Infertility and Assisted Conception Flashcards
1 in _ couples require assessment of infertility in the UK
6
why is demand of ACT rising?
increased parental age
increasing chlamydia
male factor infertility
improved success rates
by your 3rd chalmydia infection there is a __% chance youre infertile
50%
who is eligible for IVF? how many cycles?
reasonable expectation of a live birth
appropriate age
one partner has no biological children
3
what is ICSI?
intracytoplasmic sperm injection; sperm is injected directly into the egg
what is fertility preservation?
process of saving or protecting eggs, sperm, or reproductive tissue so that a person can use them to have biological children in the future
what lifestyle changes should be considered before IVF treatment?
alcohol
weight
smoking
folic acid supplements
females should be limited to _ alcohol units pw
4
recommended BMI range for pregnancy?
19-29
how much folic acid should be taken and at what point in pregnancy?
0.4mg per day from preconception to 12 weeks
what immunisations should you get before IVF?
rubella
why should you make sure cervical smears are up to date before IVF?
colposcopy is very dangerous and invasive and can be avoided if smears are up to date
what blood screens are done before IVF
hep b/c
HIV
how can you assess ovarian reserve in women?
anti-mullerian hormone blood test
antral follicle count
describe intrauterine insemination
time a woman’s cycle (eg by using ovulation inducing drugs) and then insert good sperm when theyre about to ovulate
indications for intrauterine insemination?
sexual problems
same sex relationships
discordant blood borne virus
how long must infertility be for in order to get IVF?
2yrs
indications for IVF?
unexplained infertility
pelvic disease
anovulatory infertility
failed Intrauterine insemination
how long does it take for a follicle to form?
85
what hormones are used in down regulation?
synthetic GnRH (causes pituitary LH and FSH to go low -> induce false menopause)
side effects of down regulation?
menopausal symptoms eg hot flushes, mood swings
womb lining should be in what form in down regulation?
thin
what is done in the ovarian stimulation phase in IVF?
given a hormone containing LH and FSH which can be self-administered SC
mature eggs are usually _mm
18mm
how long should men be abstinent before giving their sperm donation?
72hrs
sperm is assessed for what 4 factors?
volume
density - how many
motility - what proportion are moving
progression - how well they move
risks of oocyte collection?
bleeding
pelvic infection
failure to obtain oocytes
what does the embryologist do?
identifies eggs in the follicular fluid and collects them into cell culure medium
what does the sperm have to get through in the egg during fertilisation?
sperm breaks through zona pellucida
fuse with nucleus membrane
how do you know fertilisaton has been successful?
1st cleavage
how many embryos are normal transferred to the female?
1 (3 in exceptional circumstances)
what hormone is given once the embryo has been transferred and why?
progesterone (to support the pregnancy)
indications for intracytoplasmia sperm injection?
severe male factor infertility
previous failed fertilisation with IVF
preimplantation genetic diagnosis
sperm tends to be extracted from what area if theres azoospermia
epididymis
what is azoospermia?
condition where semen contains no sperm
symptoms of ovarian hyperstimulation syndrome?
abdominal pain
nausea and vomiting
large ovarian size
USS evidence of ascites
what is OHSS? who gets it?
too many eggs produced at once
can happen in young women
what symptoms indicate severe/critical OHSS
intense ascites hydrothorax thromboembolism ARDS renal failure hyponatraemia hyperkalaemia
Tx of OHSS
elective freeze single embryo transfer monitoring with scans and bloods reduce thrombosis risk: fluids etc analgesia supportive treatment
how are multiple pregnancies prevented?
blastocyst transfer (terminates embryos at high risk of complications)
improved cryopreservation
increase in single embryo transfer
what pregnancy complication is increased in ART?
ectopic pregnancy
what is a heterotrophic pregnancy? why is it a problem?
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
surgical risks of oocyte retrieval?
bleeding
infection
success rate is about _%
35
best predictor of success rate?
female age (<34)
