Human fertility and infertility - management

Question 1

Ovulation disorders? - most common

Answer 1

PCOS

Question 2

ovulation disorders - lifestyle factors include?

Answer 2

BMI below 30
Healthy life
style, Exercise

Question 3

Ovulation induction medications (2)

• how many cycles?

Answer 3

• Clomiphene citrate
• Gonadotrophins (direct FSH)

6 or 7

Question 4

What intervention method can be considered for PCOS patients?

Answer 4

Laparoscopic ovarian drilling

Question 5

Sperm problem-Very low count or no sperm (azoospermia) - medical treatment

Answer 5

gonadotrophins

Question 6

Surgical sperm retrieval to help with problems with the?

donor sperm?

Answer 6

epididymis/testis

- Donor sperm- intrauterine insemination

Question 7

what is the sperm injection called?

Answer 7

ICSI intracytoplasmic

Question 8

tubal problem?

Answer 8

surgical approach

• employed in a limited manner
• IVF

Question 9

Other treatments for endometriosis?

Answer 9

Endometriosis-Ablation or resection of spots, adhesiolysis, cystectomy for endometrioma

Question 10

uterine surgery may be needed for?

Answer 10

removal polyp/fibroid, adhesiolysis for synechiae

Question 11

Unresolved Infertility - what is the plan?

Answer 11

IVF

Question 12

Human Fertilisation & Embryology Authority (HFEA) )(5)

Answer 12

Regulatory authority
Licensing
Inspections
Forms - registration, treatment, outcome
Register

Question 13

What is IVF?

Answer 13

fertilise the egg with the sperm outside the body

Question 14

Eggs in IVF? What will you give to the women

Answer 14

Own eggs-gonadotrophin induced superovulation

Donor eggs - age (poor ovarian reserve)

                - poor quality
                 - ovarian failure
                - genetic cause

Question 15

Sperm in IVF?

partner vs donor sperm

Answer 15

Partner-
Fresh sample on day of egg collection
Frozen sample (thawed)from surgical retrieval or fertility preservation

Single women
Same sex relationship
Azoospermia(no sperm) Genetic cause
Infection (HIV, HepB,HepC

Question 16

IVF Process-Key steps (8)

Answer 16

Controlled ovarian stimulation
Follicular monitoring
Timing ovulation
Egg collection
Lab fertilization-Insemination/ICSI
Incubation/ embryo development
Embryo transfer
Progesterone support

Question 17

what is Intracytoplasmic Sperm Injection(ICSI) ?

Answer 17

Injection of egg with single sperm

Question 18

Embryo Transfer Catheter ?

Answer 18

embryo is loaded and transferred into the uterine cavity

Question 19

Post embryo transfer - what is given and what steps follow? (4)

Answer 19

Progesterone pessaries

Normal activity

Pregnancy test after 2 weeks

If positive- scan at 7 weeks

Question 20

Risks of IVF? (4)

Answer 20

• Ovarian hyperstimulation syndrome (OHSS) - overproduction of follicles
• Multiple pregnancy - if implant more than 1 embryo
• Medication side effects
• Procedure related

Question 21

Long term effects to children born? cancers?

Answer 21

Children born- no difference as per short term data.

Risk of ovarian cancer not confirmed

Absolute risk to women and children low.

Question 22

IVF expansions (7)

Answer 22

• Donor gametes
• Fertility preservation-gamete/embryo cryopreservation
• Ovarian tissue cryopreservation
• Preimplantation genetic diagnosis
• Assisted hatching
• In vitro maturation
• Surrogacy