Infertility and Assisted Conception

Question 1

Briefly lis the stages involved in a treatment cycle of IVF

Answer 1

1. Down regulation
2. Ovarian stimulation
3. Egg collection and sperm sample
4. Embryo transfer
5. Luteal phase support via progesterone pessaries

Question 2

Explain the down regulation stage of IVF.

Answer 2

Synthetic GnRH analogue (Buserelin) taken as a nasal spray or injection. This causes reversible down regulation so FSH and LH not produced. Taken for around 2 weeks

Question 3

What two drugs are given to stimulate the ovaries in IVF?

Answer 3

Gonal F
Menopur
Taken for around 12 days

Question 4

What do Gonal F and Menopur cause?

Answer 4

Follicular development

Question 5

What is the risk of giving menopur and gonal F?

Answer 5

Ovarian hyperstimulation syndrome

Question 6

In the lead up to IVF when do you give an HCG injection and why?

Answer 6

Mimics spontaneous LH surge

Given 36 hours prior to egg collection

Question 7

On average, how many cells does a human embryo have at day 2?

Answer 7

4

Question 8

On average, how many cells does a human embryo have at day 3?

Answer 8

6 - 8

Question 9

On what day approx does a morula form?

Answer 9

4

Question 10

At what day should the embryo be an early blastocyst?

Answer 10

5

Question 11

What is the best day for embryo transfer back into the women?

Answer 11

Day 5 blastocyst

Question 12

Briefly describe the hormonal control of the menstrual cycle (starting from day 1)

Answer 12

1. At the start of the cycle oestrogen levels are low which causes an increase in GnRh and release of FSH by the anterior pituitary gland.
2. This causes follicular development in the ovary which also results in an increase in oestrogen production.
3. Initially this rising oestrogen level inhibits the release of LH but at a certain level it causes a surge of LH.
4. This LH surges causes ovulation (around 36 hours later)
5. At ovulation the dominant follicle is released into the ampulla of the fallopian tube.
6. The remaining part of the follicle become the corpus luteum with secretes progesterone which maintain the wall of the uterus which has been built up, in case of a pregnancy,
7. If no pregnancy occurs the levels of progesterone decrease and then uterus wall is shed (menstruation)

Question 13

How long before the sample is taken is it recommended that men do not ejaculate for?

Answer 13

72 hours

Question 14

What four characteristics of the sperm are measured in a semen analysis?

Answer 14

Volume of ejaculate
Density (Numbers of sperm in ejaculate)
Motility (what proportion are moving)
Progression (how well they move)

Question 15

What is the sign than the IVF laboratory looks for to demonstrate fertilisation?

Answer 15

Two pronuclei

Question 16

What stage do you freeze embroys as?

Answer 16

Pronuclear stage

Question 17

What is the HEFA rules about how many embryos should be transferred into a women?

Answer 17

Under 40: No more than 2

Over 40: 3 may be transferred in exceptional circumstanced only.

Question 18

How much folic acid should an otherwise healthy women take before getting pregnant and for how long?

Answer 18

0.4mg/day 3 months before and 3 months after pregnancy started

Question 19

How long after embryo transfer would you do a pregnancy test?

Answer 19

2 weeks

Question 20

How long after a positive pregnancy test in someone who has had IVF would you do a transvaginal US?

Answer 20

5 weeks

Question 21

What are the success rates of IVF?

Answer 21

35% (Live birth rate per embryo transfer)