Infertility Flashcards
Give some of the main reasons couples seek ART
Endometriosis Male factor Tubal disease Ovulatory disorder Idiopathic
What advice should be given to couples before starting ART?
4 units alcohol per week (woman) BMI 19-29 Stop smoking Folate supplement Rubella immunisation
What are the main ART treatments?
Donor insemination
Intra-uterine insemination (IUI)
In-vitro fertilisation (IVF)
Intra-cytoplasmic sperm injection (ICSI)
What occurs in intra-uterine insemination?
Prepared semen inserted into uterine cavity at time of ovulation
Give some indications for IVF
Unexplained infertility
Pelvic disease
Anovulatory infertility
What is the first step of IVF?
Down regulation - synthetic GnRH given to time ovulation
What occurs after down regulation?
The ovary is stimulated with high dose gonadotrophin
After ovary stimulation what occurs?
Oocyte collected in theatre
What occurs once the oocyte has been collected?
Fertilisation using sperm
How many days after fertilisation is the embryo transferred?
5
Give some indications for intra cytoplasmic sperm injection
Severe male infertility
Previous failed fertilisation
In ICSI, what procedure is carried out if the man has azoospermia?
Surgical sperm aspiration
What is the main complication of ART?
Ovarian hyperstimulation syndrome
What occurs in ovarian hyperstimulation syndrome?
Too many eggs are produced
Give some clinical features of OHSS
Ascites
Oliguria
Thromboembolism
Renal failure
How can OHSS be treated?
Reduce thrombosis risk (fragmin)
Single embryo transfer
Why are rates of multiple pregnancy in ART decreasing?
As there is a move to blastocyst transfer
There is an increased incidence of ectopic pregnancy in ART. True/false?
True
What are the approximate success rates for IVF?
35%
What are the two primitive genital tracts?
Wolffian
Mullerian
Which primitive genital tract leads to the development of the male internal genital tract?
Wolffian
Which hormone is responsible for the differentiation of external genitalia?
Dihydrotestosterone
What occurs in androgen insensitivity syndrome?
Patients have a male karyotype but are phenotypically female
Why it is important for the testes to descend?
As the lower temperature outside the body facilitates spermatogenesis
What is cryptorchidism?
Failure of testes descent
Which cells are responsible for the production of testosterone?
Leydig cells
Give some functions of the Sertoli cells
Form blood-testes barrier
Nutrition
Phagocytosis
Seminiferous tubule fluid secretion
Which pituitary hormone regulates testosterone secretion?
LH
Which pituitary hormone enhances spermatogenesis?
FSH
Give some of the effects of testosterone
Pubertal characteristics
Spermatogenesis
Secondary sexual characteristics
What is male infertility?
Failure of the sperm to normally fertilise the egg
Give some obstructive causes of male infertiltiy
Cystic fibrosis
Vasectomy
Infection (chlamydia)
Give some non-obstructive causes of male infertility
Cryptorchidism
Mumps
Testicular tumour
Chemotherapy
Give some endocrine causes of male infertility
Pituitary tumours (prolactinoma) Kallman's syndrome (no GnRH) Thyroid disorders Diabetes Congenital adrenal hyperplasia
What is the normal testicular volume in men?
12-25 ml
Give some factors which may affect semen analysis
Period of abstinence
Condition during transport
Health of donor
Give some clinical features of obstructive male infertility
Normal testicular volume
Normal secondary sexual characteristics
Absent vas deferens
Normal LH/FSH/testosterone
Give some clinical features of non-obstructive male infertility
Low testicular volume
Reduced secondary sexual characteristics
Present vas deferens
High LH/FSH
What is the main treatment for main infertility?
Intracytoplasmic sperm injection
What is involved in ICSI?
Sperm prepared from semen
Sperm injected into egg
What is involved in surgical sperm aspiration?
Needle inserted into epididymis and sperm aspirated
