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DMST 315 OBGYN 3 > Fertility management > Flashcards

Fertility management Flashcards

1
Q

What is infertility defined as?

A

The inability to conceive after 12 months of unprotected intercourse

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2
Q

The #1 reason for infertility is what?

A

Postponement of pregnancy until the later years

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3
Q

Besides postponement of pregnancy what is the other 40% of symptoms for infertility? 4

A
  1. Ovarian
  2. Uterine
  3. Cervical
  4. Immunologic
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4
Q

What are the two ovarian issues that cause infertility?

A
  1. Primary
  2. Secondary reasons
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5
Q

What is the reason for primary ovarian infertility?

A

Ovulatory dysfunction

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6
Q

What is the secondary reason for ovarian infertility?

A

Inability to transport ova/embryo- blocked fallopian tubes

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7
Q

What are uterine reason for infertility? 3

A
  1. Congenital abnormalities
  2. Fibroids
  3. Ashermans
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8
Q

What reasons for infertility in men? 3

A
  1. Varicocele
  2. Testicular failure
  3. Tubular obstruction
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9
Q

What are some reasons for testicular failure? 6

A
  1. Mumps
  2. Torsion
  3. Orchitis
  4. Testicular cancer
  5. Frequent marijuana use
  6. Undescended testes (cyptorchidism)
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10
Q

What is tubular obstructions in men?

A

Vas deferens not connecting to sperm

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11
Q

What is ART?

A

Assisted reproduction technology

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12
Q

What are four services in ART?

A
  1. Ovulation induction
  2. Intrauterine insemination
  3. In Vitro fertilization
  4. Intracytoplasmic sperm
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13
Q

What does IUI stand for?

A

Intrauterine insemination

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14
Q

What does In vitro fertilization stand for?

A

IVF

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15
Q

What does intracytoplasmic sperm insertion stand for?

A

ICSI

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16
Q

What does ultrasound do for ovulation induction? 4

A

Monitor the following

  1. Women with patent (open) fallopian tubes
  2. Ovulation impairment (no graafian follicle produced)
  3. Monitoring the cycle with ultrasound (trying to achieve only one graafian follicle)
  4. Fertility drugs are used to ensure ovulation occurs
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17
Q

What is the sonographic protocol for ovulation monitoring? 3

A
  1. Routine pelvic ultrasound
  2. Track the growth of follicles (3 dimensions of the 3 largest follicles for each ovary)
  3. Check the pouch of Douglas for FF
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18
Q

What are some things that we need to remember when using a EV when monitoring ART? 4

A
  1. Do not use a condom that has lubrication (may contain spermicidal lube)
  2. Only use non lubricated condoms or non latex probe covers
  3. Do not use gel or KY jelly on the outside of the condom
  4. Use water only
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19
Q

What does this represent?

A

How we should measure the ovary

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20
Q

What does this represent?

A

Ovary with Graafian follicle

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21
Q

IUI is usually done because of what reasons? 4

A
  1. Male infertility factors
  2. Unexplained infertility
  3. Donor insemination
  4. Same sex couples
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22
Q

Gynecology ultrasound is indicated or not indicated?

A

Usually not

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23
Q

IUI U/S may be asked to assess what?

A

Uterus for congenital abnormalities

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24
Q

What is Invitro fertilization?

A
  1. Fertilization in a glass or lab
  2. Egg and sperm are fertilized outside the body
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25
Q

What are some reasons for IVF? 4

A
  1. Blocked fallopian tubes
  2. Impaired eggs
  3. Impaired sperm
  4. Unexplained infertility
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26
Q

What are the steps in IVF? 6

A
  1. Initial lab and ultrasound investigation
  2. Ovarian suppression
  3. Ovarian stimulation
  4. Egg or oocyte retrival
  5. insemination
  6. Embryo Transfer
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27
Q

What does ovarian suppression mean?

