Human Fertility and InfertilityPart 3- Management Flashcards
Problem based management:
Management depends on what cause if found
4 key areas - what are they?
Egg (ovulation problems or reduced ovarian reserve)
Sperm (underlying problem with sperm)
Tubes (problem will fallopian tube, one or both are blocked or absent)
Others (problems with uterus or lifestyle factors affecting fertility
Could be multifactorial
what is the first line management for ovulation disorders?
Optimize body weight, Healthy life style, Exercise
what Medication (ovulation induction) may be used for ovulation disorders?
- Clomiphene citrate (oral tablets, 60-70% couples ovulation is restored)
- Gonadotrophins (give direct FHS hormones if tablets didn’t work)
what surgical option is avalible for ovarian disorders?
Laparoscopic ovarian drilling
a surgical treatment that can trigger ovulation in women with polycystic ovary syndrome (PCOS). You are trying to get pregnant but you have not been able to release eggs after losing weight and using clomiphene, with or without metformin
Sperm problem-Very low count or no sperm (azoospermia):
what management is avalible?
Treatment depends upon cause of low sperm:
Medical treatments - gonadotrophins - If low sperm production then you can give medical treatment
Surgical sperm retrieval - epididymis/testis - If problem in testicle then you can surgically get the sperm
Donor sperm - intrauterine insemination
ICSI (intracytoplasmic sperm injection) - In ICSI one sperm is injected per egg
what is the management of infertility if it is due to tubual problems?
Role of surgery limited to mild tubal disease - Surgical only done for minor blockage in the distal part of the tubes or scar tissue
IVF - Chances of conception are higher with IVF
what are some other treatments?
Endometriosis-Ablation or resection of spots, adhesiolysis, cystectomy for endometrioma
Uterine surgery- removal polyp/fibroid, adhesiolysis for synechiae
In unexplained infertility and none of these work after 2 years then given the option of IVF
what is done for Unresolved Infertility?
IVF - In vitro fertilization
Any unresolved infertility and we have tried the initial management approach for the problem identified, we would advise IVF treatment
Human Fertilisation & Embryology Authority (HFEA):
what ar ethey and what do they do?
Regulatory authority
Licensing
Inspections
Forms - registration, treatment, outcome
Register
what is IVF?
During IVF, an egg is removed from the woman’s ovaries and fertilised with sperm in a laboratory
The fertilised egg, called an embryo, is then returned to the woman’s womb to grow and develop
It can be carried out using your eggs and your partner’s sperm, or eggs and sperm from donors
what eggs are used for IVF?
Own eggs - gonadotrophin induced superovulation (process of inducing a woman to release more than one egg in a month)
Donor eggs - if you have: age (poor ovarian reserve), poor quality, ovarian failure, genetic cause
what sperm could be used for IVF?
Partner- Fresh sample on day of egg collection or Frozen sample (thawed) from surgical retrieval or fertility preservation
Donor sperm- Single women, Same sex relationship, Azoospermia(no sperm), Genetic cause, Infection (HIV, HepB,HepC)
what are the key steps in the IVF process?
Controlled ovarian stimulation
Follicular monitoring
Timing ovulation
Egg collection
Lab fertilization-Insemination/ICSI
Incubation/ embryo development - Embryo development for 3-5 days upto 6 max
Embryo transfer - Any remining embryos will be frozen
Progesterone support (maintains endometrium for pregnancy)
what are the two techiniques of IVF?
Insemination - Sperm mixed in dish with egg
Intracytoplasmic Sperm Injection(ICSI) - injection of egg with single sperm
Low sperm count
Sperm injected into the egg
Invasive
In both these techniques about 60-70% of the eggs are fertilized
picture showing Embryo development
Various stages of embryo developing
Day 5 organize into 2 cells – outer is the trophoblast which makes the placenta and inner is the inner cell mass which gives rise to the baby
how is the embryo transfered to the mother?
Embryo Transfer Catheter
under ultrasound guidance
Just one embryo to minimise risk of multiple pregnancy
how is Freezing & storage of embryos done?
Each embryo stored in labelled/colour coded ‘straw’
Additional embryo is frozen
Can be kept in freezing for 10 years
what is done post embryo transfer?
Progesterone pessaries
Normal activity
Pregnancy test after 2 weeks
If positive- scan at 7 weeks
what are the success rates of IVF?
Age has a major influence
what are the risks of IVF?
Ovarian hyperstimulation syndrome (OHSS)
Multiple pregnancy
Medication side effects
Procedure related
what are the long term effects of IVF?
Children born - no difference as per short term data
Risk of ovarian cancer not confirmed
Absolute risk to women and children low
what are IVF expansions?
Donor gametes
Fertility preservation-gamete/embryo cryopreservation (prior to toxic treatment to gonads, e.g. cancer treatment)
Ovarian tissue cryopreservation
Preimplantation genetic diagnosis (already have a child with known chromosomal problems or the couple carry genetic disease, can see if genetic problem is there first)
Assisted hatching
In vitro maturation
Surrogacy (create embryos for another owmen)
Conclusion:
Infertility more _______
Hasn’t overcome natural barrier of ___
Physical, Psychological, Financial and ______ considerations
________ changes leading to expanding IVF ________
IVF is the ultimate approach we use but doesn’t _________
treatable
age
Ethical
Societal
indications
guarantee
