH surge, losing the eggs matured through IVF treatment.
How can FSH threshold be combatted in clinic?
Pituitary downregulation (GnRH analogues or pituitary antagonist)
How does a GnRH agonist work?
GnRH analogue first stimulates pituitary gland for a couple of days then pituitary is supressed due to constant activation (normally accustomed to pulsatile signals)
What is the limitation of GnRH agonists for pituitary supression?
Must be administered the cycle prior to ovarian hyperstimulation
How does a pituitary antagonist work?
immediately down regulates pituitary gland (binds at GnRH site without illiciting normal response)
What is the criteria for follicle stimulation?
at least 3 follicles bigger than 17mm
What hormones are used to simulate the LH surge?
hCG, LH and GnRH agonist
How are oocytes recovered and when?
trans vaginally at 34-36h after LH treatment
How is the blastocyst transferred to the uterus?
A catheter is inserted as a protective tunnel. The embryo is transferred in a catheter inside the protective catheter to the desired location. All done via ultrasound.
At implantation, what hormones might women be supplemented with to help support implantation?
progesterone, to help build up the endometrium
hCG
Why might there be low progesterone levels in a women undergoing IVF?
When the oocytes are extracted, some granulosa cells are also extracted. This means the corpus luteum is not sufficient to produce prolonged progesterone to support endometrial build up.
What would you see in an ultrasound to confirm a clinical pregnancy?
Gestation sack = bean shaped embryo and a yolk sack
What is a pseudo gestational sack?
A structure identified by ultra sound in the uterus, in women suffering from ectopic pregnancy. (no actual embryo in der)
What is the current biggest limiting factor of succesful IVF?
implantation failure
