clinical overview of IVF

Question 1

why is IVF needed?

Answer 1

tubal disease 
ovulatory disorder 
endometriosis 
uterine 
multiple female factors 
male factors 
multiples female and male factors 
unxplained

Question 2

what can be wrong with sperm?

Answer 2

oligospermia
asthenospermia
teratospermia
azoospermia

Question 3

what is oligospermia?

Answer 3

low sperm count

deficiency of sperm cells in the semen.

Question 4

what is asthenospermia?

Answer 4

reduced sperm motility

Question 5

what is teratospermia?

Answer 5

abnormal morphology

Question 6

what is azoospermia?

Answer 6

semen contains no sperm

Question 7

how can sperm be collected?

Answer 7

PESA: percutaneous epididymal sperm aspiration
TESE: testicular sperm extraction

Question 8

how can eggs be collected?

Answer 8

controlled ovarian hyper stimulation

Question 9

why is pituitary down regulation needed in IVF?

Answer 9

to prevent premature LH surge

premature LH surge means less successful egg collection - not as many eggs to be collected at a lot die

Question 10

how does a GnRH antagonist act?

Answer 10

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

Question 11

how is ovarian hyper stimulation controlled?

Answer 11

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

Question 12

criteria for hCg injection and egg collection

Answer 12

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

Question 13

what are the steps that follow ovarian stimulation?

Answer 13

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

Question 14

facts about embryo process….

Answer 14

critical process
dental technique 
operator experience and learning curve 
variety of catheters - no difference
USS (abdominal) guided better results 
1-2cm from the fundus

Question 15

why do we develop embryos to the blastocyst stage?

Answer 15

improve chance of pregnancy
single embryo transfers
stem cell research

Question 16

what is luteal support?

Answer 16

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.

Question 17

early pregnancy assessment?

Answer 17

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

Question 18

what clinical and laboratory success rate are measured?

Answer 18

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

Question 19

complications of IVF

Answer 19

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

Question 20

what future research needs to be done for IVF?

Answer 20

• embryo culture systems
• time lapse morphokinetics
• metabolic proteomics
• epigenetic
• PGD / PGS
• embryo - endometrial dialogue