In Vitro Fertilization - RM

Question 1

What is the definition of infertility?

Answer 1

inability to conceive within 12 months without contraception

Question 2

What are causes of male infertility? (4)

Answer 2

low or no sperm count
problems with quality of sperm
motility issues
genetic mutation of sperm

Question 3

What are causes of female infertility? (5)

Answer 3

failure to ovulate regularly or at all
low supply of egg-producing follicles
blocked or damaged fallopian tubes
endometriosis
uterine problems--fibroids, polyps, structural problems

Question 4

How do drugs, smoking, pollution and radiation contribute to infertility?

Answer 4

contribute to oxidative stress and spermatozoal dysfunction and infertility

Question 5

What systemic pathologies can lead to infertility due to oxidative stress?

Answer 5

diabetes, cancer, systemic infection

Question 6

What happens with ovarian aging?

Answer 6

• FSH increases but doesn’t induce E2 release from ovaries

- decreased quality of eggs as well as decreased numbers

Question 7

What is IUI? Why is it done?

Answer 7

intrauterine insemination, want to avoid IVF if possible

Question 8

What is GIFT? Can it be done more than once?

Answer 8

gamete intrauterine fallopian tubes, put egg and sperm in the fallopian tubes and let them find each other
-can’t be done again because the surgery damages the fallopian tubes

Question 9

What is the swim up technique?

Answer 9

centrifuge sperm, put in culture media so they start swimming and inject the concentrated fluid with sperm in it during super ovulation

Question 10

What is the column technique?

Answer 10

aspirate the most motile pserm from the column and put into uterus

Question 11

Why shouldn’t you take aspirin or ibuprofen etc when you are trying to get pregnant?

Answer 11

prostaglandins help the egg drop so you don’t want to inhibit them

Question 12

Why do you want to inhibit the hypothalamic-pituitary-ovarian axis?

Answer 12

suppressing it prevents negative feedback on oocyte development and induces as many eggs being released as possible for IVF

Question 13

What is the long protocol for suppression of the hypothalamic-pituitary-ovarian axis? short protocol?

Answer 13

Long protocol–GnRH agonists (eventually causes downregulation of receptors and desensitization to LH/FSH)
short protocol–GnRH antagonists (cetrorelix, causes immediate drop in LH/FSH production)

Question 14

What are the risks in oocyte retrieval? What does the ovaries produce that cause this risk?

Answer 14

risk ovaries swelling up and casing hemoconcentration, which increases the risk of coagulation in vascular systems and clots/pleural effusions
ovaries produce VEGF

Question 15

What is ICSI? When is this usually done?

Answer 15

intracytoplasmic sperm injection, when males have low sperm count because it injects a single motile sperm directly into the cytoplasm of the egg

Question 16

At what stage is preimplantation genetic diagnosis done?

Answer 16

blastomere stage, one cell of the blastomere taken because at this stage all the cells are totipotent and each one can all develop into identical embryo

Question 17

What technique can be used for patients with absent Mullerian ducts or uterus, anatomically abnormal uterus, or medical contraindication to pregnancy?

Answer 17

gestational carriers/surrogacy

Question 18

What is hCG used as a trigger for? What does it mimic that allows it to be used for this?

Answer 18

ovarian hyperstimulation

mimics LH surge to cause extrusion of eggs but has a longer halflife than LH because of the sugar molecules attached

Question 19

At what stages can you transfer a developing embryo after insemination? What is the advantage of each?

Answer 19

4 cell stage or 8 cell stage–plays it safe because embryo may not make it till day 5 in vitro
blastocyst stage–hardier than 4 or 8 cell stage, corresponds with normal physiology since zygote usually reaches uterus in 5 days in vivo

Question 20

Why do you want to make sure there are only 2 pronuclei after fertilization?

Answer 20

have to make sure it wasn’t a polyspermy fertilization

Question 21

Why is a hole made in the zona pellucida in pateints with multiple IVF failures?

Answer 21

the blastocyst must hatch from the zona pellucida and making the hole helps blastocyst expand out from it

Question 22

How far from the fundal portion of the uterus should you deposit an embryo?

Answer 22

about 1 cm, because if its too close to fallopian tubes it may become ectopic

Question 23

How do you determine how many embryos to transfer?

Answer 23

age of the mother, embryo quality

Question 24

When is the risk of multiple pregnancies higher?

Answer 24

with younger moms

Question 25

What is the limiting factor for embryo quality, age of the egg or age of the uterus?

Answer 25

age of the egg

Question 26

What is the purpose of oncofertility?

Answer 26

removal of ovarian tissue to freeze eggs or fertilize them and freeze embryos so you can treat cancer without worrying about infertility after treatment

Question 27

What occurs in 3 parent embryos? What disease is this good for avoiding?

Answer 27

• healthy nuclear DNA from mother with mutated mitochondrial DNA put in enucleated donor egg cell with healthy mitochondrial DNA and fertilized with father’s sperm
• avoids mitochondrial disorders passing on through children

Question 28

How is cloning done?

Answer 28

• take the nucleus of a somatic ell with complete genetic complement
• put that nucleus in an enucleated egg cell
• trigger it to divide so all 46 chromosomes come from that 1 source
• embryos grow really fast because that somatic cell has already imprinted

Question 29

What is clomifene?

Answer 29

selective estrogen receptor modulator used to induce ovulation