Infertility and Assisted Conceptions

Question 1

What is assisted conception treatment?

Answer 1

Any treatment which involves gametes outside the body

Question 2

How many couples require assessment of infertility in the UK and how many of these will require ACT

Answer 2

1 in 6

half will require ACT

Question 3

What percentage of live births in the UK are a result of ACT

Answer 3

2 percent

Question 4

Why is the demand for ACT rising

Answer 4

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

Question 5

What are the most common indications for ACT

Answer 5

Male factor infertility
Multiple factors infertility
Unexplained infertility
Tubal disease

Question 6

What are the other indications for ART

Answer 6

Uterine factors
endometrioses
fertility preservation in cancer patients
treatment to avoid transmission of BBV between pts
Pre implantation diagnosis of inherited disorders
Single parents/same sex couples

Question 7

What things do the patients need to do before treatment can begin?

Answer 7

Alcohol- female limits to 4 units per week
Weight- BMI 19-29 for both male and female
Smoking- advised to stop
Folic acid- 0.4mg/day preconception until 12 weeks gestation (5mg if increased risk of NTD)
Rubella immunity
Cervical smears up to date
Occupational factors
Medication and recreational drug review
BBV screen- hep B/C and HIV

Question 8

What treatments are avaiblable?

Answer 8

Donor insemination
Intra-uterine insemination
In-vitro fertilisation (IVF)
Intra-cytoplasmic sperm injection (ICSI)
Surrogacy

Question 9

What are the indications for IUI

Answer 9

unexplained infertility
mild to moderate endometriosis
mild male factor infertility

Question 10

What is the methid of IUI

Answer 10

Prepared semen is inserted into uterine cavity around time of ovulation (which may be either natural or stimulated cycle)

Question 11

What are the indications for IVF

Answer 11

Unexplained (more than 2 yrs duration)
Pelvic disease (eg endometriosis)
Anovulatory infertility
Male factor infertility (if more than 1x10 to the 6 motile sperm)
Others - pre implantation genetic diagnosis

Question 12

What is the method for IVF?

Answer 12

See notes.

Question 13

What is the name of the synthetic gonadotrophin releasing hormone given in IVF

Answer 13

Buserelin

Question 14

How is a sperm sample taken for IVF?

Answer 14

Abstinence for 72 hours

Ejaculates samples - important.

Question 15

What is the sperm sample assessed for

Answer 15

Volume
Density - number of sperm
Motility- how many are moving
Progression- how well they move

Question 16

What are the indication for ICSI

Answer 16

Severe male factor infertility

Previous failed IVF

Question 17

What is the method of ICSI?

Answer 17

For female it is the same preparation as IVF
Male - sperm surgically aspirated in azoospermia

Each egg is stripped. Sperm are immobilised and a single sperm in injected into the egg. Incubate overnight at 37 degress.

The rest of the process is the same as IVF.

Question 18

What are the complications of ART?

Answer 18

Ovarian hyperstimulation syndrome
Multiple pregnancy

Others:
No eggs retrieved - uncommon
Surgical risks
Failed fertilisation (four percent)
Ectopic pregnancy
Non continuing pregnancy
Increased risk in pregnancy
Psychological

Question 19

What are the symptoms of OHSS

Answer 19

Enlarged ovaries due to excess follicles.
Abdo pain
bloating
nausea
diarrhoea
breathless

Can be mild, moderate, severe (1 in 1000)

Question 20

What is the treatment of OHSS

Answer 20

Before embryo transfer:

• coasting = with hold gonadotrophins
• elective freeze
• sinlge embryo transfer

After embryo transfer

• monitor
• fluids
• pain killers

Question 21

What are the success rates for IVF?

Answer 21

In women under 37 the success rate is just over a third (37 percent)

Success rates decrease after age 37 and success if very low in women older than 40.

ICSI success rates are comparable to IVF, maybe slightly higher in younger patients (less than 40)

Question 22

What are the risks or increasing parental age?

Answer 22

Increased risk of :
miscarriage
ectopic pregnancy
chromosomal abnormalities
low birth weight/ prem baby
still birth

Increased incidence of chronic disease eg diabetes