infertility and assisted conception

Question 1

what is assisted conception treatment

Answer 1

any treatment which involved gametes outside the body

Question 2

why is demand for ACT rising

Answer 2

increasing parental age 
increasing chlamydia 
male factor infertility 
increasing range of ACT
improved success rates

Question 3

common indications of ACT

Answer 3

endometriosis 
male factor 
tubal disease 
multiple male and female factors 
ovulatory disorder

Question 4

less common indications of ACT

Answer 4

fertility preservation in cancer, transgender patients and social reasons
treatment to avoid transmission of blood born viruses
pre-implantation diagnosis of inherited disorders
treatment of single parents or same sex couples
treatment with surrogacy when absent or abnormal uterus

Question 5

pre-treatment requirements

Answer 5

acohol: 4 units per week (female)
weight: 19-29 optimal both M+F
smoking: advise cessation
folic acid: 0.4 mg/day preconception - 12 weeks gestation
rubella: check immunity/immunise
cervical smears: check up to date
occupational factors: avoid hazard exposure
drugs: prescribed, OTC, recreational
blood borne viruses: screen from hep B/C, HIV
assess ovarian reserve: astral follicle count or AMH
counselling: offer

Question 6

what treatments are available

Answer 6

donor insemination 
intra-uterine insemination 
in vitro fertilisation 
intra-cytoplasmic sperm injection 
fertility preservation 
surrogacy

Question 7

indications for IUI

Answer 7

sexual problems
same sex relationships
discordant blood borne virus
abandoned IVF

Question 8

indications for IVF

Answer 8

unexplained (>2 years durations)
pelvic disease (endometriosis, tubal disease, fibroids)
anovulatory infertility (after failed ovarian induction)
failed IUI (6 cycles)

Question 9

what is down regulation

Answer 9

synthetic gonadotrophin releasing hormone analogue or agonist reduces cancellation from ovulation and allows precise timing of oocyte recover by using HCG trigger

Question 10

side effects of down regulation

Answer 10

hot flushes and mood swings
nasal irritation
headaches

Question 11

what is ovarian stimulation

Answer 11

gonadotrophin hormone containing either synthetic or urinary gonadotrophins (FSH +/- LH
causes follicular development

Question 12

what is semen assessed for

Answer 12

volume
density (numbers of sperm)
motility (what proportion are moving)
progression (how well they move)

Question 13

period of abstinence before semen assessment

Answer 13

72 hours

Question 14

risks of oocyte collection

Answer 14

bleeding
pelvic infection
failure to obtain oocytes

Question 15

what temperature are eggs incubated at

Answer 15

37 degrees

Question 16

what occurs of day 5 after fertilisation

Answer 16

transfer and cryopreservation

Question 17

which hormone is given after embryo transfer

Answer 17

progesterone for 2 weeks

Question 18

how long after embryo transfer should a pregnancy test be done

Answer 18

16 weeks

Question 19

indications of intra cytoplasmic sperm injection

Answer 19

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

Question 20

where can sperm be extracted from

Answer 20

epididymis (if obstructive)
testicular tissue (if non-obstructive)

Question 21

what occurs in ICSI

Answer 21

each egg is stripped
sperm immobilised
single sperm injected
incubate overnight at 37 degrees

Question 22

complications of ACT

Answer 22

ovarian hyper-stimulation syndrome 
multiple pregnancy 
ectopic pregnancy 
increased risk of miscarriage 
increase risk of prematurity, IU growth retardation, congenital abnormalities