Infertility and assisted coneption Flashcards
What is assisted conception treatment? (ACT)
Any treatment that involves gametes outside of the body
How many couples require assessment of infertility?
1 in 6 (everywhere else says 1 in 8)
-approximately half of these will require assisted conception treatment
Indications for assisted conception treatment
Fertility preservation in cancer patients
Treatment to avoid transmission of blood born viruses between patients
Pre-implantation diagnosis of inherited disorders
Treatment of single parents or same sex couples
Others: cryopreservation of gametes for social reason
How much alcohol can you drink before treatment?
Max 4 units per week
Optimal BMI before treatment?
19-29
How much folic acid should you give pre-conception and how long should you continue?
0.4mg/day and continue for 12 weeks
give 5mg a day if increased risk of NTD
Indications for intra uterine insemination
Unexplained infertility
Mild or moderate endometriosis
Mild male factor infertility
How do you carry out intrauterine insemination?
- can be part of natural or stimulated cycle
- prepared semen inserted into uterine cavity around time of ovulation
Indications for IVF?
- unexplained infertility for more than 2 years
- pelvic disease (endometriosis, tubal disease, fibroids)
- anovulatory infertility
- male factor infertility (if more than 1x10^6 motile sperm)
- others (pre-implantation genetic diagnosis)
What is down regulation and how do you achieve it?
it is “shutting down” pituitary - ovarian hormones
-do it with synthetic gonadotropin releasing hormone (Buserelin)
-adminstered as a spray or injection
Side effects of down regulation/buserelin
Hot flushes and mood swings
Nasal irritation (bc administered as a spray)
Headaches
What medication do you give in ovarian stimulation?
Gonadotrophin hormone (Gonal-F, menopur)
Side effects of ovarian stimulation
- mild allergic reactions
- ovarian hyperstimulation syndrome (OHSS)
When do you give the hCG (ovitrelle) injection and why?
Single injection given 36 hours prior to egg collection - mimics LH surge
Rule for sperm sample
Abstinence for 72 hours beforehand
Day 0
Egg collection
Day 1
Pronuclear stage
Day 2
Average 4 cell stage
Day 3
Average 6-8 cell stage
How many embryos can you transfer in a patient under 40?
No more than 2 embryos to be transferred
How many embryos can you transfer in patients aged 40 and over
3 may be transferred in exceptional circumstances only
What should you do during the luteal phase in IVF?
Give cyclogest (progesterone) pessaries (probably because progesterone is the main pregnancy hormone) and then do a pregnancy test 2 weeks after embryo transfer
If you have a positive pregnancy test after IVF what should you do?
Transvaginal scan (5 weeks after embryo transfer)
Indications for intracytoplasmic sperm injection?
Severe male factor infertility (e.g. if your sperm are super messed up/azoospermia)
Previous failed fertilisation with IVF
How do you carry out ICSI?
Egg is stripped
Sperm immobilised
Single sperm injected
Incubate at 37degreesC overnight
Symptoms of ovarian hyperstimulation syndrome?
Abdominal pain
Bloating
Nausea/diarrhoea
Breathless!!
Chances of ovarian hyperstimulation syndrome?
1 in 1000
All assisted conception stuff has to be licensed by who?
The HFEA (human fetal and embryo authority)
Steps of IVF
Down regulation Ovarian stimlation Oocyte retrieval Embryo transfer Luteal support
Complications of IVF
Multiple pregnancy
Ovarian hyperstimulation
Ectopic pregnancies
IVF success rate
35%
By age 35, how much of her ovarian reserve has a woman lost?
95%
When are embryos usually transferred to womb in IVF?
Usually allowed to develop until day 5/6 (which is when they reach blastocyst stage) and then they can be transferred
