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Repro and Sexual Health > Infertility and Assisted Conception > Flashcards

Infertility and Assisted Conception Flashcards

1
Q

What is ACT?

A

Any treatment which involved gametes outside the body

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2
Q

How many couples in the UK will require ACT to fall pregnant?

A

One in six

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3
Q

Why is the demand for ACT rising?

A 
Increasing parental age
Increased chlamydia
Male factor infertility
Increasing range of ACT
Improved success rates
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4
Q

What is the current access for ACT treatment in the UK?

A

Less than 12 months
Eligible patients (under 40) can be offered 3 cycles of IVF/ICSI where there is a reasonable expectation of a live birth
One partner has no biological child

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5
Q

What are other indications for ACT aside from heterosexual couples unable to conceive?

A

Same sex or single people
Fertility preservation in cancer, transgender patients and social reasons
Treatment to avoid transmission of BBV between patients
Pre-implantation diagnosis of inherited disorders
Treatment with surrogacy when absent/ abnormal uterus

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6
Q

What are some things that women should do before treatment begins for assisted conception?

A 
Limit alcohol to 4 units a week
Weight; BMI between 19-29 
Stop smoking
Folic acid; 400 mcg or 5mg if specific risk factors
Rubella immunisation 
Cervical smears up to date
Occupational factors
Drugs
Screen for BBV
Assess ovarian reserve; antral follicle count or AMH
Counselling
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7
Q

Who should receive the higher 5mg dose of folic acid preconception?

A 
If increased risk of NTD
Diabetes
Obese 
Antiepileptic drugs 
Folate antagonists 
Smokers
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8
Q

What different treatments are available under ACT?

A 
Donor insemination 
IUI
IVF
ICSI
Fertility preservation 
Surrogacy
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9
Q

What are the indications for IUI?

A

Sexual problems
Same sex relationship
Discordant BBV
Abandoned IVF

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10
Q

What are the methods for IUI?

A

Natural or stimulated cycle

Prepared semen inserted into uterine cavity at time of ovulation

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11
Q

What size should the follicle be to insert sperm for IUI?

A

17-18mm

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12
Q

What are the indications for IVF?

A 
Unexplained (>2 years duration) 
Pelvic disease (endometriosis, tubal disease, fibroids) 
Anovulatory infertility (after failed ovulation induction) 
Failed IUI (after 6 cycles)
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13
Q

How many couples will get pregnant within 2 years of trying?

A

Around 95/100

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14
Q

What is the tonic phase of ovarian follicular development?

A

Primary and secondary follicles to antral follicles

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15
Q

What is the growth phase of ovarian follicular development?

A

Antral follicles (3-5mm) to preovulatory follicle (20mm), dependent on gonadotrophin

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16
Q

What is down regulation?

A

Synthetic GnRH agonist to reduce ovarian production of follicles
Allows precise timing of oocyte recover by using hCG trigger

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17
Q

What are side effects to downregulation?

A

Mini menopause; hot flushes, mood swings, nasal irritation, headaches

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18
Q

What should you seen on down regulation scans of the ovary and endometrium?

A

No follicular development in ovary

Thin endometrium

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19
Q

What is ovarian stimulation?

A

Gonadotropin hormone containing synthetic or urinary gonadotrophins (FSH +/- LH)
Self administered SC injection
Results in follicular development

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20
Q

What should the stimulation scan of the ovary and endometrium look like?

A

Ovary should see follicular development

Endometrium thickening

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21
Q

When should you plan the hCG injection?

A

36 hours before oocyte recovery to help release the follicles from the follicular wall

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22
Q

How long should men be abstinent before providing semen?

A

72 hours

23
Q

What are the semen assessed for?

A

Volume
Density
Motility
Progression

24
Q

What are the risks to oocyte collection?

A

Bleeding
Pelvic infection
Failure to obtain oocytes

25
Q

What will the embryologist do when they receive the follicular fluid from the oocyte collection?

