Infertility and ART Flashcards
Risk of heterotopic pregnancy in IVF
The risk of heterotopic pregnancy among women with a naturally achieved pregnancy is estimated to range from 1 in 4,000 to 1 in 30,000, whereas the risk among women who have undergone in vitro fertilization is estimated to be as high as 1 in 100
The criteria for normal semen parameters (WHO 2010) are:
Volume (mL): ≥1.5
Concentration (x 106 mL): ≥15
Total sperm number (x 106 mL): ≥39
Total motility (%): ≥40
Progressive motility (%): ≥32 Normal morphology (%): ≥4
WBC (x 106 mL): ≤1.
PCOS has increased risk of
1) endometrial Ca
PET
RPL
When the infertility cycle cancelled ?
If
-there is no response to injections
- high estradiol levels
Micro-flare (short) protocol
For low-reserve ovarian Pt
Or who is not responding
Diffuse adenomysosis associated with
Infertility 20% and miscarriages 50%
Common side effects of CC
Hypoestrogeniemia S&S
Double vision > you have to stop medication right away associated with underlying pituitary tumor
Multiple gestational rate 8%
Usual dose: 50-150 mg
The minimum endometrial thickness for successful embryo implantation
7 mm
The rate of multiple gestation with letrozole
4% ( near the normal percent)
When did you consider removing endometrioma in infertility ?
If the size > 5 cm
When the amount measured in the circulation in the nonpregnant woman exceeds a certain level, usually —- ng/ mL (=— to —) , the condition is called hyperprolactinemia.
When the amount measured in the circulation in the nonpregnant woman exceeds a certain level, usually 20 to 25 ng/ mL (=425 to 531) , the condition is called hyperprolactinemia.
if elevated above 100 ng/mL, imaging of the sella turcica should be performed to determine whether a macroadenoma is present.
The incidence of galactorrhea in women with hyperprolactinemia has been reported to range from —- to– % and these differences probably reflect variations in the techniques used to detect mammary excretion.
The incidence of galactorrhea in women with hyperprolactinemia has been reported to range from 30% to 80%, and these differences probably reflect variations in the techniques used to detect mammary excretion.
Causes of Hyperprolactinemia
Pituitary Disease: (Prolactinomas,Acromegaly,Empty sella syndrome,Lymphocytic hypophysitis, Cushing disease)
Hypothalamic Disease:(Craniopharyngiomas,Meningiomas,Dysgerminomas,Nonsecreting pituitary adenomas, Other tumors, Sarcoidosis,Eosinophilic granuloma, Neuraxis irradiation, Vascular, Pituitary stalk section)
Medications:(tricyclic antidepressants block dopamine uptake and pro-pranolol, haloperidol, phentolamine, and cyproheptadine block hypothalamic dopamine receptors)
Neurogenic:(Chest wall lesions,Spinal cord lesions,Breast stimulation)
Other:(Pregnancy,Hypothyroidism,Chronic renal failure,Cirrhosis, Pseudocyesis, Adrenal insufficiency, Ectopic, Polycystic ovary syndrome, Idiopathic)
Pharmacologic Agents Affecting Prolactin Concentrations
Stimulators: Anesthetics, including cocaine
Psychoactive drugs Phenothiazines Tricyclic antidepressants Opiates Chlordiazepoxide Amphetamines Diazepam Haloperidol Fluphenazine Chlorpromazine SSRIs
Hormones Estrogen Oral-steroid contraceptives Thyrotropin-releasing hormone
Antihypertensives α-Methyldopa Reserpine Verapamil
Dopamine receptor antagonists Metoclopramide
Antiemetics Sulpiride Promazine Perphenazine
Others Cimetidine Cyproheptadine
Protease inhibitors Inhibitors l-Dopa Dopamine Bromocriptine Pergolide Cabergoline Depot bromocriptine
Primary hypothyroidism can also produce hyperprolactinemia and galactorrhea because of decreased negative feed-back of thyroxine (T4) on the hypothalamic-pituitary axis. The resulting increase in TRH stimulates PRL secretion and thyroid-stimulating hormone (TSH) secretion from the pituitary.
