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Reproduction > Infertility & Assisted Conception > Flashcards

Infertility & Assisted Conception Flashcards

1
Q

What percentage of couples struggle with infertility?

A

1/6

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2
Q

List 5 reasons why the demand for assisted conception is increasing

A 
Increasing parental age
Increasing chlamydia
Male infertility increasing
Increased options for ART
Improved success rates
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3
Q

Give 5 pieces of lifestyle advice for couples struggling to conceive:

A 
Limit alcohol intake 
Stop smoking
Keep BMI 19-24
Cervical smears
No recreational drug use
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4
Q

List the different fertility treatments available currently?

6 options

A 
IVF
ICSI (intra-cytoplasmic sperm injection)
Intra-uterine-insemination (IUI)
Fertility preservation
Donor insemination Surrogacy
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5
Q

What is down regulation?

A

This is when a synthetic gonadotrophin releasing hormone agonist allows precise timing for oocyte recovery

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6
Q

What does ovarian stimulation do?

A

Stimulates follicular development

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7
Q

What % of eggs fertilise normally in IVF?

A

60%

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8
Q

What day of division is the fertilised egg transferred to the uterus?

A

Day 5

Blastocyte stage

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9
Q

What must the patient take for “luteal support” after embryo transfer?

A

Progesterone suppositories for 2 weeks

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10
Q

Define azoospermia

A

No sperm found in ejaculate

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11
Q

Where is sperm aspiration carried out?

A

Epididymis - obstructive problem

Testicular tissue - non-obstructive problem

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12
Q

What is significant about ICSI?

A

A single sperm is injected into the ovum - sperm does not penetrate by itself

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13
Q

What is a serious complication of ART?

A

Ovarian Hyper Stimulation Syndrome

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14
Q

What preventative methods are used against OHSS?

A

Lose dose protocol

Antagonist suppression

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15
Q

What is the current success rate of ICSI?

A

35%

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16
Q

Which ducts degenerate in male development?

A

Mullerian Ducts

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17
Q

What ducts degenerate in female development?

A

Wolffian Ducts

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18
Q

What stimulates the differentiation of male external genitalia?

A

Dihydrotestosterone

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19
Q

What syndrome is an X-linked recessive disorder, responsible for having outward genitalia of a female but genetic make up of a male?

A

Androgen Insensitivity Syndrome

Testes do not descend in this condition and are better off removed when discovered

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20
Q

What is cryptorchidism?

A

Undescended testes

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21
Q

If patients testes have not descended by adulthood, what is the increase in their risk of cancer?

A

6x increased risk

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22
Q

Where is testosterone produced?

A

Leydig Cells

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23
Q

Where does spermatogenesis occur?

A

Seminiferous tubules

24
Q

Where do the matured sperm sit in the cells?

A

The centre

When taking biopsy, make sure to take sample from very centre

25
Q

What is the role of the sperm’s acrosome?

A

This contains enzymes for penetrating the ovum

In the head of the sperm

26
Q

List the 6 roles of the Sertoli cells?

A 
Forms blood testes barrier
Provides nutrients
Phagocytosis
Secretes seminiferous fluid
Secretes androgen-binding globulin
Secretes inhibin and activin
27
Q

Where does LH act in the males?

A

Leydig cells

Regulates testosterone production

28
Q

Where does FSH act in males?

A

Sertoli cells

Enhances spermatogenesis

29
Q

Where is the most common site of obstruction in males?

A

Vas deferens

30
Q

Before beginning fertility treatment, what medication should you have the woman on?

A

Folic acid

0.4mg daily from preconception up until 12 weeks gestation

31
Q

When would a woman be on 5mg of folic acid instead?

A

Obese

or if increased risk of neural tube defect

32
Q

How do you assess the ovarian reserve?

A

Antral follicle count
Or
Anti-Mullerian hormone

33
Q

What vaccine should you check a woman has before fertility treatment?

A

Rubella

If not - immunise

34
Q

What is the optimal BMI for both males and females undergoing fertility treatment?

A

19-29

35
Q

How is intra-uterine insemination carried out?

A

Prepared semen is inserted into the uterine cavity around the same time as ovulation
The cycle can be stimulated or can occur naturally

36
Q

What are some of the indications for intra-uterine insemination?

A

Same sex couple
Abandoned IVF
Blood borne virus

37
Q

What are the main indications for IVF treatment?

A

> 2 years no conception unexplained
Pelvic disease
Anovulatory infertility (failed induction)
Failed intra-uterine insemination (after 6 cycles)

38
Q

What is the tonic phase of folliculogenesis and how long does it last?

A

65 days

Primary and secondary follicles become antral follicles

39
Q

What is the growth phase of folliculogenesis and how long does it last?

A

20 days
Antral follicles grow from 3-5mm to become pre-ovulatory follicles (20mm)
Dependent on growth hormone

40
Q

What are some of the side effects of down regulation/

A

Hot flushes
Mood swings
Nasal irritation
Headaches

41
Q

What 4 things is a sperm sample assessed for?

A

Volume
Density (no. of sperm)
Motility
Progression

42
Q

What are some risks associated with oocyte collection?

A

Bleeding
Pelvic infection
Failure to get oocyte

43
Q

What temperature are human eggs stored at?

A

37 degrees

44
Q

What is a morula?

A

A 16 cell embryo

45
Q

At what stage does an embryo implant?

A

As a blastocyst

46
Q

When should you take a pregnancy test in the IVF process?

A

16 days after initial oocyte collection

47
Q

What are the main indications for ICSI?

A

Severe male infertility
Previous failed IVF
Preimplantation genetic diagnosis

48
Q

What hormones are secreted by a foetal testes, to cause the development of the male genital tract?

A

Testosterone

Mullerian Inhibiting Factor

49
Q

At what gestational age should there be external genitalia differentiation?

A

9 weeks

Can be seen on scan from 16 weeks

50
Q

What hormone, secreted by Sertoli cells, inhibits FSH?

A

Inhibin

51
Q

What hormone, secreted by Sertoli cells, activates FSH secretion?

A

Activin

52
Q

What is the zonal reaction’?

A

Prevents multiple sperm from fertilising the egg

53
Q

Where does fertilisation typically occur?

A

Ampullary region of the fallopian tube

54
Q

What are the clinical features of an obstructive male infertility problem?

A

Normal testicular volume
Normal secondary sexual characteristics
May have absent vas deferens
Normal LH, FSH and testosterone

55
Q

What are some of the clinical features of a non obstructive cause of male infertility?

A

Low testicular volume
Reduced secondary sexual characteristics
Vas deferens present
High LH FSH +/- low testosterone

56
Q

What can be given to a man suffering from infertility due to a hyperprolactinaemia ?

A

Cabergoline

Reproduction (19 decks)

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