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DMST 315 OBGYN 3 > Fertility management > Flashcards

Fertility management Flashcards

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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
What are some reasons for IVF? 4
1. Blocked fallopian tubes 2. Impaired eggs 3. Impaired sperm 4. Unexplained infertility
26
What are the steps in IVF? 6
1. Initial lab and ultrasound investigation 2. Ovarian suppression 3. Ovarian stimulation 4. Egg or oocyte retrival 5. insemination 6. Embryo Transfer
27
What does ovarian suppression mean?
Stopping the normal Ovulatory cycle
28
What does ovarian stimulation mean? 2
1. Gonadotropins administered to hyperstimulate the ovaries 2. More than one egg is produced
29
What do we do in a lab to investigate for patency of IVF? 2
1. Bloodwork 2. Ovarian reserve testing
30
What are some things that are done with ovarian reserve testing? 2
1. FSH 2. Insight into number of eggs left or ovarian age
31
What can ultrasound do for IVF? 3
1. Assessing uterus 2. Assessing Adnexa 3. Assessing ovaries
32
What does ultrasound investigate for in the uterus? 2
1. Fibroids 2. Congenital uterine abnormalities
33
What does ultrasound investigate for in the adnexa?
Hydrosalpinx
34
What does ultrasound investigate for in terms of the ovaries? 3
1. Cysts - PCOS 2. Ovarian cysts 3. Baseline antral follicle count (BAFC)
35
What is Baseline antral follicle count?
Number of small antral follicles observed at the beginning of the menstrual cycle
36
What is indicative of poor ovarian response in terms of BAFC?
<10
37
What does this indicate?
BAFC
38
What is a hysterosalpingogram?3 (Abbreviation, what kind of exam is it, what is it)
1. HSG 2. X-ray 3. Dye or contrast is injected into the uterus
39
What does hysterosalpingograms assess for?2
1. uterine cavity for congenital abnormalities 2. Patency of the fallopian tubes
40
How does someone check for the patency of the fallopian tubes?
Contrast spilling into the posterior cul de sac indicates at least one fallopian tube is patent
41
What is a sonohysterogram?3
1. SHG 2. Saline injected into the uterus 3. Ultrasound guided
42
What does the ultrasound assess of a sonohysterogram tell us? 2
1. Uterine cavity 2. Patency of fallopian tubes
43
What is the patency of the fallopian tubes?
Not as reliable as HSG
44
What are complications associated with HSC and SHG? 4
1. Infection 2. Fainting 3. HSG radiation and iodine allergy 4. Spotting
45
What is downregulation?
When GnRH agonist is given to stop natural ovulation cycle
46
What does downregulation do? 3
1. Temporary state of menopause 2. Prevents premature ovulation 3. **Controls the timing of the IVF cycle**
47
What is ovarian suppression check?
Ultrasound to ensure no new findings such as ovarian cysts has not occurred
48
What does Clomid do? 2
1. Increase FSH 2. Acts like a normal cycle and produces only one graafian follicle
49
What is Clomid? And what does it stand for?
Clomiphene citrate or CC
50
What does hMG stand for?
human menopausal gonodotropin
51
What does pergonal do? What does this lead to? 2
1. Stimulates FSH and LH 2. This leads to more than one follicle matures per cycle
52
What does hCG do?
Induces ovulation and encourages implantation
53
Controlled ovarian stimulation is what? When is medication injected?
1. Trying to achieve superovulation with gonadotropins 2. Medication injected for 9-14 days
54
With controlled ovarian stimulation, ultrasound is performed when? 3
1. Day 4 2. Day 7 3. Every 2nd day after day 7 while on FSH (9,11,13)
55
Why does ultrasound monitor controlled ovarian stimulation?
To monitor the size and number of follicles on each ovary
56
What is egg retrieval?
Oocyte is retrieved
57
What happens during the process of egg retrieval? 5
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
What does this image represent?
IVF ovary
59
What is the IVF insemination process like? 3
1. Semen sample is collected 1-3 hours after egg retrival 2. conventional insemination in a petri dish 3. Intracytoplasmic sperm injection
60
During IVF insemination the embryologist assess the zygote for what? 5
1. Cell division 2. Timing of division 3. Cell size 4. Cellular components 5. Any fragmentation
61
What happens during cryopreservation?
Good quality zygotes can be frozen on day five or six of fertilization to be used for future embryo transfers
62
Cyropreservered zygotes can be frozen with what?
Liquid nitrogen
63
When does embryo transfer happen?
On day 3 to 4 after retrieval
64
What happens on day 5 of embryo transfer?
Better assessment of implantation abilities, usually only one embryo is transferred
65
What are some factors determining number of embryos?3
1. Mothers age 2. Quality of embryos 3. Previous fertility history
66
What does sonography do with IVF? post transfer?
Confirmation of pregnancy (number, location) usually 6-8 weeks gestation
67
What are some risks of IVF? 4
1. Complications during egg retrieval 2. Multiple gestations 3. Ectopic pregnancy 4. Ovarian hyperstimulation syndrome
68
Ovarian hyperstimulation syndrome may occur how?
With drugs used in fertility managment
69
What drugs are used with ovarian hyperstimuation syndrome?
Pergonal together with hCG and pregnancy
70
What does ovarian hyper stimulation syndrome result in? 4
1. Abdominal pain, N and V, bloating 2. Ascites 3. Pleural effusions 4. Possible thromboembolic states (DVTs)
71
What kind of cysts might we see with ovarian hyper stimulation syndrome?
Theca luteal cysts
72
What does this image demonstrate?
OHSS
73
What does this image demonstrate?
OHSS
74
What does pergonal do in terms of multiple gestations? How many cases are affected?
1. Multiple follicles 2. 35-60% of cases
75
What happens with Pergonal and hCG do in terms of multiple gestation?
1. Multiple follciles 2. 80% of cases
76
What is the risk of multiple pregnancies?
High risk for preterm delivery
77
What might we have to do with multiple pregnancies?
May choose to reduce number of embryos
78
What is done after transfer of embryos? 3 (drugs schedule)
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
What does hCG do after transfer?
Encourages implantation
80
What happens with unsuccessful IVF?
Premature ovulation
81
Why would there be unsuccessful IVF? 5
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
We are more aware of prengancy failure in IVF than general pregnancy, why?
Because it is so much more closely monitored
83
What is GIFT?
Gamete intrafallopian transfer
84
What happens with GIFT?
Oocytes and sperm are injected into the ampulla of the fallopian tube
85
Gift is usually done with what?2
1. Laparoscopy 2. Can be done using transvaginal ultrasound
86
When is GIFT usually used?
When couples have unexplained infertility or endometriosis
87
Which one is more considered GIFT or IVF?
GIFT
88
What is ZIFT?
Zygote intrafallopain transfer
89
What happens with ZIFT in terms of process?
1 day old zygotes are placed into the fallopian tubes
90
What is the theoretical advantage of ZIFT?
The embryo develops in the fallopian tube
91

DMST 315 OBGYN 3 (21 decks)

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