3% to 5% of individuals with hyperprolactinemia have hypothyroidism. Therefore TSH, the most sensitive indicator of hypothyroidism, should be measured in all individuals with hyperprolactinemia.
Hyperprolactinemia has been reported to occur in approximately 25% of those with acromegaly and 10% of those with Cushing disease, indicating that these pituitary adenomas, which mainly secrete growth hormone (GH) and adrenocorticotropic hormone (ACTH), frequently also secrete PRL.
Various types of pituitary tumors, lactotroph hyperplasia, and the empty sella syndrome can be associated with hyperprolactinemia. It has been estimated that as many as 80% of all pituitary adenomas secrete PRL.
Functional hyperprolactinemia
the term used for the clinical diagnosis of cases of elevated PRL levels without imaging evidence of an adenoma.
primary empty sella syndrome
describes a clinical situation in which an intrasellar extension of the subarachnoid space results in compression of the pituitary gland and an enlarged sella turcica. The cause is believed to result from a congenital or acquired (by radiation or surgery) defect in the sella diaphragm that allows the subarachnoid membrane to herniate into the sella turcica.
The best modality for diagnosing empty sella syndrome is ……….. It is important to establish the diagnosis because the syndrome has a benign course.
magnetic resonance imaging (MRI)
Several studies have reported that pregnancy is beneficial for women with functional hyperprolactinemia or PRL-secreting microadenomas. Following pregnancy, PRL levels decrease in approximately 50% of women.
Therefore if women with hyperprolactinemia desire to become pregnant, they should be encouraged to do so, because pregnancy is likely to result in normal or lowered PRL levels.
IMAGING STUDIES Current recommended for central causes of hyperprolactinemia
CT scan with intravenous contrast or an MRI with gadolinium enhancement. T he latter provides better soft tissue definition, without radiation
Those with hyperprolactinemia, with or without microadenomas, who have adequate estrogen levels and who do not wish to conceive should be treated with
periodic progestogen withdrawal (e.g., medroxyprogesterone acetate, 5 to 10 mg/day for 10 days each month) or with combination oral contraceptives to prevent endometrial hyperplasia.
Post-op complications of micro/macroadenomas removal
T he risk of temporary postoperative diabetes insipidus is 10% to 40%, but the risk of permanent diabetes insipidus and iatrogenic hypopituitarism is less than 2%. The initial cure rate, with normalization of PRL levels and return of ovulation, is relatively high for microadenomas (65% to 85%) but less so with macroadenomas (20% to 40%). Vision can return to normal in 85% of patients with loss of acuity and visual field defects.The initial cure rate is related to the pretreatment PRL levels. T hose tumors with PRL levels less than 100 ng/mL have an excellent prognosis (85%), and those with levels higher than 200 ng/ mL have a poor prognosis (35%).
breastfeeding and hyperprolactinemia
Breastfeeding may be initiated without adverse effects on the tumors and may be initiated after delivery unless there have been visual field defects during pregnancy
The commonest cause of anovulation is
Polycystic Ovarian Syndrome (PCOS)
is the first drug of choice used in management of anovulatory infertility.
Clomiphene Citrate (CC)
Congenital bilateral absence of the vas deferens is associated with
Cystic fibrosis
lnfertilityTesting of ovulatory function/ ovarian reserve
Ovulation predictor kit
Early follicular FSH ± estradiol level
Antimullerian hormone (AMH)
Endocrine disorders (TSH, prolactin)
Ovarian sonography (antral follicle count)
lnfertilityTesting of Tubal/pelvic disease
Hysterosalpingography Laparoscopy + chromotubation
Probable ovulation is also suggested by mittelschmerz, which is
midcycle pelvic pain associated with ovulation, or by moliminal symptoms such as breast tenderness, acne, food cravings, and mood changes.
the midluteal progesterone level (serum is obtained on cycle day number 21 following the first day of menstrual bleeding, or 7 days following ovulation) is best regarded as an acceptable test for
ovulation but not an absolute indicator of adequate: luteal function.
