Clinical overview of IVF

Question 1

What is oligospermia?

Answer 1

reduced sperm concentration

Question 2

What is asthenospermia?

Answer 2

Reduced sperm motility

Question 3

What is teratospermia?

Answer 3

Low morphology of sperm

Question 4

What is azoospermia?

Answer 4

No sperm in ejaculate :(

Question 5

In what circumstance might you collect sperm from a patients urine?

Answer 5

retrograde ejaculation

Question 6

What is PESA?

Answer 6

percutaneous epididymal sperm aspiration (removal of sperm from epididymis via aspiration needle)

Question 7

What is TESE?

Answer 7

testicular sperm extraction

Question 8

In what case would you need to use TESE?

Answer 8

When the cause of azoospermia means that there is not even any sperm in the epididymis.

Question 9

What factors are considered when planning a controlled ovarian hyperstimulation protocol?

Answer 9

age, ovarian reserve, body weight, antral follicle count

Question 10

How can you measure ovarian reserve?

Answer 10

baseline FSH, LH and AMH levels (2-3 day of period)

Question 11

What is the FSH threshold concept?

Answer 11

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.

Question 12

How can FSH threshold be combatted in clinic?

Answer 12

Pituitary downregulation (GnRH analogues or pituitary antagonist)

Question 13

How does a GnRH agonist work?

Answer 13

GnRH analogue first stimulates pituitary gland for a couple of days then pituitary is supressed due to constant activation (normally accustomed to pulsatile signals)

Question 14

What is the limitation of GnRH agonists for pituitary supression?

Answer 14

Must be administered the cycle prior to ovarian hyperstimulation

Question 15

How does a pituitary antagonist work?

Answer 15

immediately down regulates pituitary gland (binds at GnRH site without illiciting normal response)

Question 16

What is the criteria for follicle stimulation?

Answer 16

at least 3 follicles bigger than 17mm

Question 17

What hormones are used to simulate the LH surge?

Answer 17

hCG, LH and GnRH agonist

Question 18

How are oocytes recovered and when?

Answer 18

trans vaginally at 34-36h after LH treatment

Question 19

How is the blastocyst transferred to the uterus?

Answer 19

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.

Question 20

At implantation, what hormones might women be supplemented with to help support implantation?

Answer 20

progesterone, to help build up the endometrium

hCG

Question 21

Why might there be low progesterone levels in a women undergoing IVF?

Answer 21

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.

Question 22

What would you see in an ultrasound to confirm a clinical pregnancy?

Answer 22

Gestation sack = bean shaped embryo and a yolk sack

Question 23

What is a pseudo gestational sack?

Answer 23

A structure identified by ultra sound in the uterus, in women suffering from ectopic pregnancy. (no actual embryo in der)

Question 24

What is the current biggest limiting factor of succesful IVF?

Answer 24

implantation failure