clinical overview of IVF Flashcards
why is IVF needed?
tubal disease ovulatory disorder endometriosis uterine multiple female factors male factors multiples female and male factors unxplained
what can be wrong with sperm?
oligospermia
asthenospermia
teratospermia
azoospermia
what is oligospermia?
low sperm count
deficiency of sperm cells in the semen.
what is asthenospermia?
reduced sperm motility
what is teratospermia?
abnormal morphology
what is azoospermia?
semen contains no sperm
how can sperm be collected?
PESA: percutaneous epididymal sperm aspiration
TESE: testicular sperm extraction
how can eggs be collected?
controlled ovarian hyper stimulation
why is pituitary down regulation needed in IVF?
to prevent premature LH surge
premature LH surge means less successful egg collection - not as many eggs to be collected at a lot die
how does a GnRH antagonist act?
it acts as down regulator of the pituitary
it stops GnRH binding to pituitary so LH and FSH are not secreted.
and therefore prevents a premature LH surge
how is ovarian hyper stimulation controlled?
1) choice of protocol
2) dose - dependant on age, body weight, ovarian reserve, astral follicle count.
3) follicular monitoring (scan, serum oestrogen, progesterone)
4) triggering ovulation
criteria for hCg injection and egg collection
hCG acts like LH to stimulate ovulation
- 3 or more follicles >17mm diameter
- 10,000 iu hCG
- transvaginal oocyte recover 36 hours later
- GA or sedation
- risks 1:2000
what are the steps that follow ovarian stimulation?
ovarian stimulation and monitoring then egg collection then sperm insemination or ICSI fertilisation check day 1 embryo culture 2-5 days embryo transfer (USS guided max 2 +/- cryopreservation) luteal support (2 weeks progesterone) pregnancy test
facts about embryo process….
critical process dental technique operator experience and learning curve variety of catheters - no difference USS (abdominal) guided better results 1-2cm from the fundus
why do we develop embryos to the blastocyst stage?
improve chance of pregnancy
single embryo transfers
stem cell research
what is luteal support?
Luteal support is the administration of medication, generally progesterone, progestins or GnRH agonists, to increase the success rate of implantation and early embryogenesis, thereby complementing and/or supporting the function of the corpus luteum.
early pregnancy assessment?
beta hCG at ovulations, 14 days and 21 days
low levels repeat at 48 hours
6 week and 8 week scan and then can refer back to the GP for ante-natal care
what clinical and laboratory success rate are measured?
clinical: - pregnancy rate -clinical pregnancy rate -take home baby rate -per cycle started/per oocyte retrieval/per embryo transferred laboratory: - fertilisation rate -cleavage rate -blastocyst formation rate
complications of IVF
multiple pregnancy
ectopic pregnancy
miscarriage
dissappointment
infection - rare
OHSS - rare –> triggered by hCG, increases when pregnancy occurs, can be manages medically, can be life threatening
what future research needs to be done for IVF?
- embryo culture systems
- time lapse morphokinetics
- metabolic proteomics
- epigenetic
- PGD / PGS
- embryo - endometrial dialogue