With PID, tubal infertility has been estimated following one, two, or three cases of PID,
to follow in 12 percent, 23 percent, and 54 percent of women
Salpingitis isthmica nodosa
is an inflammatory condition of the fallopian tube, characterized by nodular thickening of its isthmic portion. Histologically, smooth muscle proliferation and diverticula of tubal epithelium contribute to this thickening. This uncommon condition typically develops bilaterally and progressively leads to ultimate tubal occlusion and infertility
Causes of male infertility can roughly be categorized as
abnormalities of sperm production, sperm function, or obstruction of the ductal outflow tract.
The seminiferous tubules contain
developing sperm and support cells called Sertoli cells or sustentacular cells
The Sertoli cells form tight junctions that produce a
blood-testis barrier. This avascular space within the seminiferous tubules protects sperm from anti-bodies and toxins but also makes these cells dependent on dif-fusion for oxygen, nutrients, and metabolic precursors.
Located between the seminiferous tubules are Leydig cells, also called interstitial cells, which are responsible for
steroid hormone production.
Oligospermia means
Sperm concentration 10-15 million sperm/ml (mild-moderate) or <5-1O million/ml (severe)
Asthenospermia
Greater proportion of immotile sperm or sperm with decreased motility
Teratospermia
Increased proportion of morphologically abnormal sperm
Azoospermia VS. Aspermia
Azoospermia Semen present but lacks sperm
Aspermia Sperm and seminal plasma lacking (anejaculation)
Leukocytospermia
Increased white blood cell count
Necrospermia
All sperm nonviable or immotile
Low semen volume can indicate
incomplete specimen collection or short abstinence interval.
partial vas deferens obstruction or retrograde ejaculation.
Partial or complete vas deferens obstruction may be caused by
infection, tumor, prior testicular or inguinal surgery, or trauma.
Retrograde ejaculation follows
failed closure of the bladder neck during ejaculation and allows seminal fluid to flow backward into the bladder. Retrograde ejaculation is sus-pected in men with diabetes mellitus, spinal cord damage, or prior prostate or other retroperitoneal surgery that may have damaged nerves, Medications, particularly f3-blockers, may contribute to this problem.
Retrograde ejaculation diagnosis
A postejaculatory urinalysis can detect sperm in the bladder and confirm the diagnosis. If urine is properly alkalinized, these sperm are viable and can be retrieved to achieve pregnancy.
In any patient with POi, what karyotype testing for ….. should be considered?
trisomy 21/ Turner syndrome
Fragile X premutation carrier screening should be discussed with any woman with a family or personal history of POi or family history of intellectual disability.
For anovulatory infertility in women with PCOS , ESRE/ASRM guidelines recom-mend first-line treatment with
letrozole or clomiphene citrate
The chance of a couple to conceive is – % per a month
The chance of a couple to conceive is 25% per a month
The best predictor of ovarian follicles reserve?
US antrafollicular counts
Fertility vs. Fecundity vs. Fecundability ?
Fertility: ability to conceive and produce offspring
Fecundity: ability/ chance of achieving a live birth during any menestrual cycle
Fecundability: the ability/ chance of achieving a pregnancy during any menestrual cycle
Best predictor of ovulation is
Regular cycle
Among those tests of ovulation which one of them the most reliable:
- BBT (0.2-0.4 degree Celsius)
- mid luteal progesterone (>16mmol)
- serial test of LH surge (serum, urine)
- follicular tracking
- endometrial biopsy
mid luteal progesterone (>16mmol)
In which mechanism does prolactin causes anovulation??
