In Vitro Fertilization Clinical Correlation Flashcards
Infertility def
- inability to conceive within 12 months without contraception with the same partner
- affects approximately 10-15% of the general population
- 10-20% of couples have “unexplained”
Common Causes of Male Infertility
- low or no sperm count
- problems with the quality of sperm
- motility issues
- genetic mutation of sperm
- drugs, smoking, pollution and radiation
- male accessory gland infection
- immature/abnormal spermatozoa
- prolonged stasis of spermatozoa in the epididymis or in transit
- spermatozoal dysfunction- infertility: evalution for oxidative stress, treatment of underlying pathology, antioxidant supplementation, avoiding factors promoting ROS gene value
Common Causes of Female Infertility
-failure to ovulate regularly or at all
-low supply of egg-producing follicles
-blocked or damaged Fallopian tubes
endometriosis
-uterine problems (fibroids, polyps, or uterine structural problems)
-Ovarian Dysfunction
-Tubal Occlusive Disease
-Uterine Dysfunction
-Cervical Dysfunction
-Endocrine Dysfunction
-Genetic Abnormalities
Ovarian Reserve
-FSH increases and E2 decreases as age
-ovarian reserve peaks in early fetal life
5-7 million gametes at 20 weeks gestation
1-2 million gametes at birth
-approximately 400,000 gametes at the time of puberty
-fertility can begin to decline as early as age 27
-significant decline is seen at age 35 and beyond
-spontaneous pregnancies are rare after age 45
Treatment of Infertility
- Ovulation Induction (Clomiphene citrate, DA agonists, Pulsatile GnRH, Aromatase Inhibitors, Gonadotropins)
- Reproductive Tract surgery (Microtuboplasty)
- Intrauterine Insemination “IUI”
- Assisted Reproduction (In Vitro Fertilization, GIFT)
IVF- Overview
- patient selection- male factor, tubal factor
- hypothalamic-pituitary-ovarian (“HPO”) Down Regulation and Suppression- “Long Protocol”- GnRH agonists vs “Short Protocol” - GnRH antagonist
- controlled ovarian hyperstimulation (“COH”)
- oocyte retrieval
- preimplantation embryo culture
- embryo transfer
IVf History
- 1978 Louise Joy Brown, first IVF baby (UK)
- 1981 Elizabeth Carr, first IVF baby in USA
- 1983 First birth after oocyte donation
- 1985- first birth from cryopreserved embryo
- 1985- transvaginal ultrasound for follicle monitoring
- 1990- first report of births after PGD
- 1990- first report of egg donation to older mothers
- 1992- first human birth after ICSI
Specialized Ancillary IVF Procedures
- assisted embryo hatching
- intra cytoplasmic sperm injection (ICSI)
- preimplantation genetic diagnosis (PGD)
- oocyte and embryo cryopreservation
- oocyte and embryo donation
- gestational carriers (surrogacy)
HPO Down Regulation and Suppression
- hypothalamic pituitary ovarian axis
- have to down regulate and suppress then GnRH so that you can mature lots of follicles
- GnRH-agnost: flare of LH and FSH initially, LH and FSH after down regulation and desensitization- Cetrorelix
- GnRH-anatagonist- LH and FSH downregulated- Leuprolide
Fertilization Techniques
- standard oocyte insemination
- ICSI- Intra Cytoplasmic Sperm Injection
Number of Embryos Transferred
- determined by age of mother and embryo quality
- 40= up to 5
- for patients with 2 or more failed IVF cycles, or a poor prognosis, can add more based on clinical judgment
Options for Excess Embryos
- freeze embryos
- donate for research/stem cells
- embryo adoption
- discard
Gestational Surrogacy Medical Indications
- uterus abscent; congenital or iatrogenic
- anatomically abnormal uterus
- medical contraindication to pregnancy
- recurrent pregnancy wastage and loss
- repeated IVF failures with good embryos
Preimplantation Genetics (PGD)
- single gene defects
- balanced translocations
- advanced maternal age (aneuploidy)
- repetitive IVF failure
- recurrent pregnancy loss
- embryo selection
Future direction in Fertility
- genetic engineering- three parent embryos
- cloning-reproductive and therapeutic
- stem cell research
- artificial gametes
- oncofertility
