Infertility and assisted conception Flashcards
(36 cards)
What changes should be advised before treatment for infertility begins?
Alcohol: females limit to 4 units per week
Weight: BMI between 19-29
Stop smoking
Folic acid: 0.4mg/day preconception-12 weeks gestation
Check rubella immunisation
Check cervical smears
Drugs: prescribed, over-the-counter and recreational
Screen for blood born viruses
What is the method for intrauterine insemination?
Prepared semen inserted into uterine cavity around time of ovulation
In which cases would intrauterine insemination be used?
Mild male infertility
Mild endometriosis
Unexplained infertility
What are the indications for IVF?
Unexplained infertility > 2 years duration
Pelvic disease (endometriosis, tubal disease, fibriods)
Anovulatory infertility
Male factor infertility (if > 1 X 106 motile sperm)
What is buserelin and when is it administered?
Synthetic GnRH, which causes ‘downregulation’ and suppresses pituitary release of FSH and LH
Given 21 days after menstrual bleed
What are the side effects of buserelin?
Hot flushes
Nasal irritation
Headaches
Mood swings
After downregulation by buserelin has been going on for 2-3 weeks, what is the next step in IVF treatment?
Ovarian stimulation by gonadotrophin hormone, causing follicular development
What is the risk associated with ovarian stimulation?
Ovarian hyperstimulation syndrome
What is the next step in IVF treatment after ovarian stimualtion?
HCG injection, mimicking the LH surge that occurs prior to ovulation
How many embryos may be transferred into the uterus?
Patients under the age of 40 - no more than 2 embryos to be transferred
Patients aged 40 and over - 3 may be transferred in exceptional circumstances only
Why are so few embyos transferred?
To reduce risk of mulitple pregnancy
What are the indications for intracytoplasmic sperm injection?
Severe male factor infertility
Previous failed fertilisation with IVF
What is intracytoplasmic sperm injection (ICSI)?
An in vitro fertilization procedure in which a single sperm is injected directly into an egg
How are sperm retrieved for ICSI?
Surgical aspiration
What are the symptoms of ovarian hyperstimulation syndrome?
Abdominal pain / bloating
Nausea / Diarrhoea
Breathless
How does the Y chromosome cause development of the male genital tract?
Y chromosome has the region that codes for testes
Fetal testes release testosterone and mullerian inhibiting factors
The Wolffian ducts then begin to develop the male genital tract as the Mullerian ducts recede
Which becomes the female genital tract: Mullerian or Wolffian ducts?
Mullerian
Wolffian ducts degenerate in the absence of testosterone
What is androgen insensitivity disorder?
An X-linked recessive disorder in which male chromosomes have been inherited and so the testes develop, but do not respond to testosterone
As a result, testes never descend and Wolffian tracts never develop
Patients often think they are female, and present at puberty with a short vagina, no pubic hair and amenorrheoic
What is cryptorchidism?
Undescended testes
Why should orchidectomy be considered in an adult whos testes have not descended?
Risk of germ cell cancer 6x
What are the implication on fertility if testes undescended?
Sperm count reduced
Usually fertile if unilateral
What do Leydig cells do?
Secrete testosterone
What do sertoli cells do?
Protects the sperm from antibody attack
Provide nutrients for the developing cells
Phagocytosis
Secrete seminiferous tubule fluid
Produces hormone that binds testosterone so concentration remains high in lumen
Secretes inhibins and activins that regulate FSH
Where are sertoli cells located?
The semniferous tubules
