Infertility and Assisted Conception Flashcards
List some factors that are increasing the demand for assisted conception therapy (ACT)
Increasing parental age
Increasing chlamydia
Male factor infertility
Improved success rates of ACT
List the main indications for ACT
Male factors Unexplained infertility Endometriosis Tubal disease Ovulatory disorder Single parents/same sex couples
At what age does fertility start to decrease?
27
Significantly so at 37
What should females limit their alcohol limit to per week to improve fertility?
4 units a week
What is the optimal weight for males + females to improve fertility?
BMI 19-29
What medical interventions should be assessed before ACT to improve fertility?
Folic acid
Check rubella immunity
Cervical smear
Blood-borne viruses screen
Which drug class in particular can cause male infertility/azoospermia?
Steroids (if abused)
How long should a female wait before trying to conceive after being vaccinated against rubella?
3 months
List all the assisted conception treatments available
Donor insemination Intra-uterine insemination (IUI) In vitro fertilisation (IVF) Intra-cytoplasmic sperm injection (ICSI) Fertility preservation Surrogacy
What does intra-uterine insemination involve?
Sperm are injected into the uterine cavity around the time of ovulation
What does in vitro fertilisation involve?
Sperm and egg fertilise outside body and implanted into uterus
How is the normal menstrual cycle down-regulated in preparation for IVF? What are the side effects?
Synthetic GnRH agonist administered as spray/injection and a scan is performed
Hot flushes + mood swings
Nasal irritation
Headaches
How is the ovary stimulated to cause follicular development?
Synthetic GH injection
What are the risks to GH injection?
Allergy
Ovarian hyperstimulation syndrome
How long must a male be abstinent before providing a sperm sample? What is the sperm assessed for?
72 hours
Volume, density, motility, progression
What does intra-cytoplasmic sperm injection involve?
Injecting sperm into egg outside the body (i.e. no fertilisation)
What is ACT?
Any treatment which involves gametes outside the body
What lifestyle interventions should be assessed before ACT to improve fertility?
Alcohol Weight Smoking Drugs Occupational exposure to hazards
What dose of folic acid should most women be taking preconception? For how long into gestation?
0.4mg/day
12 weeks
List indications for IUI
Sexual problems
Same sex
Discordant BBV
Abandoned IVF
List indications for IVF
Unexplained infertility (>2 years)
Pelvic disease
Anovulatory infertility or mild male factor
Failed IUI (after 6 cycles)
List the six stages of IVF
- Down regulation
- Ovary stimulation
- Oocyte collection
- Embryo growth
- Fertilisation
- Embryo transfer and luteal support
What are the risks of oocyte collection?
Bleeding
Pelvic infection
Failure to obtain oocytes
Outline the process of normal development of the human embryo
2 pronuclei –> fertilised egg –> 2 cells –> 4 cells –> 8 cells –> 16 cells (MORULA) –> early blastocyst –> blastocyst –> hatched blastocyst
What day is the blastocyst typically transferred and undergoes cryopreservation?
Day 5
List the components of the blastocysts
An inner cell mass (ICM) which forms the embryo
The outer layer of the blastocyst consists of cells called the trophoblast
A fluid-filled cavity surrounded by the trophoblast known as the blastocoele
What is involved in luteal support during embryo transfer in IVF?
Progesterone supplement for 2 weeks
List indications for ICSI
Severe male factor infertility
Previous failed fertilisation with IVF
Preimplantation genetic diagnosis
When is surgical sperm aspiration indicated?
Azoospermia (very low sperm count)
What is ovarian hyperstimulation syndrome?
Overesponse to treatment were you produce too many eggs –> bulging ovaries suck coagulation out of blood
How is ovarian hyperstimulation syndrome prevented?
Use of antagonist for prevention
Elective freeze, single embryo transfer
Monitoring, analgesia, thrombosis prevention (fluids, TED stockings, fragmin)
Hospital admission (IV fluids, monitoring, paracentesis)
List complications of ART
Ovarian hyperstimulation syndrome
Multiple pregnancy
Ectopic pregnancy
Failed treatment or fertilisation
Surgical risks (bleeding, infection)
Problems in early pregnancy (miscarriage, ectopic)
Problems in pregnancy (prematurity, IUGR, congenital)
What is the overall IVF success rate? What is the biggest predictor?
35%
Female age
Which harmone is used clinically to measure ovarian reserve prior to IVF?
Anti-mullerian harmone
List investigations for female infertility
Mid-progesterone (ovulating)
HSG (patency of tubes)
STI screen
TVUS
In what situation would you have to surgically aspirate sperm?
Very low sperm count
Males with CF
