Infertility & Assisted Conception Flashcards
Before assisted conception begins, what has to be taken into consideration?
alcohol: females <4 units per week
weight: BMI 19-29 for male and female
stop smoking
folic acid: 0.4mg/day (preconception)-12 weeks gestation OR 5mg/day if risk of NTD is high/obese/diabetic
rubella immunisation
cervical smear
assess ovarian reserve
What treatments are available?
- Intra-uterine insemination (IUI)
- In-Vitro fertilisation (IVF)
- Donor insemination
- Intra-cytoplasmic sperm injection
- Surrogacy
- Fertility preservation
What are the indications of IUI?
- sexual problems
- same sex relationships
- discordant blood borne virus (one partner has BBV but the other doesn’t
- abandoned IVF
What are the methods involved in IUI?
- natural/stimulated cycles
- prepared semen inserted around time of ovulation
What are the indications of IVF?
- unexplained infertility for >2 years
- Pelvic disease (endometriosis, tubal disease, fibroids)
- Anovulatory infertility
- Failed IUI (6 cycles)
What are the steps in IVF?
1) Down regulation
2) Ovarian Stimulation
3) Occyte collection
4) Fertilisation
What occurs in down regulation?
- The female patient is given GnRH agonist to stop the ovaries from ovulating.
- Allows precise timing for when oocyte can be recovered by using HCG trigger
- Side effects like hot flushes, mood swings and headaches can occur
- scan is performed to ensure endometrium is thin and ovaries are no stimulated (no follicles present)
What occurs in ovarian stimulation?
- gonadotrophin hormone containing FSH/LH is self administed (S.cut)
- HCG is given to ensure meiosis resumes 36h before oocyte recovery
- leads to follicular development
How is semen prepared?
- abstinence by male patient for 72h beforehand
- Semen assessed for volume, density, motility (how many move) ann progression (how well they move)
- seminal plasma is removed and concentrated
How are oocytes collected?
- search through follicular fluid
- identify eggs and surrounding cells
- collect them in cell culture medium
- incubate at 37 degrees
What occurs after fertilisation?
- embryo transfer occurs (normally 1, but max 2 can be transferred)
- luteal support (progesterone suppositories) for 2 weeks
- pregnancy test 16 days after oocyte recovery
what are the indications for intracytoplasmic sperm injection?
- severe male factor infertility
- previous failed fertilisation with IVF
- preimplantation genetic diagnosis
How is sperm collected?
- extracted from epididymis (if obstructive)
- extracted from testiscular tissue (if non obstructive)
- surgical sperm aspiration (if azoospermia-semen contains no sperm)
How is sperm inserted into the oocyte?
- sperm immobilised and a single sperm is injected int o the oocyte
- incubated in 37degrees
What is ovarian hyperstimulation syndrome?
hCG stimulation causes vascular endothelial growth factor (VEGF) which induces vascular hyperpermeability which leads to fluid shift from vascular system to abdominal/pleural cavity”
