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Reproductive - Reproductive Gynaecology > Infertility and Assisted Conception > Flashcards

Infertility and Assisted Conception Flashcards

1
Q

How many couples in the UK require assessment for infertility? How many of these go on to require fertility treatment?

A

1/6 require assessment, half of these go on to require treatment

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2
Q

The demand for ACT is rising because of what?

A

Increasing parental age, chlamydia infection, male factor infertility and increased successes of ACT

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3
Q

3 chlamydia infections gives what risk of infertility?

A

50% chance of blocked tubes or vas deferens

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4
Q

Treatment of ‘infertility’ for who is not provided on the NHS?

A

Single parents

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5
Q

Who is surrogacy used as a treatment option for?

A

Same sex male couples and women with an absent or abnormal uterus

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6
Q

What advice should you give to couples who are trying to conceive about sex?

A

Have sex 2-3 times a week and avoid lubricants which are toxic to sperm

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7
Q

Females should limit their alcohol consumption to what?

A

< 4 units per week

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8
Q

What is the advice about weight for couples before starting IVF?

A

Both male and female partners should have a BMI between 19 and 29

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9
Q

Are individuals eligible for IVF is they smoke?

A

No (male and female)

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10
Q

What is folic acid used for? How and when should it be given?

A

It reduces the risk of neural tube defects. 0.4mg/day should be taken pre-conception to 12 weeks gestation and this should be increased to 5mg if there is any increased risk of neural tube defects or if the mother is obese

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11
Q

Before starting IVF treatment, you should check that the mother is immunised against what?

A

Rubella

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12
Q

What are couples going through IVF screened for before starting?

A

Blood borne viruses

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13
Q

The type of fertility treatment that is used depends on what?

A

The cause of the infertility

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14
Q

Describe what happens in intra-uterine insemination?

A

Fast moving sperm are isolated from sluggish ones and are injected directly into the uterus shortly after ovulation

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15
Q

What are the indications for intra-uterine insemination?

A

Sexual problems, same sex relationships, BBV, abandoned IVF

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16
Q

What fertility treatment is used to inject donor sperm or into a surrogate?

A

Intra-uterine insemination

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17
Q

IVF can be used if there has been unexplained infertility for how long?

A

> 2 years

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18
Q

What are some examples of pelvic diseases that may require the use of IVF?

A

Endometriosis, tubal disease, fibroids

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19
Q

IVF can be used if intra-uterine insemination has failed how many times?

A

6 cycles

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20
Q

What is the single biggest predictor of IVF success?

A

A woman’s age

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21
Q

What is ICSI?

A

Essentially the same process as IVF except fertilisation is achieved by injecting a single sperm into each mature oocyte rather than mixing multiple sperm with each oocyte

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22
Q

What are the 3 main indications for ICSI?

A

Severe male factor infertility, previously failed IVF, preimplantation genetic diagnosis

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23
Q

If a couple are having ICSI and there is azoospermia, what must be done?

A

Surgical aspiration of sperm

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24
Q

Where is sperm aspirated from in ICSI if there is a) obstructive b) non-obstructive male infertility?

A

a) epididymis b) testicular tissue

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25
Q

After the sperm has been injected into the egg during ICSI, it should be incubated overnight at what temperature?

A

37 degrees

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26
Q

How long does ovarian follicular development take?

A

85 days

27
Q

Describe the first phase of ovarian follicular development?

A

Tonic phase, takes 65 days, primary and secondary follicles develop into antral follicles

28
Q

Describe the second phase of ovarian follicular development?

A

Growth phase, takes 20 days, antral follicles develop into pre-ovulatory follicles

29
Q

In a normal menstrual cycles, during the early follicular phase, what do gonadotrophins do?

A

Result in synchronised growth of all ovarian follicles

30
Q

What is the first stage of IVF treatment and why is it done?

A

Down regulation: essentially turns off the ovaries to allow better control of ovulation and egg maturation during treatment

31
Q

What medications can be used to induce ovarian down regulation?

A

GnRH agonists/antagonists

32
Q

How do GnRH agonists cause ovarian down regulation?

A

They flood the body with ‘fake’ GnRH causing the ovaries to become overwhelmed and shut down the production of LH/FSH after 3 weeks

33
Q

How do GnRH antagonists cause ovarian down regulation?