Suppression of GnRH secretion
What is the likelihood percentage of having tubal disease and blockage after having:
1 episode of PID
2 episodes of PID
3 episodes of PID
1 episode of PID: 10-12 %
2 episodes of PID: 25- 35%
3 episodes of PID: 54- 75%
What is the most common cause of hyperprolactinemia
Hypothyroidism
In woman with tubal disease
IVF is best option for:
- Proximal tubal obstruction
- bilateral hydrosalpinx (after salpingectomy Or occlusion)
- moderate to severe distal disease
- older female
What is the most common cause of infertility
Female factors collectively
Among female factors is ovulatary
The most Individual factor is male factor
IUI pregnancy success rate
20 %
Risk factors for ovarian hyperstimulation syndrome include
high antral follicle counts, polycystic ovary syndrome, young age, and a previous history of ovarian hyperstimulation syndrome.
fecundability is
The conception rate per menstrual cycle
For the indication of recurrent pregnancy loss, postoperative live birth rate approximate 85 percent following septoplasty
For the indication of recurrent pregnancy loss, postoperative live birth rate approximate — percent following septoplasty
–% of women conceive within 1 year of regular unprotected intercourse
84% of women conceive within 1 year of regular unprotected intercourse
–% of women would conceive within 2 years of regular unprotected intercourse
92% of women would conceive within 2 years of regular unprotected intercourse
A couple present to the fertility clinic after failing to conceive despite trying for 2.5 years. The semen analysis shows azoospermia.You perform a full examination of the male partner which reveals Height 192cm, BMI 20.5, small testes and scant facial hair. You decide to organise karyotyping. What is the result likely to show?
47XYY karyotypes affect around 1 in 1000 men but they have normal phenotypes. 47XXY is the Karyotype seen in Klinefelters. In the exam if you asked about Karyotypes associated with azoospermia and infertility it is highly likely they are alluding to Klinefelter’s Syndrome. Other chromosomal abnormalities leading to azoospermia would be Cystic fibrosis (usually DeltaF508 mutation) or microdeletions of the Y-Chromosome.
Who need to be evaluated earlier than 1 year for infertility ?
If the couple had any of these risk factors:
- >35 yrs old
- Family h/o infertility or POI
- cancer / pervious chemo or radiotherapy
- Undescended testis
- autoimmune disease
- male with h/o trauma
For preimplantion diagnostic test of single gene defect from which stage the cell taken :
Blastomere (8 cell stage)
Or blastocyst from tropho-ectoderm
Biopsy of PGD can be taken from :( each option mention pros and cons)
There are two clinical forms of OHSS, both hCG related:
the early-onset form (occurring on the first eight days after exogenous hCG administration) and the late-onset form (occurring nine or more days after hCG administration, related to pregnancy-induced hCG production)
fecundability is
the ability to conceive, and data from large population studies show that a monthly probability of conceiving is 20 to 25 percent.
In those attempting conception, more than – percent will be pregnant by 1 year.
In those attempting conception, more than 85 percent will be pregnant by 1 year.
Fecundity of Normal Couples Over Time %/ month
Time (months) Couples Achieving Pregnancy(%)
20-36% At 1 month
57% at 3 months
72% at 6 months
85% at 12 months
93% at 24 months
Low semen volume often reflects
incomplete specimen collection or short abstinence interval. However, it may indicate partial vas deferens obstruction or retrograde ejaculation. Partial or complete vas deferens obstruction may be caused by infection, tumor, prior testicular or inguinal surgery, or trauma. Retrograde ejaculation follows failed closure of the bladder neck during ejaculation and allows seminal fluid to flow backward into the bladder. Retrograde ejaculation is suspected in men with diabetes mellitus, spinal cord damage, or prior prostate or other retroperitoneal surgery that may have damaged nerves. Medications, particularly ~-blockers, may contribute to this problem. A postejaculatory urinalysis can detect sperm in the bladder and confirm the diagnosis. If urine is properly alkalinized, these sperm are viable and can be retrieved to achieve pregnancy.
controlled ovarian stimulation (COS)
If ovulation induction agents are administered solely to stimulate follicles and then egg harvesting is completed by ART
“step-up” protocol
ovulation induction attempts at a low gonadotropin dosage of 50 to 75 IU/d. This is gradually increased if no ovarian response (as assessed by serum estradiol measurements) is noted after several days
long protocol.
