Infertility and assisted conception

Question 1

list indictions for assisted conception treatment

Answer 1

fertility preservation in cancer patients
treatment to avoid transmission of blood borne viruses between patients
pre implantation diagnosis of inherited disorders
treatment of single parents or same sex couples

Question 2

before treatment begins 
alcohol 
weight 
smoking 
folic acid 
rubella 
smear
occupation factors 
drugs 
screen for what 
assess what

Answer 2

females limit to 4 units/wk
19-29 both male and female 
stop smoking 
0.4g/day pre conception 
check if immune 
cervical smear 
exposure to hazards
OTC, prescribed, recreational 
blood borne viruses - hepB/C, HIV
assess ovarian reserve - antral follicle count or AMH

Question 3

what treatments are available

Answer 3

donor insemination 
intra uterine isemination 
in vitro fertilisation 
intra cytoplasmic sperm injection
fertility preservation 
surrogacy

Question 4

indications for IUI and method

Answer 4

unexplained infertility, mild or mod endometriosis, mild male factor infertility
natural/stimulated cycle
prepared semen inserted into uterine cavity around time of ovulation

Question 5

IVF indications

Answer 5

unexplained >2 years
pelvic disease (endometriosis, tubal disease, fibroids)
anovolulatory infertility
male factor infertility if >1x106 motile sperm

Question 6

down regulation in IVF is what

Answer 6

artificial menopause

Question 7

how is down regulation done

Answer 7

synthetic gonadotrophin releasing hormone analogue or agonist which is administered as a spray or injection

Question 8

what does down regulation do

Answer 8

reduces cancellation from ovulation and improves success rate
allows precise timing of oocyte recover by using HCG trigger

Question 9

SE of down regulation

Answer 9

hot flushes and mood swings
nasal irritation
headaches

Question 10

what is the next step for IVF and how
what does it do
S/E

Answer 10

ovarian stimulation - gonadotrophin hormone containing synthetic or urinary gonadotrophins (FSH/LH)
can be self administered s/c injection
causes follicular development
mild allergic reaction and ovarian hyper stimulation syndrome

Question 11

what happens if there is a slow response

Answer 11

repeat scan 72 hours later

Question 12

what happens if there is a poor response

Answer 12

increase dose of FSH
assess for hyper stimulation
plan date/timing of HCG injection

Question 13

how is a sperm sample taken

Answer 13

abstinence for 72 hours beforehand

mens room in the ward or at home

Question 14

assessment of the sperm sample

Answer 14

volume
density - number
motility - how many are moving
progression - how well they move

Question 15

oocyte collection risks

Answer 15

bleeding
pelvic infection
failure to obtain oocytes

Question 16

what does the embryologist then do

Answer 16

search through follicular fluid and identify eggs and surrounding mass of cells
collect them into cell culture medium
incubate at 37oC

Question 17

what happens during the embryo transfer

Answer 17

normally transfer 1 (max is 3)

progesterone suppositories for 2 weeks

Question 18

indications for a intra cytoplasmic sperm injection

Answer 18

severe male factor infertility
previous failed fertilisation with IVF
preimplantation genetic diagnosis

Question 19

if azoospermia - surgical sperm aspiration where form

Answer 19

epididymis if obstructive

testicular tissue if non-obstructive

Question 20

what happens to the aspiration then

Answer 20

each egg is stripped
sperm immobilised
single sperm injected
incubate at 37oC overnight

Question 21

hyperstimulation is what

symptoms

Answer 21

enlarged ovaries- enlarged follicles
abd pain/bloating
N/diarrhoea
breathless

Question 22

treatment for hyperstimulatio before embryo transfer

Answer 22

coasting - stop the GDT
elective freeze
single embryo transfer

Question 23

treatment after embryo transfer

Answer 23

monster with scans and blood
antithrombotic - fluids, TED stockings, fragmin
analgesia
hospital admission if required IV fluids/more intensive monitoring/paracentesis

Question 24

other risks of artificial conception

Answer 24

multiple pregnancies 
no edges retrieved 
surgical risks of oocyte retrieval 
surgical risks of sperm aspiration
failed fertilisation 
ectopic pregnancy 
non continuing pregnancy 
increase risk in on going preg
psychological issues