Infertility and Assisted Conception Flashcards
What is ACT?
Any treatment which involves gametes outside the body.
What proportion of couples in the UK are said the be ‘infertile’?
1 in 6
What proportion of the 1 in 6 infertile couples will need ACT?
1 in 2
Outline reasons why the demand for ACT is rising.
- Increasing parental age.
- Increasing chlamydia.
- Male factor infertility.
- Increasing range of ACT.
- Improved success rates.
List some indications for ACT.
- Fertility preservation in cancer patients
- To avoid transmission of BBV’s
- Preimplantation diagnosis of inherited conditions
- Single parents
- Same sex couples
Before treatment begins, what are the requirements on the basis of?
- Alcohol
- Smoking
- Weight
- Folic acid
- Rubella
- Cervical smears
- Occupational factors
- Drugs
- BBV’s
- Assess ovarian reserve
- Counselling
What are the 6 different treatment options available in terms of ACT?
- Donor insemination
- Intra-Uterine Insemination (IUI)
- In Vitro Fertilisation (IVF)
- Intra-Cytoplasmic Sperm Injection (ICSI)
- Fertility Preservation
- Surrogacy
When does LH surge happen?
36 hours before ovulation
State the different stages of IVF treatment.
- Down Regulation.
- Ovarian Stimulation.
(+ collection of semen) - Oocyte collection – theatre.
- Fertilisation.
- Embryology lab.
- Embryo Transfer
Outline some indications for IVF.
- Unexplained infertility of >2years duration.
- Pelvic disease i.e. endometriosis, tubal disease, fibroids.
- Anovulatory infertility (after failed ovulation induction).
- Male factor infertility, IF > 1X106 MOTILE SPERM!
- Others (i.e. pre-implantation genetic diagnosis).
In the down regulation stage of IVF, what hormone is given? Why?
GRH
Reduces cancellation from ovulation, improving success rates
How does this down regulation allow precise timing of oocyte recovery?
By using a HCG trigger
What are the side effects of down regulation (i.e increased GHR)
Hot flushes and mood swings.
Nasal irritation.
Headaches.
i.e menopausal side-effects
What does down regulation essentially do?
Puts someone into menopause
What hormone is given in ovarian stimulation?
Gonadotrophin hormone (GH)
Containing either synthetic or urinary gonadotrophins (FSH +/- LH).
How is gonadotrophin hormone administered?
As a self-administered sc injection
What does the SC injection of gonadotrophin hormone cause?
Follicular development.
What will an USS after ovarian stimulation show?
Ovary containing lots of follicles
Thickened endometrium
LH/FSH stimulates ________ development
FOLLICLE
HCG mimics LH causing ___________ of meiosis
resumption
It is important to plan the date/timing of HCG injection. Why?
HCG mimics LH, causing resumption of meiosis in oocyte 36 hours before oocyte recovery.
For how long before giving a semen sample, should a male abstain from sex or masturbation?
72 hours
For how long before giving a semen sample, should a male abstain from sex or masturbation?
72 hours
What is semen assessed for?
Volume.
Density – numbers of sperm.
Motility – what proportion are moving.
Progression – how well they move.
Name some risks associated with oocyte collection.
Bleeding.
Pelvic infection.
Failure to obtain oocytes
What does the embryologist in the lab do?
Searches through the follicular fluid.
Identifies eggs and surrounding mass of cells.
Collects them into cell culture medium.
Incubate at 370C.
What happens on day 5 of IVF?
Transfer and cryopreservation
How many embryos are usually transferred during IVF?
1
max. 3 in exceptional circumstances.
What luteal support is given in IVF post embryo transfer stage?
Progesterone suppositories for 2 weeks
When should a pregnancy test be done in IVF?
16 days after oocyte recovery.
What are the indications for ICSI?
- Severe male factor infertility.
- Pervious failed fertilisation with IVF.
- Preimplantation genetic diagnosis.
What will azoospermia require?
Surgical sperm aspiration
Where can sperm be extracted from?
Epididymis – if obstructive
OR
Testicular tissue – if non-obstructive
Describe the process of ICSI.
- Each egg is stripped.
- Sperm immobilised.
- Single sperm injected.
- Incubate at 370C overnight
What are the ovaries like in OHSS? Why? What is the danger of this?
Ovaries are enlarged, and produce excess follicles.
Ovaries can then get ‘leaky,’ and fluid leaks into the abdominal cavity.
What are the symptoms of OHSS?
- abdominal pain/bloating ascites.
- nausea/diarrhoea.
- breathlessness increased haematocrit can lead to blood clots
Outline treatment of OHSS before embryo transfer.
- ‘Coasting.’
- Elective freeze.
- Single embryo transfer.
Outline treatment of OHSS after embryo transfer.
- Monitoring with scans and bloods
- Reduce risk thrombosis: Fluids, TED stockings and fragmin
- Analgesia
- Hospital admission if required IV fluids/more intensive monitoring/paracentesis
