Infertility Flashcards
What assisted contraception techniques are available?
Donor insemination Intra-uterine insemination (IUI) In vitro fertilisation (IVF) Intra-cytoplasmic sperm injections (ICSI) Fertility preservation Surrogacy
What are the indications for Intra uterine insemination?
Unexplained infertility, mild or moderate endometriosis, mild male factor infertility
What is the method of intra uterine insemination?
Can be natural/stimulated cycle
Prepared semen inserted into uterine cavity around time of ovulation
What are the indications for in vitro fertilisation?
Unexplained >2 years
Pelvic disease (endometriosis, tubal disease, fibroids)
Anovulatory infertility
Male factor infertility (>1X10to the 6 motile sperm)
What is down regulation?
Synthetic gonadotrophin releasing hormone anologue or agonsit
Administered as a spray or injection
Allows precise timing of oocyte recover by using HCG trigger
Reduces cancellation from ovulation improves success rate
What are side effects of down regulation?
Hot flushes and mood swings
Nasal irritation
Headaches
What is Ovarian stimulation?
Gonadotrophin hormone containing either synthetic or urinary gonadotrophins (FSH+/- LH)
Self-administered subcut injections
What does ovarian stimulation cause?
Cause follicular development
What are side effects of ovarian stimulation?
Mild allergic reactions
Ovarian hyper stimulation syndrome (OHSS)
How long must a man remain abstinent for before handing in a sperm sample?
72 hours
What is assessed regarding a sperm sample?
Volume
Density - numbers of sperm
Motility - what proportion are moving
Progression - how well they move
What is a sperm sample prepared for?
Remove seminal plasma and concentrate
Where does oocyte collection occur?
In theatre
What are the risks of oocyte collection?
Bleeding
Pelvic infection
Failure to obtain oocytes
What is given (and how, and for how long) after embryo transfer?
Progesterone suppositories for 2 weeks
What are indications for intra cytoplasmic sperm injection?
Severe male factor infertility
Previous failed fertilisation with IVF
Preimplantation genetic diagnosis
What are complications of ART?
Enlarged ovaries - Excess follicles
Multiple pregnancies
Ovarian hyperstimulation
Ectopic pregnancies
What are symptoms of the complications of ART?
Abdo pain/ bloating
Nausea/ Diarrhoea
Breathlessness
What treatment is involved before the embryo transfer?
Coasting
Elective freeze
Single embryo transfer
What treatment occurs after the embryo has been transferred?
Monitoring with scans/bloods
Antithrombotic: fluids, TED stockings and fragmin
Analgesia
Hospital admission if required IV fluids/more intensive monitoring/ paracentesis
