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REPRO > Infertility and Assisted Conception > Flashcards

Infertility and Assisted Conception Flashcards

1
Q

What is ACT?

A
  • Assisted Conception Treatment

- RX involving gametes OUTSIDE the body

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2
Q

Why is ACT demand rising?

A
  • increasing PARENTAL age
  • Increasing cases of chlamydia
  • MALE infertility
  • increased RANGE of ACT
  • improved success rates
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3
Q

Why do people seek IVF or ICSI?

A
  • endometriosis
  • male factor
  • Tubal Disease
  • unexplained
  • Ovulatory disorder
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4
Q

What are recent changes that have occurred for ACT indications?

A
  • increase in single and same sex couples
  • increase in rx with surrogate
  • increase in transgender referral
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5
Q

Name other indications for Assisted conception treatment.

A
  • fertility pservation in CANCER, transgender
  • rx to avoid transmission of blood born viruses (Hep B, C, HIV)
  • pre-implantation dx of inherited disorder
  • rx of single parents/ same sex couples
  • rx with surrogacy
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6
Q

How should the people prepare before the rx begins?

A
  • Limit alcohol intake to 4 units/week
  • WGT: 19-29 (M and F)
  • no smoking
  • FOLIC ACID: 0.4mg/day—12 weeks gestation
  • —-increase to 5mg if risk of NTD/Obese
  • Rubella check
  • Cervical smear
  • Occupational hazards
  • Drugs
  • Hep B/C nad HIV
  • assess Ovarian reserve; antral Follicle count or AMH
  • Counselling
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7
Q

What is IUI, and what are its indications?

A
  • PREPARED semen is inserted into uterine cavity at time of ovulation
  • “intra-uterine insemination”
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8
Q

What are the indications for IUI?

A
  • sexual problems
  • same sex relationships
  • abandoned IVF
  • discordant BBV (blood borne virus)
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9
Q

What is IVF?

A

in vitro fertilisation

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10
Q

WHat are the indications for IVF?

A
  1. unexplained infertility >2years
  2. pelvic disease (fibroids, endometriosis, tubal disease)
  3. Anovulatory infertility (after failed ovulation induction)
  4. Failed IUI (after 6 cycles)
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11
Q

How long does ovarian folliculogenesis take place?

A

85 days

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12
Q

What are the phases of ovarian follicular development?

A
  1. Tonic Phase (65 days) - Iary and IIary follicles to ANTRAL follicles
  2. Growth phase (20 days) - antral follicles 3-5mm>20mm pre-ovulatory follicle —-depends on gonadotropin
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13
Q

What occurs in a stimulated cycle of gonadotropins?

A
  • early follicular phase results in SYNCHRONISED growth of all follicles
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14
Q

What do you mean by downregulation during IVF rx?

A
  • administration of Pulsatile synthetic gonadotropin releasing hormone agonist/analogue
  • reduces cancellation from ovulation (improves success rates)
  • —–precise timing for oocyte recover (using HCG trigger)
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15
Q

What are the S/Es of downregulation?

A
  • hot flushes
  • mood swings
  • nasal irritation
  • headaches
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16
Q

What are the 6 stages of IVF?

A
  1. Downregulation
  2. Ovarian Stimulation
  3. Oocyte Collection
  4. Lab fertilisation
  5. Transfer and cryopreservation
  6. Embryo transfer
17
Q

Why does the IVF rx start with supression of the ovaries with the use of synthetic GNRH agonist?

A
  • helps to have a little control of the ovarian cycle of the lady
  • can actually plan for stimulation of ovulation by HCG trigger
18
Q

How are the ovaries stimulated?

A
  • pt is given gonadotropin hormone containing synthetic or URINARY gonadotropins (FHS/LH)
  • self-administered (s.c injection)
  • causes follicular development
19
Q

How does the ultrasound scan change when compared to the down regulation stage and stimulation stage?

A
  • endometrium has thickened

- folllicular appearance of ovaries has appeared

20
Q

What is the semen assessed for?

A
  1. Volume
  2. Density (# of sperms)
  3. Motility (what proportion move)
  4. Progression (how well they move)
21
Q

What are the risks of oocyte collection?

A
  • bleeding
  • pelvic infection
  • failure to obtain oocytes
22
Q

What is the procedure for men to obtain their sperm ?

A
  • abstinence for 72 hrs

- produced in the men’s room

23
Q

What is the role of the embryologist?

A
  • search the follicular fluid for eggs

- collect them into cell culture and INCUBATE at 37*C

24
Q

What percent of eggs may fertilize normally?

A
  • 60%~
25
Q

When is the embryo transferred?

A
  • Day 5 of the Blastocyst stage
26
Q

What occurs with embryo transfer?

A
  • normally 1 is transferred (max 3 in exceptional circumstances)
  • luteal support : PROGESTERONE suppositories for 2 weeks
27
Q

When is the pregnancy test performed?

A
  • 16 days after oocyte recovery
28
Q

What is ICSI?

A

-intra-cytoplasmic sperm injection

29
Q

What are the indications for ICSI?

A
  • Severe male factor infertility
  • previous failed fertilisation with IVF
  • pre-implantation genetic diagnosis
30
Q

How to treat obstructive azoospermia?

A
  • surgical sperm ASPIRATION
31
Q

When does ovulation occur in the uterine cycle?

A
  • day 14

- start secretory phase

32
Q

How ICSI work?

A
  1. Egg is Stripped
  2. Sperm is immobilized
  3. Single Sperm INJECTED
  4. incubate at 37* C overnight
33
Q

What are the features of moderate Ovarian Hyper-stimulation syndrome?

A

MODERATE OHSS: -moderate abdominal pain
nausea and vomitting
-USG evidence iof ASCITES
- 8-12cm3 size of ovaries

34
Q

How may severe OHSS present as?

A
  • clinical ascites (+/- hydrothorax)
  • hyponatremia
  • hypo-osmolality
  • hyperkalemia
  • hypoproteinemia
  • ovarian size >12cm3
  • OLIGOURIA
35
Q

How to prevent OHSS?

A
  • suppress the ovaries! with antagonists
36
Q

What treatment is required after embryo transfer?

A
  • scan and blood monitoring
  • reduce thrombosis risk (FLUIDS/ TED stockings/ FRAGMIN)
  • analgesia
  • hospital admission if IV fluids and intensive monitoring is needed
37
Q

How to reduce MULTIPLE pregnancy>

A
  • move embryo at BLASTOCYST stage

- improve CRYOPRESERVATION

38
Q

What pregnancy complications may arise from ART?

A
  • ECTOPIC pregnancy: incidence increases 2-3 fold

- increase risk of heterotropic pregnancy

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