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3 Reproduction and Sexual Health > Infertility and Assisted Conception > Flashcards

Infertility and Assisted Conception Flashcards

1
Q

1 in _ couples require assessment of infertility in the UK

A

6

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2
Q

why is demand of ACT rising?

A

increased parental age
increasing chlamydia
male factor infertility
improved success rates

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3
Q

by your 3rd chalmydia infection there is a __% chance youre infertile

A

50%

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4
Q

who is eligible for IVF? how many cycles?

A

reasonable expectation of a live birth
appropriate age
one partner has no biological children
3

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5
Q

what is ICSI?

A

intracytoplasmic sperm injection; sperm is injected directly into the egg

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6
Q

what is fertility preservation?

A

process of saving or protecting eggs, sperm, or reproductive tissue so that a person can use them to have biological children in the future

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7
Q

what lifestyle changes should be considered before IVF treatment?

A

alcohol
weight
smoking
folic acid supplements

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8
Q

females should be limited to _ alcohol units pw

A

4

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9
Q

recommended BMI range for pregnancy?

A

19-29

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10
Q

how much folic acid should be taken and at what point in pregnancy?

A

0.4mg per day from preconception to 12 weeks

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11
Q

what immunisations should you get before IVF?

A

rubella

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12
Q

why should you make sure cervical smears are up to date before IVF?

A

colposcopy is very dangerous and invasive and can be avoided if smears are up to date

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13
Q

what blood screens are done before IVF

A

hep b/c

HIV

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14
Q

how can you assess ovarian reserve in women?

A

anti-mullerian hormone blood test

antral follicle count

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15
Q

describe intrauterine insemination

A

time a woman’s cycle (eg by using ovulation inducing drugs) and then insert good sperm when theyre about to ovulate

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16
Q

indications for intrauterine insemination?

A

sexual problems
same sex relationships
discordant blood borne virus

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17
Q

how long must infertility be for in order to get IVF?

A

2yrs

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18
Q

indications for IVF?

A

unexplained infertility
pelvic disease
anovulatory infertility
failed Intrauterine insemination

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19
Q

how long does it take for a follicle to form?

A

85

20
Q

what hormones are used in down regulation?

A

synthetic GnRH (causes pituitary LH and FSH to go low -> induce false menopause)

21
Q

side effects of down regulation?

A

menopausal symptoms eg hot flushes, mood swings

22
Q

womb lining should be in what form in down regulation?

A

thin

23
Q

what is done in the ovarian stimulation phase in IVF?

A

given a hormone containing LH and FSH which can be self-administered SC

24
Q

mature eggs are usually _mm

A

18mm

25
Q

how long should men be abstinent before giving their sperm donation?

A

72hrs

26
Q

sperm is assessed for what 4 factors?

A

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

27
Q

risks of oocyte collection?

A

bleeding
pelvic infection
failure to obtain oocytes

28
Q

what does the embryologist do?

A

identifies eggs in the follicular fluid and collects them into cell culure medium

29
Q

what does the sperm have to get through in the egg during fertilisation?

A

sperm breaks through zona pellucida

fuse with nucleus membrane

30
Q

how do you know fertilisaton has been successful?

A

1st cleavage

31
Q

how many embryos are normal transferred to the female?

A

1 (3 in exceptional circumstances)

32
Q

what hormone is given once the embryo has been transferred and why?

A

progesterone (to support the pregnancy)

33
Q

indications for intracytoplasmia sperm injection?

A

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

34
Q

sperm tends to be extracted from what area if theres azoospermia

A

epididymis

35
Q

what is azoospermia?

A

condition where semen contains no sperm

36
Q

symptoms of ovarian hyperstimulation syndrome?

A

abdominal pain
nausea and vomiting
large ovarian size
USS evidence of ascites

37
Q

what is OHSS? who gets it?

A

too many eggs produced at once

can happen in young women

38
Q

what symptoms indicate severe/critical OHSS

A 
intense ascites
hydrothorax
thromboembolism
ARDS
renal failure
hyponatraemia
hyperkalaemia
39
Q

Tx of OHSS

A 
elective freeze
single embryo transfer
monitoring with scans and bloods
reduce thrombosis risk: fluids etc
analgesia
supportive treatment
40
Q

how are multiple pregnancies prevented?

A

blastocyst transfer (terminates embryos at high risk of complications)
improved cryopreservation
increase in single embryo transfer

41
Q

what pregnancy complication is increased in ART?

A

ectopic pregnancy

42
Q

what is a heterotrophic pregnancy? why is it a problem?

A

one egg implants in the uterus and the other in the fallopian tube; can be mistaken for a healthy pregnancy as you discount ectopic by seeing an egg in the uterus

43
Q

surgical risks of oocyte retrieval?

A

bleeding

infection

44
Q

success rate is about _%

A

35

45
Q

best predictor of success rate?

A

female age (<34)

3 Reproduction and Sexual Health (51 decks)

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