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Ob / Gyn 2 > Fertility Managment > Flashcards

Fertility Managment Flashcards

1
Q

ART

A

Assisted Reproductive Technology

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2
Q

Define infertility

A

Inability to conceive after 12 months of unproducted intercourse

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3
Q

What is the #1 reason for infertility

A

Postponement of pregnancy until the later years

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4
Q

What is the primary cause relating to ovaries for the infertility in women

A

Ovulatory dysfunction

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5
Q

What is the secondary cause of infertility in women relating to ovaries

A

Inability to transport ova/embryo

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6
Q

The inability to transport ova/embryo is typically due to what

A

Blocked Fallopian tube

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7
Q

What are the uterine causes related to infertility in women

A

Congenital abnormalities (uterine anomalies)
Fibroids
Asherman’s

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8
Q

What are % of infertility is linked to women

A

40

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9
Q

What are the different causes of infertility in women

A

Ovarian
Uterine
Cervical
Immunologic

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10
Q

What % of infertility is linked to men

A

40

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11
Q

What are the causes of infertility in men

A

Varicocele
Testicular failure
Tubular obstruction

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12
Q

What are the different forms of testicular failure

A 
Mumps
Torsion
Orchitis
Testicular Ca
Frequent marijuana use
Undescended testes
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13
Q

What is another term for undescened testes

A

Cryptoorchidism

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14
Q

What is orchitis

A

Inflammation of the teste

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15
Q

What causes a tubular obstruction

A

Vas deferens not connecting to sperm

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16
Q

What makes up the other 20% of infertility

A

Unknown causes, which is when all the test of the male and female come back normal but the doctors do not know the cause

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17
Q

IUI

A

Intrauterine insemination

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18
Q

IVF

A

In vitro fertilization

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19
Q

ICSI

A

Intracytoplasmic sperm insertion

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20
Q

What are the services in ART

A

Ovulation induction
IUI
IVF
ICSI

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21
Q

What must a women have for ovulation induction ART

A

Patent Fallopian tubes

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22
Q

What causes the need for ovulation induction

A

Ovulation impairment, when no Graafian follicle is produced

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23
Q

What is US role in ART ovulation induction and why

A

Monitoring the cycle, as they are trying to achieve only one Graafian follicle

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24
Q

When assessing follicles on US, how are the assessed for ART

A

Measuring the 3 dimensions of the 3 largest follicles on each ovary
Checking the pouch of Douglas for ff

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25
Q

In ovulation induction what are used to ensure ovulation occurs

A

Fertility drugs

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26
Q

Why is IUI done

A

Usually due to male infertility factors
Unexplained infertility
Donor insemination
Same sex couples

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27
Q

What is US role in IUI ART

A

Gynaecology US not typically indicated

May be asked to assess uterus for congenital abnormalities

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28
Q

What is the definition of IVF

A

Fertilization in a glass or lab

Egg and sperm are fertilized outside the body

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29
Q

What are the reasons for IVF

A

Blocked Fallopian tubes
Impaired eggs
Impaired sperm
Unexplained infertility

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30
Q

How many steps are there in IVF

A

6

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31
Q

What are the 6 steps of IVF

A 
Initial lab and US investigations 
Ovarian suppression 
Ovarian stimulation
Egg to oocyte retrieval 
Insemination
Embryo transfer
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32
Q

What does step 1 of IVF involve

A

Lab- bloodwork, ovarian reserve testing
US-assessing uterus, adnexa and ovaries
Hysterosalpingogram
Sonohysterogram

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33
Q

what is ovarian reserve testing

A

Insignt into number of eggs left or ovarian age

FSH

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34
Q

In ovarian reserve testing FSH should be what for indicating eggs are present

A

<10

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35
Q

In IVF US is assessing the uterus for

A

Fibroids

Congenital abnormalities

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36
Q

In US for IVF what is the adenxa being assessed for

A

HYDROSALPINX

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37
Q

US role in IVF for the ovaries is to assess for

A

Cysts- PCOS
Ovarian cysts
BAFC

38
Q

BAFC

A

Baseline natural follicle count

39
Q

What is the BAFC

A

The number of small natural follicles observed at the beginning of the menstral cycle

40
Q

What BAFC indicated poor ovarian response

41
Q

HSG

A

Hysterosalpingogram

42
Q

What is a HSG

A

X-ray, where dye or contrast is injected into the uterus

43
Q

What is a HSG assessing for

A

Uterine cavity for congenital abnormalities

Patience of the Fallopian tubes

44
Q

Why is HSG good for assessing the patency of the Fallopian tubes

A

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

45
Q

SHG

A

Sonohysterogram

46
Q

What is a SHG

A

Saline is injected into the uterus; US guided

47
Q

What is a SHG assessment of

A

Uterine cavity

Patency of the Fallopian tubes

48
Q

What is more reliable for assessing Fallopian tube patency, HSG or a SHG

49
Q

What are the complications associated with HSG and SHG

A

Infection
Fainting
Spotting
HSG- radiation and iodine allergy

50
Q

What does step 2 of IVF involve

A

Downregulation

Ovarian suppression checks

51
Q

What does downregualtion involve

A

GnRH agonist is given to stop natural ovulation
Temporary state of menopause
Prevents premature ovulation
CONTROLS THE TIMING OF THE IVF CYCLE

