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Reproduction, Development and Aging > Infertility > Flashcards

Infertility Flashcards

1
Q

What’s the definition of Infertility?

How many couples are affected?

A

“Failure to conceive after 12months of unprotected intercourse.

1/4 couples.

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2
Q

How many kids are we expected to have on average in NZ

A

2.2

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3
Q

___% of women are childless by choice at midpoint of childbearing years

A

17%

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4
Q

What is done to assess Male Fertility?

Done before woman

A

A semen Analysis!

Lower Reference Points to Infertility:

  • S.Count: <15mill/ml
  • Motility: <40% progressive and non-progressive
  • Volume <1.5ml
  • Total # Sperm <39mill in ejaculate (should be 100-300M)
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5
Q

What is done to Assess female fertility?

A
  1. Ovulation: to see she’s ovulating and has a functioning corpus Luteum
    • Check E2 day 12
    • Check P4 day 21
    • FSH day 2-4 <10IU/I
    • AMH anti-mullerian hormone (only done last 5-10y via age related graph)
  2. Timing (not frequency) of Intercourse: Only 16% population and 27% clients know when they are ovulating. Be careful with wording! “do you have it at least 2 times around the women’s fertile period?”
    ​​
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6
Q

Causes of infertility in %

A

Unexplained 20%

Male 30%

Female 30%

Both 20%

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7
Q

What are the 6 causes of Female Infertility?

Treatment for each?

A
  1. Anovulation
    • Weight gain/loss
    • Drugs
  2. PCOS
    • metformin, clomiphene citrate or FSH
    • IVF
  3. Tubal disease
    • Surgery
    • IVF
  4. Cervical problems
    • IUI
  5. Endometriosis
    • IVF
    • Ablation or hormone contraceptives
  6. Premature menopause (rising FSH and decr AMH with age)
    • donor egg
  7. No uterus
    • surrogacy
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8
Q

What drugs are used to treat Anovulation?

A
  • GnRH
  • Clomiphene citrate: used to be 1st line treatment, now outdated and SERM (non-steroidal) used
  • FSH
  • Letrazole: Aromatase inhibitor → decreases amount of estrogen. Better for a single not multiple ovulation
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9
Q

What is PCOS

A
  • Multiple cysts/follicles on ovary cortex
  • Often infrequent/no period
  • Weight gain is common as it’s a metabolic syndrome
First line treatment = WEIGHT LOSS
then metformin (insulin sensitiser), CC, FSHn or IVF
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10
Q

What can cause tubal Defects

A
  1. Blocked tubes: often by infection or STI; (clamhydia)
  2. Also Fibroids, cysts/tumours, endometriosis, tubal pregnancy
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11
Q

Describe the Steps involved in IVF

A
  1. Ovarian Stimulation
    • Stimulation: FSH
    • Control: prevent ovulation via GnRH antagonist
    • Trigger: stimulate Ovulation via HCG or GnRH agonist (whilst trying to avoid fatal overactive ovaries)
    • Luteal support: progesterone (to balance the system)
  2. ​Egg Retrival: 36h post stimuli
  3. Sperm preperation and Fertilisation
  4. Embryo Culture
  5. Embryo Transfer: day 3-5
  6. Embryo Freezing: day 5 is the earliest you can do this!
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12
Q

How does age affect the cumulative pregnancy rate of IVF

(chance of success with every embryo picked from one lot)

A

<35 is 51%

35-39 is 45%

40+ is 25%

So once in your 40’s it’s a massive failure rate!

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13
Q

IVF cycle tracking

A

Scans: day 1, 5 and 9

Daily injection of ovarian stimulation drugs: Days 1-10

Daily injections of antagonist: Days 5-10

Egg +sperm implanted Day 12

Blood tests look at Estrogen (~1000m/follile) and progesterone (<6pmol/L)

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14
Q

Fertilised embryo becomes unique embryo when ___

A

8cell.

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15
Q

What are the pro’s of the recent innovation of ‘Time Lapse Photography and single step media”

A
  • Undisturbed culture from external environ.
  • Individual embryo tracking of cell division: can see hidden abnormalities
  • Algorithms predict those with best potential
  • Provides full info instead of snapshiot selection
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16
Q

The four main causes of Male infertility?

A
  1. Oligospermia (decr. sperm conc)
    • ICSI
    • Donor Sperm (cheaper)
  2. OATS (oligoasthenoteratospermia; low Sperm conc, and slow, no much you can do!)
    • ICSI
    • Donor Sperm
  3. CAVD congenital absence of the Vas Deferens
    • ICSI
  4. Azoospermia (no sperm)
    • Treatment dependent on type
17
Q

What are the differing types and therefore treatments for Azoospermia (NO sperm)

A
  1. Kallman’s Syndrome (no GnRH) → FSH/LH replacement
    delayed puberty and impaired sense of smell
  2. No spermatogenesis → Donor insemination
  3. Obstuctive or Vasectomy → reversal, PESA or TESA + ICSI
  4. Non-Obstuctive → TESE + ICSI

PESA: percutaneous epididymal sperm aspiration
TESA: Testicular sperm aspiration
TESE: testicular sperm extraction

18
Q

What is ICSI

A

in vitro fertilization (IVF) procedure in which a single sperm is injected directly into an egg.

Via a big microscope

19
Q

Steps involved in ICSI in sperm vs egg

A

Sperm:

  1. Select motile sperm with normal morphology
  2. Immobilize sperm
  3. aspirate sperm tail first
  4. Position sperm in needle

Egg:

  1. Position PB at 12o’clock
  2. suction pipette
  3. insert needle into egg
  4. rupture egg membrane by aspirating
  5. expel the sperm
  6. culture overnight
20
Q

What do you do about unexplained infertility?

A

Mild stimulation with IUI or IVF and hope for the best!

21
Q

Whats the impact of Age on fertility?

A

Leading underlying cause of infertility

>40year eggs have more mitochondrial issues and chromosome defects (Pre-implantation Genetic Screening (PGS))

Age of first child is increasing; ~30year in NZ

Due to pressure: social, financial, career and lack of knowledge

Education is key; do the AMH testing

22
Q

What’s PGS

A

Pre-implantation Genetic Screening

  1. Trophoectoderm biopsy day 5/6
  2. Freeze ALL biopsied embryos
  3. tube the 8-10 cells
  4. amplify
  5. Next generation sequencing
  6. Analysis results
  7. Thaw and transfer unaffected euploid embryo
23
Q

Describe in more depth the day 5/6 trophectoderm biopsy for PGS

A

Page 54

24
Q

What’s the pros/cons of EGG FREEZING

A
  • Less succesful then embryo freezing
  • Vitrification more successful then slow freezing
  • Need ~10 eggs frozen to achieve pregnancy
  • Chemo and radiation
  • Social egg freezing
25
Q

What are some final alternative solutions

A

Surrogacy

Donor embryo

Adoption

Moving on

Reproduction, Development and Aging (30 decks)

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