Infertility And Assisted Conception Flashcards
Why is demand for assisted conception increasing?
Increasing parental age Increasing chlamydia Increasing range of ARTs Male infertility Improved success rates Single/ same sex parents Fertility preservation of cancer patients
What is the criteria for patients before ART begins?
No smoking, drugs or alcohol
BMI 19-29
Folic acid 0.4mg/day preconception - 12 weeks gestation
Rubella immunised
Cervical smears up to date
Screen for blood borne viruses - hep B/C, HIV
assess ovarian revere - antral follicle count / AMH
Available ARTs?
Donor insemination Intra-uterine insemination (IUI) In-vitro fertilisation (IVF) Intra-cytoplasmic sperm injection (ICSI) Fertility preservation Surrogacy
Indications for IUI?
Sexual problems
Unexplained infertility
Mild or moderate endometriosis
Mild male factor infertility
Method of IUI?
Prepared semen inserted into uterine cavity around time of ovulation.
Indications for IVF?
Unexplained infertility
Pelvic disease
Anovulatory infertility (after failed ovulation induction)
Male factor infertility
Method of IVF?
Down regulation Ovarian stimulation Oocyte collection Fertilisation Embryo transfer
How is down regulation achieved in IVF?
Synthetic GnRH analogue or agonist.
Allows precise timing of oocyte recovery by using HCG trigger
Side effects of down regulation?
Hot flushes
Mood swings
Nasal irritation
Headaches
What is involved in ovarian stimulation?
Gonadotrophin hormone (FSH +/- LH) . Causes follicular development
How long do men have to be abstinent for before giving semen sample?
72 hours
What is assessed in semen sample?
Morphology
Motility
Volume
Concentration
Risks of oocyte collection ?
Bleeding
Pelvic infection
Failure to obtain oocytes
After how many days does the embryo transfer occur ?
Day 5
After embryo transfer, dos the woman need any support?
Literal support - progesterone suppositories for 2 weeks
