Infertility and Assisted Conceptions Flashcards
What is assisted conception treatment?
Any treatment which involves gametes outside the body
How many couples require assessment of infertility in the UK and how many of these will require ACT
1 in 6
half will require ACT
What percentage of live births in the UK are a result of ACT
2 percent
Why is the demand for ACT rising
increasing parental age
increasing chlamydia and male factor infertility
improved ACT range of treatments and success rates
What are the most common indications for ACT
Male factor infertility
Multiple factors infertility
Unexplained infertility
Tubal disease
What are the other indications for ART
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
What things do the patients need to do before treatment can begin?
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
What treatments are avaiblable?
Donor insemination Intra-uterine insemination In-vitro fertilisation (IVF) Intra-cytoplasmic sperm injection (ICSI) Surrogacy
What are the indications for IUI
unexplained infertility
mild to moderate endometriosis
mild male factor infertility
What is the methid of IUI
Prepared semen is inserted into uterine cavity around time of ovulation (which may be either natural or stimulated cycle)
What are the indications for IVF
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
What is the method for IVF?
See notes.
What is the name of the synthetic gonadotrophin releasing hormone given in IVF
Buserelin
How is a sperm sample taken for IVF?
Abstinence for 72 hours
Ejaculates samples - important.
What is the sperm sample assessed for
Volume
Density - number of sperm
Motility- how many are moving
Progression- how well they move
What are the indication for ICSI
Severe male factor infertility
Previous failed IVF
What is the method of ICSI?
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.
What are the complications of ART?
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
What are the symptoms of OHSS
Enlarged ovaries due to excess follicles. Abdo pain bloating nausea diarrhoea breathless
Can be mild, moderate, severe (1 in 1000)
What is the treatment of OHSS
Before embryo transfer:
- coasting = with hold gonadotrophins
- elective freeze
- sinlge embryo transfer
After embryo transfer
- monitor
- fluids
- pain killers
What are the success rates for IVF?
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)
What are the risks or increasing parental age?
Increased risk of : miscarriage ectopic pregnancy chromosomal abnormalities low birth weight/ prem baby still birth
Increased incidence of chronic disease eg diabetes
