Infertility and Assisted Conception Flashcards by Kerry Hendrie

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

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List the main indications for ACT

Male factors
Unexplained infertility
Endometriosis
Tubal disease
Ovulatory disorder
Single parents/same sex couples

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At what age does fertility start to decrease?

Significantly so at 37

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What should females limit their alcohol limit to per week to improve fertility?

4 units a week

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What is the optimal weight for males + females to improve fertility?

BMI 19-29

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What medical interventions should be assessed before ACT to improve fertility?

Folic acid
Check rubella immunity
Cervical smear
Blood-borne viruses screen

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Which drug class in particular can cause male infertility/azoospermia?

Steroids (if abused)

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How long should a female wait before trying to conceive after being vaccinated against rubella?

3 months

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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

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What does intra-uterine insemination involve?

Sperm are injected into the uterine cavity around the time of ovulation

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What does in vitro fertilisation involve?

Sperm and egg fertilise outside body and implanted into uterus

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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

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How is the ovary stimulated to cause follicular development?

Synthetic GH injection

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What are the risks to GH injection?

Allergy

Ovarian hyperstimulation syndrome

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How long must a male be abstinent before providing a sperm sample? What is the sperm assessed for?

72 hours

Volume, density, motility, progression

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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