combined with combination oral contraceptive (COC) pill pretreatment. With the long protocol, GnRH agonists are begun typically 7 days prior to gonadotropins. GnRH agonists suppress endogenous pituitary release of gonadotropins. This minimizes the risk of a premature luteinizing hormone (LH) surge and thus premature ovulation. During all protocols, serial serum estrogen levels and sonographic surveillance of follicular development accompany gonadotropin administration. Human chorionic gonadotropin (hCG) is administered to mimic the normal luteinizing hormone (LH) surge and trigger ovulation. HCG is given when sonography shows three or more follicles measuring at least 17 mm. Eggs are retrieved 36 hours later. Embryos are transfer back to the uterus 3-5 days following retrieval. Progesterone supplementation, with either vaginal preparations or intramuscular injection, follows during the luteal phase to support the endometrium. One major drawback of GnRH agonist therapy is the induction of initial transient gonadotropin release or flare, which may lead to ovarian cyst formation. Functional ovarian cysts can prolong the duration of pituitary suppression required prior to gonadotropin initiation and may also exert a detrimental effect on follicular development because of their steroid production. However, COC pretreatment can help prevent ovarian cyst formation. Moreover, COC pretreatment may improve induction results by providing an entire cohort of follicles synchronized at the same developmental stage that will reach maturity at the same time once stimulated by gonadotropins.
What is GnRH flare protocol. This is also known as the short protocol.
GnRH agonists initially bind gonadotropes and stimulate follicle-stimulating hormone (FSH) and LH release. This initial flare of gonadotropes stimulates follicular development. Following this initial surge of gonadotropins, the GnRH agonist causes receptor downregulation and an ultimately hypogonadotropic state. Gonadotropin injections begin 2 days later to continue follicular growth.
During exogenous ovulation, strategies to avoid OHSS induction include
decreasing follicular stimulation (a lowered FSH dose), “coasting” (withholding FSH administration for one or more days prior to the hCG trigger injection), prophylactic treatment with volume expanders, and substitution of hCG for FSH during the final days of ovarian stimulation.
Proximal tubal occlusion describes
obstruction proximal to the fimbria and may develop at the tubal ostium, isthmus, or ampulla.
distal tubal occlusion describes obstruction at
the tube’s fimbria. It typically results from prior pelvic infection and may be associated with concomitant adnexal adhesions.
women desiring neosalpingostomy for treatment of distal occlusion are counseled about what ?
the risk of ectopic pregnancy is high, the likelihood of pregnancy is 50 percent or lower, and postoperative reocclusion is common (Bayrak, 2006). Moreover, hydrosalpinges that are dilated more than 3 cm in diameter, that are associated with significant adnexal adhesions, or that display an obviously attenuated endosalpinx yield a poor prognosis. These tubes are best treated by salpingectomy. If both cubes are affected, bilateral salpingectomy is recommended prior to proceeding with IVF. This stems from data showing women with hydrosalpinges undergoing IVF have approximately half the pregnancy rate of other women with unaffected tubes (American Society for Reproductive Medicine, 2015c).
Emission and closure of the bladder neck during wjaculatoon are primarily mediated by
alpha-adrenergically mediated thoracolumbar sympathetic reflex events with supraspinal modulation.
Ejaculation is a sacral spinal reflex mediated by
the pudenda! nerve.
Obstructive azoospermia, especially resulting from
prior vasectomy or ejaculatory duct obstruction, may be amenable to surgical treatment. However, congenital bilateral absence of the vas deferens (CBAVD) is a common cause of azoospermia. In such candidates, testicular sperm extraction (TESE) may be performed in conjunction with ICSI.
Nonobstructive azoospermia may be caused by
a karyotypic abnormality such as Klinefelter syndrome (47,XXY) or balanced translocation; deletion of a small portion of the Y chromosome; testicular failure; or unexplained causes.
What is the success rate (pregnancy rate) with oral ovulatory induction CC/ letrozole ?
8-12 %
What is the success rate (pregnancy rate) with oral ovulatory induction CC/ letrozole ?
8-12 %
What is the twinning rate with oral ovulatory induction ?