A

Blocks the release of GnRH so no LH/FSH is produced almost immediately

34
Q

What are the aims of ovarian downregulation in IVF?

A

To allow more than 1 follicle to develop into a mature egg, and allow the eggs to stay within the follicles so they can be easily harvested

35
Q

What are some side effects of ovarian down regulation?

A

Hot flushes, moodswings, nasal irritation, headaches

36
Q

What is the second stage of IVF? What medication is given?

A

Ovarian hyperstimulation: daily SC FSH injections are given

37
Q

What is the function of giving FSH injections in IVF?

A

To mature the follicles (hopefully more than 1 mature egg is produced)

38
Q

What monitoring is used during the ovarian hyperstimulation phase of IVF?

A

On day 8, and every 2 days after, a pelvic US is done

39
Q

In the ovarian hyperstimulation stage of IVF, once a lead follicle has reached 18mm and two more have reached 16mm, what is given to the patient?

A

hCG injection

40
Q

What is the purpose of the hCG injection given in IVF? When is it given?

A

To mimic LH and trigger ovulation, it is given 36 hours before oocyte collection

41
Q

After producing a sample, the semen has to be used within how long?

A

1 hour

42
Q

A man has to abstain from ejaculation for how long before providing a semen sample for IVP?

A

72 hours

43
Q

Oocyte collection for IVF occurs where? What are the risks?

A

In theatre - bleeding, pelvic infection, failure to obtain oocytes

44
Q

Once oocytes have been collected, they should be incubated at what temperature?

A

37 degrees

45
Q

How are the oocytes fertilised for IVF?

A

Up to 50,000 sperm are added to a Petri dish containing a single mature egg

46
Q

Approximately what proportion of oocytes obtained from IVF will fertilise normally?

A

60%

47
Q

After fertilisation in IVF, when is the pronuclei transferred into the mother?

A

After 5 days, at the blastocyst stage

48
Q

How many embryos are normally transferred in IVF?

A

Usually just one

49
Q

What is the maximum number of embryos that can be transferred into mother in IVF under exceptional circumstances?

A

Three

50
Q

How are embryos inserted into the mother in IVF?

A

Directly into the uterus via ultrasound guidance

51
Q

What is given as luteal support after the embryo has been inserted in IVF? How long for?

A

Progesterone suppositories for 2 weeks

52
Q

When should you do a pregnancy test in IVF?

A

16 days after oocyte recovery

53
Q

What are some risk factors for ovarian hyperstimulation syndrome?

A

Young age, low BMI, PCOS

54
Q

What are some mild presentations of ovarian hyperstimulation syndrome?

A

Abdominal bloating, mild pain and ovarian size < 8cm

55
Q

What are some features of more severe ovarian hyperstimulation syndrome?

A

Ascites, oliguria, hyponatraemia, hyperkalaemia, ovarian size > 12cm

56
Q

Ovarian hyperstimulation syndrome is associated with capillary leakage which can result in what?

A

Pleural effusion, pericardial effusion, ascites, intravascular volume depletion

57
Q

When does ovarian hyperstimulation syndrome normally present? What would be classed as a late presentation?

A

Normal = 2-3 days after oocyte collection / late = 7-10 days after

58
Q

How can ovarian hyperstimulation syndrome be prevented?

A

Using low dose protocols and GnRH antagonists for suppression

59
Q

What are some treatment options for ovarian hyperstimulation syndrome before embryo transfer?

A

Elective freezing or a single embryo transfer

60
Q

What are some treatment options for ovarian hyperstimulation syndrome after embryo transfer?

A

Monitoring with scans and bloods, thromboprophylaxis, IV fluids, drainage of any fluid collections

61
Q

What are the 2 main risks to the foetuses associated with multiple pregnancy?

A

Foetal growth restriction and premature birth

62
Q

The risk of multiple pregnancies with IVF can be reduced how?

A

Moving to blastocyst transfer, improved cryopreservation, increased single embryo transfer

63
Q

What is the relationship between IVF and ectopic pregnancy?

A

2-3 fold increase with IVF

Reproductive - Reproductive Gynaecology (12 decks)

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