Infertility and assisted coneption

Question 1

What is assisted conception treatment? (ACT)

Answer 1

Any treatment that involves gametes outside of the body

Question 2

How many couples require assessment of infertility?

Answer 2

1 in 6 (everywhere else says 1 in 8)

-approximately half of these will require assisted conception treatment

Question 3

Indications for assisted conception treatment

Answer 3

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

Question 4

How much alcohol can you drink before treatment?

Answer 4

Max 4 units per week

Question 5

Optimal BMI before treatment?

Answer 5

19-29

Question 6

How much folic acid should you give pre-conception and how long should you continue?

Answer 6

0.4mg/day and continue for 12 weeks

give 5mg a day if increased risk of NTD

Question 7

Indications for intra uterine insemination

Answer 7

Unexplained infertility
Mild or moderate endometriosis
Mild male factor infertility

Question 8

How do you carry out intrauterine insemination?

Answer 8

• can be part of natural or stimulated cycle

- prepared semen inserted into uterine cavity around time of ovulation

Question 9

Indications for IVF?

Answer 9

• 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)

Question 10

What is down regulation and how do you achieve it?

Answer 10

it is “shutting down” pituitary - ovarian hormones
-do it with synthetic gonadotropin releasing hormone (Buserelin)

-adminstered as a spray or injection

Question 11

Side effects of down regulation/buserelin

Answer 11

Hot flushes and mood swings
Nasal irritation (bc administered as a spray)
Headaches

Question 12

What medication do you give in ovarian stimulation?

Answer 12

Gonadotrophin hormone (Gonal-F, menopur)

Question 13

Side effects of ovarian stimulation

Answer 13

• mild allergic reactions

- ovarian hyperstimulation syndrome (OHSS)

Question 14

When do you give the hCG (ovitrelle) injection and why?

Answer 14

Single injection given 36 hours prior to egg collection - mimics LH surge

Question 15

Rule for sperm sample

Answer 15

Abstinence for 72 hours beforehand

Question 16

Day 0

Answer 16

Egg collection

Question 17

Day 1

Answer 17

Pronuclear stage

Question 18

Day 2

Answer 18

Average 4 cell stage

Question 19

Day 3

Answer 19

Average 6-8 cell stage

Question 20

How many embryos can you transfer in a patient under 40?

Answer 20

No more than 2 embryos to be transferred

Question 21

How many embryos can you transfer in patients aged 40 and over

Answer 21

3 may be transferred in exceptional circumstances only

Question 22

What should you do during the luteal phase in IVF?

Answer 22

Give cyclogest (progesterone) pessaries (probably because progesterone is the main pregnancy hormone)
and then do a pregnancy test 2 weeks after embryo transfer

Question 23

If you have a positive pregnancy test after IVF what should you do?

Answer 23

Transvaginal scan (5 weeks after embryo transfer)

Question 24

Indications for intracytoplasmic sperm injection?

Answer 24

Severe male factor infertility (e.g. if your sperm are super messed up/azoospermia)

Previous failed fertilisation with IVF

Question 25

How do you carry out ICSI?

Answer 25

Egg is stripped
Sperm immobilised
Single sperm injected
Incubate at 37degreesC overnight

Question 26

Symptoms of ovarian hyperstimulation syndrome?

Answer 26

Abdominal pain
Bloating
Nausea/diarrhoea
Breathless!!

Question 27

Chances of ovarian hyperstimulation syndrome?

Answer 27

1 in 1000

Question 28

All assisted conception stuff has to be licensed by who?

Answer 28

The HFEA (human fetal and embryo authority)

Question 29

Steps of IVF

Answer 29

Down regulation
Ovarian stimlation
Oocyte retrieval
Embryo transfer
Luteal support

Question 30

Complications of IVF

Answer 30

Multiple pregnancy
Ovarian hyperstimulation
Ectopic pregnancies

Question 31

IVF success rate

Answer 31

35%

Question 32

By age 35, how much of her ovarian reserve has a woman lost?

Answer 32

95%

Question 33

When are embryos usually transferred to womb in IVF?

Answer 33

Usually allowed to develop until day 5/6 (which is when they reach blastocyst stage) and then they can be transferred