52
Q

What does an ovarian suppression check involve

A

Ultrasound to ensure no new finding such as an ovarian cyst has not occurred

53
Q

What is step 3 of ovarian stimulation involve

A

Controlled ovarian stimulation

54
Q

What is involved with controlled ovarian stimulation

A

Medication injected for 9-14 days
US is preformed on days 4,7, 9, 11, 13 (9/11/13 only while on FSH)
To monitor the size and number of follicles on each ovary
Trying to achieve superovulation- with gonadotropins

55
Q

What is step 4 of IVF

A

Egg retrieval

56
Q

What is involved with IVF egg retrieval

A

Oocyte retrieval done under endovaginal guidance
Patient is sedated
Needle is inserted through vaginal wall
Follicular fluid, cells and egg are aspirated into a tets tube
Eggs are examined under a microscope for quality

57
Q

What is step 5 of IVF

A

Insemination

58
Q

What does IVF insemination involve

A

Semen is collected 1-3 hrs after egg retrieval

The embryologist assess the zygotes

59
Q

ICSI

A

Intracytoplasmic sperm injection

60
Q

What is conventional insemination in IVF

A

Done in a Petri dish

61
Q

What does the embryologist assess the zygotes for in IVF

A 
Cell division 
Timing of the division 
Cell size
Cellular components 
Any fragmentation
62
Q

What is step 6 of IVF

A

Embryo transfer

63
Q

What days are embryos transferred in IVF after retrieval

64
Q

What are day 5 embryos classified

A

Blastocyst

65
Q

Why are day 5 embryos more preferable for IVF

A

Better assessment of implantation abilities

Usually only ONE embryo is transferred

66
Q

What are the factors involved with determining the number of embryos transferred in an IVF cycle

A

Maternal age
Quality of the embryos
Previous fertility history

67
Q

What is the sonographic contributions in ART

A

Confirmation of pregnancy and number

Around 6-8 weeks gestation

68
Q

What is the sonographic protocol for ART

A 
Ovulation induction
-follicular monitoring 
Routine pelvic US 
Tracking the growth of follicles 
Checking the pouch of Douglas for FF
69
Q

Why is a non lubricate/ non latex condom or probe cover used on a EV transducer

A

May contain spermicid and latex allergy

70
Q

Is gel or lube used on the outside of the condom

A

No, only water is used

71
Q

What are the different types of hormonal drugs used in ART

A 
Clomiphene citrate
Clomid 
Pergonal 
GnRH agonist
 hCG
hMG
72
Q

What is clomid

A

Increase FSH
Acts like a normal cycle
Produces one Graafian follicle

73
Q

hMG

A

Human menopausal gonadotropin

74
Q

What is pergonal

A

Stimulates FSH and LH

More than one follicle matures per cycle

75
Q

What does a GnRH agonist do

A

Shuts off pituitary

76
Q

What does hCG do in ART

A

Induces ovulation

Encourages implantation

77
Q

If hCG is used in ART what can the patient not do

A

Take a pregnancy test right away to determine if they are pregnant because it will produce a positive test

78
Q

ovarian hyper stimulation syndrome may occur with ___ and is caused by

A

drugs used in fertility management
Higher incident rate when PERGONAL and hCG are used together
-over production of theca luteal cysts

79
Q

Ovarian hyper stimulation syndrome math result in

A 
Ascites 
Pleural effusion 
Possible thromboembolic states 
-DVT’s
Even shock and death
80
Q

What is given after transfer

A

hCG is given on the day of transfer
-than every other day for 3 doses
Progesterone is continued until 10weeks gestation

81
Q

Why is progesterone continued until 10 week gestation

A

Physicians want to maintain the placenta until the placenta hormones take over and can keep the pregnancy viable

82
Q

Why is hCG given after embryo transfer and maintained for 3 doses

A

Encourages implantation

83
Q

Unsuccessful IVF occurs when

A

Ovaries lack response to hormones
No eggs in the follicular fluid
Ova fail to fertilize or grow
Failure to implant

84
Q

What is the most common problem in an unsuccessful IVF

A

Failure to implant

85
Q

Why are we more aware of pregnancy failure in IVF than the general public

A

Because IVF is so closely monitored

86
Q

Cryopreservation

A

Good quality zygotes are cryopreserved in liquid nitrogen for later attempts at pregnancy

87
Q

GIFT

A

Gamete intrafallopian transfer

88
Q

GIFT is

A

Oocyte and sperm are injected into the ampulla of the Fallopian tube
Usually done laparoscopically
Sometimes done using transvaginal US
Usually used when couples have unexplained infertility or endometriosis
Considered more natural than IVF

89
Q

ZIFT

A

Zygote intrafallopian transfer

90
Q

ZIFT is

A

Modification to IVF

1 day old zygotes are placed into the Fallopian tubes

91
Q

What is the theoretical advantages of ZIFT

A

The embryo develops in the Fallopian tube

Ob / Gyn 2 (8 decks)

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