Infertility and Assisted Conception

Question 1

List some factors that are increasing the demand for assisted conception therapy (ACT)

Answer 1

Increasing parental age
Increasing chlamydia
Male factor infertility
Improved success rates of ACT

Question 2

List the main indications for ACT

Answer 2

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

Question 3

At what age does fertility start to decrease?

Answer 3

27

Significantly so at 37

Question 4

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

Answer 4

4 units a week

Question 5

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

Answer 5

BMI 19-29

Question 6

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

Answer 6

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

Question 7

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

Answer 7

Steroids (if abused)

Question 8

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

Answer 8

3 months

Question 9

List all the assisted conception treatments available

Answer 9

Donor insemination
Intra-uterine insemination (IUI)
In vitro fertilisation (IVF)
Intra-cytoplasmic sperm injection (ICSI)
Fertility preservation
Surrogacy

Question 10

What does intra-uterine insemination involve?

Answer 10

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

Question 11

What does in vitro fertilisation involve?

Answer 11

Sperm and egg fertilise outside body and implanted into uterus

Question 12

How is the normal menstrual cycle down-regulated in preparation for IVF? What are the side effects?

Answer 12

Synthetic GnRH agonist administered as spray/injection and a scan is performed
Hot flushes + mood swings
Nasal irritation
Headaches

Question 13

How is the ovary stimulated to cause follicular development?

Answer 13

Synthetic GH injection

Question 14

What are the risks to GH injection?

Answer 14

Allergy

Ovarian hyperstimulation syndrome

Question 15

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

Answer 15

72 hours

Volume, density, motility, progression

Question 16

What does intra-cytoplasmic sperm injection involve?

Answer 16

Injecting sperm into egg outside the body (i.e. no fertilisation)

Question 17

What is ACT?

Answer 17

Any treatment which involves gametes outside the body

Question 18

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

Answer 18

Alcohol
Weight
Smoking
Drugs
Occupational exposure to hazards

Question 19

What dose of folic acid should most women be taking preconception? For how long into gestation?

Answer 19

0.4mg/day

12 weeks

Question 20

List indications for IUI

Answer 20

Sexual problems
Same sex
Discordant BBV
Abandoned IVF

Question 21

List indications for IVF

Answer 21

Unexplained infertility (>2 years)
Pelvic disease
Anovulatory infertility or mild male factor
Failed IUI (after 6 cycles)

Question 22

List the six stages of IVF

Answer 22

1. Down regulation
2. Ovary stimulation
3. Oocyte collection
4. Embryo growth
5. Fertilisation
6. Embryo transfer and luteal support

Question 23

What are the risks of oocyte collection?

Answer 23

Bleeding
Pelvic infection
Failure to obtain oocytes

Question 24

Outline the process of normal development of the human embryo

Answer 24

2 pronuclei –> fertilised egg –> 2 cells –> 4 cells –> 8 cells –> 16 cells (MORULA) –> early blastocyst –> blastocyst –> hatched blastocyst

Question 25

What day is the blastocyst typically transferred and undergoes cryopreservation?

Answer 25

Day 5

Question 26

List the components of the blastocysts

Answer 26

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

Question 27

What is involved in luteal support during embryo transfer in IVF?

Answer 27

Progesterone supplement for 2 weeks

Question 28

List indications for ICSI

Answer 28

Severe male factor infertility
Previous failed fertilisation with IVF
Preimplantation genetic diagnosis

Question 29

When is surgical sperm aspiration indicated?

Answer 29

Azoospermia (very low sperm count)

Question 30

What is ovarian hyperstimulation syndrome?

Answer 30

Overesponse to treatment were you produce too many eggs –> bulging ovaries suck coagulation out of blood

Question 31

How is ovarian hyperstimulation syndrome prevented?

Answer 31

Use of antagonist for prevention
Elective freeze, single embryo transfer
Monitoring, analgesia, thrombosis prevention (fluids, TED stockings, fragmin)
Hospital admission (IV fluids, monitoring, paracentesis)

Question 32

List complications of ART

Answer 32

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)

Question 33

What is the overall IVF success rate? What is the biggest predictor?

Answer 33

35%

Female age

Question 34

Which harmone is used clinically to measure ovarian reserve prior to IVF?

Answer 34

Anti-mullerian harmone

Question 35

List investigations for female infertility

Answer 35

Mid-progesterone (ovulating)
HSG (patency of tubes)
STI screen
TVUS

Question 36

In what situation would you have to surgically aspirate sperm?

Answer 36

Very low sperm count

Males with CF