10%
With IVF up to 30%
Risk factors of OHSS
1- young age
2- previous OHSS
3- high AFC
4- high E2 > 10000
5- low BMI
6- high dose of FSH
7- PCOS
8- long agonist protocol
Strategies to decrease OHSS
1- coasting
2- cancel cycle
3- antagonist cycle trigger with GnRH agonist decapeptyl 0.2 mg ( it works because it trigger endogenous flare that led to mild increase FSH/ LH and less risk of OHSS)
4- freeze all
5- cabergolin 0.5 mg 2 hours before trigger for 8 days
6- aspirin
7- calcium gluconate
Management of mild/ moderate OHSS (present with abd pain, US < 8 cm , mild fluid)
F/u as outpatient contact the patient on daily basis
Analgesia and anti- emetic
Instruct her to Weigh herself
Monitor input/output
Drink electrolytes rich fluid
Patient with OHSS in ER what is the main point you obtain from history ?
1- age
2- dose of FSH
3- type of trigger that she received (hCG, GnRH agonist)
4- number of eggs was retrieve
5- when the procedure done
6- S&S that she present with
7- estradiol levels
8- PMH: ? PCOS
9- embryo transfer done or not
10- pregnant or not
Investigations to order in OHSS:
CBC hct if more than 40 is concerning
Leukocytosis (acute phase reactant)
Electrolyte level / LFT/ RFT
CXR
Pelvic US
Most often, a GnRH agonist is coupled with gonadotropins (FSH or hMG). Why ?
These agonists prevent the possibility of spontaneous LH surge and ovulation prior to egg retrieval. Optimally, 10 to 20 ova are harvested, and from these, one healthy embryo is ideally transferred back to the uterus.
Complications of Assisted Reproductive Technology
Of maternal risks, preeclampsia, placenta previa, and placental abruption are more common in IVF-conceived pregnancies. congenital anomalies and epigenetic issues.
Factors that can influence the development of retrograde ejaculation include
type 2 diabetes mellitus, spinal trauma, history of retroperitoneal lymph node dissection, congenital anomalies, as well as factors that may be idiopathic.
For risk-reducing salpingo-oophorectomy in patients with hereditary breast and ovarian cancer syndromes, chance of finding occult malignancy at surgery or during final pathologic analysis approximates– percent (Finch, 2006; Manchanda, 2011). Thus, preoperative serum CA125 level and pelvic sonography should evaluate for malignancy.
For risk-reducing salpingo-oophorectomy in patients with hereditary breast and ovarian cancer syndromes, chance of finding occult malignancy at surgery or during final pathologic analysis approximates 5 percent (Finch, 2006; Manchanda, 2011). Thus, preoperative serum CA125 level and pelvic sonography should evaluate for malignancy.
Intrauterine insemination indications and contraindications
is a preferred treatment for mild or moderate male factor infertility. For IUI to be successful, generally more than 10 million total motile sperm in the ejaculate is required. With fewer than 10 million total motile sperm, there are steep decreases in the per-cycle pregnancy rate.
Fecundity rate of ovulation induction with CC if isolated ovulatory disfunction present:
20-22 %
IUI increase Fecundity rate
Ovulation rate (OR) with CC
80%
It decreases with BMI, age, free androgen index and history of oligomenorrhea
What is CC (CLOMIPHENE CITRATE)
an orally active nonsteroidal triphenylethylene derivative .
It has both estrogen agonist and antagonist effects by acting on a and b estrogen receptors.
What are the Two components of CLOMIPHENE CITRATE?
Enclomiphene, Zuclomiphene
CLOMIPHENE CITRATE indications
- Anovulation or infrequent ovulation as in PCO (WHO category II).
2.Infertility for causes other than ovulatory to time IUI or increase number of oocytes.
3.Luteal phase defects.
4.Unexplained infertility
CLOMIPHENE CITRATE contraindications
- Liver disease
2.Ovarian cyst
3.Development of visual symptoms on administration of drug
4.Ovarian failure
5.Hypothalamic pituitary failure (WHO Group I)
Cycle fecundity with CC in unexplained infertility is — to —% and is increased up to —% if IUI is added.
