Infertility Flashcards
What is the definition of infertility?
A failure to conceive after 12 months of unprotected intercourse
What is the incidence of infertility in the developed world?
1/4 couples
Which hormones are measured to assess normal ovulation in a fertility clinic?
- FSH
- E2
- P4
- AMH
Lower reference limits for male sperm:
Count \_\_\_ M/mL Motility \_\_\_% progressive + non progressive Volume \_\_\_\_ mL Total # \_\_\_\_ m Morphology \_\_\_\_%
Count = 15 M/mL Motility= 40% progressive + non progressive Volume = 1.5 mL Total # = 3.9m Morphology = 4 %
What is a common cause of anovulation?
Being under/overweight
Clomiphene citrate is a selective ____ receptor modulator
Oestrogen
Which drugs can be used to treat anovulation?
- FSH
- Clomiphene citrate
- Letrozole
What is the first line treatment for Polycistic Ovarian Syndrome (PCOS)?
Weight loss
Which drugs can be used to treat PCOS?
- Metformin
- Clomiphene citrate
- FSH
What are the treatment options for tubal disease?
Surgery or IVF
What is the treatment for cervical problems?
IUI (Intra-uterine insemination)
What are the treatment options for endometriosis?
- Hormonal contraceptives
- Surgical ablation
What is an advantage of letrozole over clominephine citrate?
A greater chance of single pregnancy
What are the 6 steps in IVF?
- Ovarian stimulation
- Egg retrieval
- Sperm preparation and fertilisation
- Embryo culture
- Embryo transfer
- Embryo freezing
Why might a GnRH agonist be administered in the early stages of IVF?
To prevent ovarian hyperstimulation syndrome
In IVF, the egg is collected ___ hours after the trigger injection
36
How is IVF cycle tracking done?
- Transvaginal ultrasound scans
- Blood tests (oestrogen, progesterone)
Why is IVF cycle tracking done?
- Prevent premature rise of progesterone, affects quality of eggs and lining of uterus
What needs to be seen on a transvaginal ultrasound before being able to trigger?
3 follicles, at least 17mm each
At what stage is the lab media changed for the growing embryo in IVF?
8 cell stage (day 3)
How is the lab culture made as close to physiological conditions as possible?
- Incubator is 5-6% CO2
What are the three abnormalities in OATS (oligoasthenoteratospermia)?
- Low concentration
- Poor motility
- Irregular morphology
Congenital absence of the vas deferens is present in almost 100% of ____ patients
Cystic fibrosis
What are four causes of azoospermia?
- Kallman’s syndrome
- No spermatogenesis
- Obstructive/vasectomy
- Non-obstructive
What are three methods of surgical removal of sperm?
- PESA = percutaneus epididymal sperm aspiration
- TESA = testicular sperm aspiration
- TESE = testicular sperm extraction
What as an important factor in unexplained fertility?
Age
How is unexplained fertility treated?
Mild stimulation with IUI or IVF
40 year old eggs have more ____ issues and ____ defects
Mitochondrial
Chromosomal
A patient with a high ovarian reserve may have _____
Polycystic Ovarian Syndrome
What is aneuploidy?
An abnormal number or arrangement of chromosomes
What are the benefits of time-lapse photography and single step media?
- Undisturbed culture
- Algorithms predict embryos with best potential
- No more snapshot selection
What is a benefit of PGD?
- Only put back embryos we know have a complement of chromosomes
How is PGD achieved?
Trophodecterm biopsy
Hole in zona -> cells herniate -> biopsy -> analyse
What are three recent innovations in IVF?
- Time lapse photography and single step media of IVF
- PGS
- Egg freezing