A

Stopping the normal Ovulatory cycle

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28
Q

What does ovarian stimulation mean? 2

A
  1. Gonadotropins administered to hyperstimulate the ovaries
  2. More than one egg is produced
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29
Q

What do we do in a lab to investigate for patency of IVF? 2

A
  1. Bloodwork
  2. Ovarian reserve testing
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30
Q

What are some things that are done with ovarian reserve testing? 2

A
  1. FSH
  2. Insight into number of eggs left or ovarian age
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31
Q

What can ultrasound do for IVF? 3

A
  1. Assessing uterus
  2. Assessing Adnexa
  3. Assessing ovaries
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32
Q

What does ultrasound investigate for in the uterus? 2

A
  1. Fibroids
  2. Congenital uterine abnormalities
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33
Q

What does ultrasound investigate for in the adnexa?

A

Hydrosalpinx

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34
Q

What does ultrasound investigate for in terms of the ovaries? 3

A
  1. Cysts - PCOS
  2. Ovarian cysts
  3. Baseline antral follicle count (BAFC)
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35
Q

What is Baseline antral follicle count?

A

Number of small antral follicles observed at the beginning of the menstrual cycle

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36
Q

What is indicative of poor ovarian response in terms of BAFC?

A

<10

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37
Q

What does this indicate?

38
Q

What is a hysterosalpingogram?3 (Abbreviation, what kind of exam is it, what is it)

A
  1. HSG
  2. X-ray
  3. Dye or contrast is injected into the uterus
39
Q

What does hysterosalpingograms assess for?2

A
  1. uterine cavity for congenital abnormalities
  2. Patency of the fallopian tubes
40
Q

How does someone check for the patency of the fallopian tubes?

A

Contrast spilling into the posterior cul de sac indicates at least one fallopian tube is patent

41
Q

What is a sonohysterogram?3

A
  1. SHG
  2. Saline injected into the uterus
  3. Ultrasound guided
42
Q

What does the ultrasound assess of a sonohysterogram tell us? 2

A
  1. Uterine cavity
  2. Patency of fallopian tubes
43
Q

What is the patency of the fallopian tubes?

A

Not as reliable as HSG

44
Q

What are complications associated with HSC and SHG? 4

A
  1. Infection
  2. Fainting
  3. HSG radiation and iodine allergy
  4. Spotting
45
Q

What is downregulation?

A

When GnRH agonist is given to stop natural ovulation cycle

46
Q

What does downregulation do? 3

A
  1. Temporary state of menopause
  2. Prevents premature ovulation
  3. Controls the timing of the IVF cycle
47
Q

What is ovarian suppression check?

A

Ultrasound to ensure no new findings such as ovarian cysts has not occurred

48
Q

What does Clomid do? 2

A
  1. Increase FSH
  2. Acts like a normal cycle and produces only one graafian follicle
49
Q

What is Clomid? And what does it stand for?

A

Clomiphene citrate or CC

50
Q

What does hMG stand for?

A

human menopausal gonodotropin

51
Q

What does pergonal do? What does this lead to? 2

A
  1. Stimulates FSH and LH
  2. This leads to more than one follicle matures per cycle
52
Q

What does hCG do?

A

Induces ovulation and encourages implantation

53
Q

Controlled ovarian stimulation is what? When is medication injected?

A
  1. Trying to achieve superovulation with gonadotropins
  2. Medication injected for 9-14 days
54
Q

With controlled ovarian stimulation, ultrasound is performed when? 3

A
  1. Day 4
  2. Day 7
  3. Every 2nd day after day 7 while on FSH (9,11,13)
55
Q

Why does ultrasound monitor controlled ovarian stimulation?

A

To monitor the size and number of follicles on each ovary

56
Q

What is egg retrieval?

A

Oocyte is retrieved

57
Q

What happens during the process of egg retrieval? 5

A
  1. Patient is sedated
  2. Oocyte retrieval is done under endovaginal guidence
  3. A needle is inserted through the vaginal wall
  4. Follicular fluid, cells and egg are aspirated into a test tube
  5. Eggs are examined under a microscope for quality
58
Q

What does this image represent?