A

Search through the follicular fluid
Identify eggs and surrounding mass of cells
Collect them into medium culture
Incubate at 37 degrees

26
Q

What will the egg do once fertilised?

A

Two pro-nuclei

Will continue to cleave

27
Q

When will a blastocyst form?

A

Day 5

28
Q

When is the transfer performed?

A

Usually day 5 of the mature blastocyst

29
Q

How many blastocysts are transferred?

A

1 (max 3 in exceptional circumstances)

30
Q

What hormones are given in the embryo transfer?

A

Luteal support; as the corpus luteum won’t form, need to produce progesterone for 2 weeks

31
Q

When is a pregnancy test performed?

A

16 days after oocyte recovery

32
Q

What are the indications for ICSI?

A

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

33
Q

What is required if the man has azoospermia?

A

Surgical sperm aspiration; extracted from epididymis or testicular tissue

34
Q

When is surgical sperm aspiration from the epididymis?

A

Obstructive azoospermia

35
Q

When is surgical sperm aspiration from the testicular tissue?

A

Non-obstructive azoospermia

36
Q

What is the method for ICSI?

A

Each egg is stripped
Sperm immobilised
Single sperm injected
Incubate at 37 degrees overnight

37
Q

What are the complications for ICSI?

A 
Hypospadias
Chromosomal abnormalities (Klinefelter's)
38
Q

What is the most serious side effect of ART?

A

Ovarian Hyper-stimulation Syndrome

39
Q

What is mild OHSS?

A

Abdominal pain
Abdominal bloating
Ovarian size usually <8cm

40
Q

What is moderate OHSS?

A

Mod abdo pain
N+V
USS ascites
Ovarian size usually 8-12 cm

41
Q

What is severe OHSS?

A 
Clinical ascites 
Oliguria (<300 ml/day <30 ml/hr) 
Haematocrit >0.45
Hyponatraemia <135
Hypo-osmolality <282 mOsm/kg 
Hyperkalaemia >5 
Hypoproteinemia <35 g/l 
Ovarian size >12 cm
42
Q

What is critical OHSS?

A 
Tense ascites
Haematocrit >0.55
WCC > 25,000/ml 
Oliguria/ anuria
Thromboembolism
ARDS
43
Q

How many patients will develop OHSS?

A

1% will develop severe OHSS

44
Q

How can OHSS be prevented?

A

Low dose protocols

Use of antagonists for supression

45
Q

Should you treat OHSS before embryo transfer?

A

Yes; freeze embryos

hCG will result in worsening of OHSS

46
Q

How should OHSS be treated after the embryo transfer?

A

Monitor with scans and bloods
Reduce risk of thrombosis; fluids, TED stockings and fragmin
Analgesia
Hospital admission if IV fluids required/ more intensive monitoring/ paracentesis

47
Q

How can the risk of multiple pregnancies be reduced?

A

Move to blastocyst transfer
Improved cytopreservation
Increase in single embryo transfer

48
Q

How many babies born fro ART are multiple pregnancies in the UK?

A

Approx. 10%

49
Q

What is the IVF success rate?

A

35%

50
Q

What are other problems assoc with ART aside from OHSS, multiple pregnancies and ectopic pregnancies?

A 
No eggs retrieved
Surgical risks of oocyte retrieval 
Surgical risks of surgical sperm aspiration 
Failed fertilisation 
Problems in early pregnancy 
Increased risk of on-going pregnancy
Psychological problems 
Failed treatment
51
Q

What are the surgical risks assoc with surgical sperm aspiration?

A

Haematoma

Infection

52
Q

How does the HFEA regulate ART activities?

A

Regulates all treatment and research
Considers welfare of child
Rights of people seeking treatment to appropriate care
Respect for human life at all stages of development

53
Q

What are the main steps to ART?

A 
Down regulation 
Ovarian stimulation 
Oocyte collection 
Fertilisation 
Transfer 
Luteal support

Repro and Sexual Health (77 decks)

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