Cycle fecundity in unexplained infertility is 3.4 to 8% and is increased up to 9.5% if IUI is added.
CLOMIPHENE RESISTANCE
Failure to ovulate with 3 months use of clomiphene at 150 mg/day for 5 days
●It occurs in 20% cases more so in PCOS patients.
CLOMIPHENE FAILURE
Patients who ovulate but fail to conceive after treatment with 3 cycles of clomiphene in a dose of 150 mg/day
●due to excess LH, androgens or insulin which leads to impaired folliculogenesis, increased atresia, poor oocyte quality, poor endometrial receptivity and deficient corpus luteum function
●Other potential infertility factors must be ruled out
LETROZOLE dose and regimen
single dose of 2.5 to 5 mg/day from day 3 to 7 for 5 days
GNRH AGONIST protocol advantages
- Decreases the need for close monitoring to detect spontaneous LH surge.
2.Less cycle cancelation.
3.Better response.
4.More flexible schedule.
5.Higher oocyte recovery and pregnancy rate.
GNRH AGONIST disadvantages
1.Increased time for stimulation in the long protocol.
2.Luteal phase support is needed.
3.increased cost due to increased requirement of gonadotropin.
4.It may cause hyperstimulation due to flare response in luteal phase in the long protocol leading to high estradiol levels and ovarian cyst.
GNRH ANTAGONIST protocols
• Lubeck protocol (multidose protocol):
Fixed Protocol
Flexible Protocol
•French protocol (Single dose protocol)
GnRH Antagonsit medications names
1- cetrotide (cetrorelix acetate)
2- orgalutran (Ganiralx)
the number needed to treat with ICSI to prevent one case of failed fertilization for couples with unexplained infertility is —-
the number needed to treat with ICSI to prevent one case of failed fertilization for couples with unexplained infertility is 33. powered, multicenter, randomized controlled trial noted a 5% rate of failed fertilization with conventional insemination compared with a 2% rate with ICSI. However, because the overall rate of failed fertilization with both modalities is low, ICSI is not recommended for routine use.
Proximal fallopian tube occlusion has been classified into three types:
nodular (eg, salpingitis isthmic nodosa, endometriosis), non-nodular (eg, true fibrotic occlusion), and “pseudo” occlusion (eg, debris, polyps, hypoplastic tubes).
Chromosomal abnormalities are discovered in 10–15% of males with azoospermia and approximately 5% of males with severe oligozoospermia. The most common chromosomal abnormality is
47,XXY or Klinefelter syndrome.
Pelvic radiotherapy greater than – Gy could destroy 50% of available primordial follicles, and radiotherapy greater than – Gy produces irreversible damage.
Pelvic radiotherapy greater than 2 Gy could destroy 50% of available primordial follicles, and radiotherapy greater than 8 Gy produces irreversible damage.Therefore, it is prudent to have a discussion with patients who are about to initiate cancer therapy should fertility preservation be a desired option. Therefore, it is prudent to have a discussion with patients who are about to initiate cancer therapy should fertility preservation be a desired option.
Triptorelin (Decapeptyl)
is a medication that acts as an agonist analog of gonadotropin-releasing hormone, repressing expression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
highly purified menotropin (hMG)and recombinant follicle-stimulating hormone have similar ongoing pregnancy and live birth rates in women having controlled ovarian stimulation
GnRH antagonist protocols associated with similar live birth rate and lower risk of ovarian hyperstimulation syndrome compared to long-course GnRH agonist protocols in women having assisted reproductive technology
GnRH agonist generic names
Lupron (leuprolide)
Decapeptyl (triptolin)
Synarel (intranasal Nafarelin)
Zoladex (Goserelin)
TRELSTAR (triptorelin pamoate)
FSH generic name
Recombinant FSH
Gonal-F
Puregon
HMG
- Menopor
- merional
- Fostimon 75 IU (Urofollitropin)
The standard starting dose of FSH? And what is the maximum dose?
150 - 450 IU
HCG trigger by which medications
Pregnyl - choriomon - recombinant ovitterelle 250 mcg