59
Q

What is the IVF insemination process like? 3

A
  1. Semen sample is collected 1-3 hours after egg retrival
  2. conventional insemination in a petri dish
  3. Intracytoplasmic sperm injection
60
Q

During IVF insemination the embryologist assess the zygote for what? 5

A
  1. Cell division
  2. Timing of division
  3. Cell size
  4. Cellular components
  5. Any fragmentation
61
Q

What happens during cryopreservation?

A

Good quality zygotes can be frozen on day five or six of fertilization to be used for future embryo transfers

62
Q

Cyropreservered zygotes can be frozen with what?

A

Liquid nitrogen

63
Q

When does embryo transfer happen?

A

On day 3 to 4 after retrieval

64
Q

What happens on day 5 of embryo transfer?

A

Better assessment of implantation abilities, usually only one embryo is transferred

65
Q

What are some factors determining number of embryos?3

A
  1. Mothers age
  2. Quality of embryos
  3. Previous fertility history
66
Q

What does sonography do with IVF? post transfer?

A

Confirmation of pregnancy (number, location) usually 6-8 weeks gestation

67
Q

What are some risks of IVF? 4

A
  1. Complications during egg retrieval
  2. Multiple gestations
  3. Ectopic pregnancy
  4. Ovarian hyperstimulation syndrome
68
Q

Ovarian hyperstimulation syndrome may occur how?

A

With drugs used in fertility managment

69
Q

What drugs are used with ovarian hyperstimuation syndrome?

A

Pergonal together with hCG and pregnancy

70
Q

What does ovarian hyper stimulation syndrome result in? 4

A
  1. Abdominal pain, N and V, bloating
  2. Ascites
  3. Pleural effusions
  4. Possible thromboembolic states (DVTs)
71
Q

What kind of cysts might we see with ovarian hyper stimulation syndrome?

A

Theca luteal cysts

72
Q

What does this image demonstrate?

73
Q

What does this image demonstrate?

74
Q

What does pergonal do in terms of multiple gestations? How many cases are affected?

A
  1. Multiple follicles
  2. 35-60% of cases
75
Q

What happens with Pergonal and hCG do in terms of multiple gestation?

A
  1. Multiple follciles
  2. 80% of cases
76
Q

What is the risk of multiple pregnancies?

A

High risk for preterm delivery

77
Q

What might we have to do with multiple pregnancies?

A

May choose to reduce number of embryos

78
Q

What is done after transfer of embryos? 3 (drugs schedule)

A
  1. hCG is given the day of transfer
  2. hCG is also given every other day for 3 more doses
  3. Progesterone is continued until 10 weeks
79
Q

What does hCG do after transfer?

A

Encourages implantation

80
Q

What happens with unsuccessful IVF?

A

Premature ovulation

81
Q

Why would there be unsuccessful IVF? 5

A
  1. Ovaries lack of response to hormones
  2. No eggs in the follicular fluid
  3. Ova fail to fertilize or grow
  4. Sperm quality
  5. Failure to implant is the most common
82
Q

We are more aware of prengancy failure in IVF than general pregnancy, why?

A

Because it is so much more closely monitored

83
Q

What is GIFT?

A

Gamete intrafallopian transfer

84
Q

What happens with GIFT?

A

Oocytes and sperm are injected into the ampulla of the fallopian tube

85
Q

Gift is usually done with what?2

A
  1. Laparoscopy
  2. Can be done using transvaginal ultrasound
86
Q

When is GIFT usually used?

A

When couples have unexplained infertility or endometriosis

87
Q

Which one is more considered GIFT or IVF?

88
Q

What is ZIFT?

A

Zygote intrafallopain transfer

89
Q

What happens with ZIFT in terms of process?

A

1 day old zygotes are placed into the fallopian tubes

90
Q

What is the theoretical advantage of ZIFT?

A

The embryo develops in the fallopian tube

DMST 315 OBGYN 3 (21 decks)

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