Fertility Treatment Flashcards
What is primary infertility?
Pregnancy has never occurred
What is secondary infertility?
One/both members of the couple have previously conceived, but are unable to conceive again after 1 year of trying
What is the success rate for IVF and donor insemination?
IVF = 22% DI = 14%
What is prostatitis?
Inflammation of the prostate gland
What is orchitis?
Inflammation of the testicles
What is retrograde ejaculation?
Semen enters the bladder instead of the penis during ejaculation
What hormone is tested in women to assess ovarian stimulation?
Serum progesterone
What is endometriosis?
Endometrium grows outside the uterus and attaches to other organs (e.g. fallopian tubes, ovaries)
What is the management for Endometriosis?
- Surgical ablation
- Consider ovarian stimulation (IUI)
- In severe cases, consider ART
What does ART stand for?
Assisted Reproductive Technology
What are the types of ART?
- Donor insemination
- Double embryo transfer
- Elective single embryo transfer
- IVF
- Uterine embryo transfer
- Gamete intra-fallopian transfer
- Zygote intra-fallopian transfer
- Intracytoplasmic sperm injection
- Assisted hatching
What is gamete intra-fallopian transfer?
Retrieval of eggs and transfer of unfertilised eggs and sperm into the fallopian tubes by laparoscopy
What is zygote intra-fallopian transfer?
Retrieval of eggs and transfer of fertilised eggs into the fallopian tubes by laparoscopy
What is assisted hatching?
Making a microscopic opening in the embryo wall to facilitate hatching of the embryo
What is step 1 of IVF?
Down-Regulation:
- Suppress natural hormone cycle by giving GnRH to inhibit premature rise of LH
- This prevents follicles rupturing before egg collection
- Daily injection for 2 weeks
What is step 2 of IVF?
Boosting Egg Supply:
- FSH given as daily injection for 12 days
What is step 3 of IVF?
Ultrasound:
- Used to determine right time for egg collection based on maturity of follicles
- Given trigger injection of hCG 36 hours before egg collection to stimulate final maturation of oocytes
What is step 4 of IVF?
Egg Collection:
- Procedure under sedation
- USS used for guidance
- Can cause cramping and small amount of PV bleed
- Given progesterone injection to stimulate endometrial thickening
What is step 5 of IVF?
Fertilisation:
- Eggs fertilised in lab and left for 16-20 hours to fertilise
- Grown for 1-2 days
What is step 6 of IVF?
Egg Transfer:
- Usually 1 or 2 eggs
- Remaining eggs can be frozen for future use
- 10/7 of progesterone to maintain pregnancy
What is obstructive azoospermia?
Semen containing no spermatozoa despite normal spermatogenesis
What is non-obstructive azoospermia?
Semen containing no spermatozoa due to failure of spermatogenesis
At what age are women able to have IVF treatment?
18-43
What is a Hycosy?
Procedure where fallopian tubes are filled with dye to detect problems with eggs travelling - should see dye pooling in ovaries
What must be done before any fertility treatment takes place?
Testing for infectious diseases
What is FSH given for?
Stimulates ovaries to produce more follicles
What is Clomid given for?
- Stimulates ovaries to produce more eggs
- 1st treatment for PCOS and used for irregular/late periods
What is the risk of giving women Clomid?
Overdevelopment of follicles, leading to a risk of multiple pregnancy
What is Metformin given for?
- Decreases insulin levels
- Some women with PCOS can’t ovulate properly due to abnormal insulin levels
What are Gonadotrophins given for?
- Women with PCOS who have tried Clomid but still experiencing issues
- Stimulates egg production
What are Bromocriptine and Cabergoline given for?
- Used by women with hyperprolactinaemia
- Increases levels of dopamine in the brain which reduces prolactin levels
How does hyperprolactinaemia affect fertility?
Too much prolactin results in decreased oestrogen levels which causes difficulty ovulating
Why might men be given Gonadotrophins?
To increase sperm production
Until what age can women receive donor eggs?
50 years old
What is PGS?
Pre-implantation Genetic Screening:
- testing embryo DNA for chromosomal abnormalities
- not available on NHS
What is PGD?
Pre-implantation Genetic Diagnosis:
- testing embryo DNA for specific genetic abnormalities
- e.g. if FHx Down’s
What is PTT?
Pre-implantation Tissue Typing:
- determines tissue type to aid transfusion of stem cells from a tissue-matched donor as part of IVF
- helps children with blood disorders
What is OHSS?
Ovarian Hyperstimulation Syndrome:
- ovaries over-respond to drugs
What are the symptoms of OHSS?
- Bloating
- Abdominal discomfort
- N+V
- Reduced urine output
What is the treatment for OHSS?
- Reduce drug dose
- Avoid intercourse for 7 days
- Extreme cases = stop treatment
