Infertility 3 (management)

Question 1

How are ovulation disorders managed?

Answer 1

Optimising body weight (BMI) = first line

• Healthy lifestyle, diet, exercise

Medication (ovulation induction)

• Clomiphene citrate tablets
• Gonadotrophins

Laporoscopic ovarian drilling

Question 2

How are problems such as a very low sperm count or azoospermia managed?

Answer 2

Gonadotrophins - if hormonal cause

Surgical sperm retrieval - epididymis/testis

Donor sperm - intrauterine insemination

ICSI - intracytoplasmic sperm injection

Question 3

How are tubal problems managed?

Answer 3

Surgery - but can only be done on mild tubal disease ie minor blockage in distal fallopian tube

IVF

Question 4

How is infertility caused by endometriosis treated?

Answer 4

Endometriosis - Ablation or resection of spots

Adhesiolysis - surgery to remove adhesions that may form following surgery

Cystectomy for endometrioma

Question 5

If there are uterine problems that are causing infertility - how can this be managed?

Answer 5

Removal of polyps or fibroids

Adhesiolysis for synechiae

Question 6

When is IVF indicated for couples trying to conceive a beby?

Answer 6

Trying for 2 years

If management of known problem is unsuccessful

or unexplained infertility

Question 7

Who regulates IVF treatment?

Answer 7

Human Fertilization & Embryology Authority (HFEA)

Question 8

How are eggs sourced for IVF?

When are donor eggs used?

Answer 8

Own eggs if possible:

• through Gonadotrophin induced superovulation

But donor eggs are used if:

• Older (poor ovarian reserve)
• Poor quality
• Ovarian failure
• Genetic cause

Question 9

If a man is able to use his own sperm for IVF - how can this sperm be sourced?

Answer 9

Fresh sperm sample on day of egg collection

or

Frozen sample (thawed) from surgical retrieval or fertility preservation

Question 10

For what reasons would a sperm donor be used for IVF?

Answer 10

Donor sperm is used if:

• the woman is single or in a same sex relationship
• azoospermia
• genetic cause
• infection
  
  • HIV
  • HepB
  • HepC

Question 11

What are the key steps in IVF?

Answer 11

Controlled ovarian stimulation using hormone injections

Follicular monitoring using USS - in 2nd week

Stimulation of ovulation and collection of eggs

Lab fertilization - insemination/ICSI

Incubation / embryo development

Embryo transfer

Progesterone support

Question 12

What is ICSI and when is it indicated for fertilization in IVF?

Answer 12

Intracytoplasmic sperm injection (ICSI)

Indicated when there are very low sperm counts

Question 13

Following embryo transfer - what support/management does the woman receive?

Answer 13

Progesterone pessaries

Advise normal activity

Pregnancy test after 2 weeks following transfer

If positive - scan at 7 weeks

Question 14

What are the risks of IVF treatment?

Answer 14

Ovarian hyperstimulation syndrome (OHSS):

• following ovarian stimulation for egg collection - overresponse of the ovaries and production of multiple follicles - which can produce symptoms

Multiple pregnancies

Medication side effects

Procedure related

Ectopics