Infertility and assisted conception Flashcards
list indictions for assisted conception treatment
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
before treatment begins alcohol weight smoking folic acid rubella smear occupation factors drugs screen for what assess what
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
what treatments are available
donor insemination intra uterine isemination in vitro fertilisation intra cytoplasmic sperm injection fertility preservation surrogacy
indications for IUI and method
unexplained infertility, mild or mod endometriosis, mild male factor infertility
natural/stimulated cycle
prepared semen inserted into uterine cavity around time of ovulation
IVF indications
unexplained >2 years
pelvic disease (endometriosis, tubal disease, fibroids)
anovolulatory infertility
male factor infertility if >1x106 motile sperm
down regulation in IVF is what
artificial menopause
how is down regulation done
synthetic gonadotrophin releasing hormone analogue or agonist which is administered as a spray or injection
what does down regulation do
reduces cancellation from ovulation and improves success rate
allows precise timing of oocyte recover by using HCG trigger
SE of down regulation
hot flushes and mood swings
nasal irritation
headaches
what is the next step for IVF and how
what does it do
S/E
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
what happens if there is a slow response
repeat scan 72 hours later
what happens if there is a poor response
increase dose of FSH
assess for hyper stimulation
plan date/timing of HCG injection
how is a sperm sample taken
abstinence for 72 hours beforehand
mens room in the ward or at home
assessment of the sperm sample
volume
density - number
motility - how many are moving
progression - how well they move
oocyte collection risks
bleeding
pelvic infection
failure to obtain oocytes
what does the embryologist then do
search through follicular fluid and identify eggs and surrounding mass of cells
collect them into cell culture medium
incubate at 37oC
what happens during the embryo transfer
normally transfer 1 (max is 3)
progesterone suppositories for 2 weeks
indications for a intra cytoplasmic sperm injection
severe male factor infertility
previous failed fertilisation with IVF
preimplantation genetic diagnosis
if azoospermia - surgical sperm aspiration where form
epididymis if obstructive
testicular tissue if non-obstructive
what happens to the aspiration then
each egg is stripped
sperm immobilised
single sperm injected
incubate at 37oC overnight
hyperstimulation is what
symptoms
enlarged ovaries- enlarged follicles
abd pain/bloating
N/diarrhoea
breathless
treatment for hyperstimulatio before embryo transfer
coasting - stop the GDT
elective freeze
single embryo transfer
treatment after embryo transfer
monster with scans and blood
antithrombotic - fluids, TED stockings, fragmin
analgesia
hospital admission if required IV fluids/more intensive monitoring/paracentesis
other risks of artificial conception
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
