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REPRODUCTION & GYNAECOLOGY > Infertility Assisted Conception > Flashcards

Infertility Assisted Conception Flashcards

1
Q

What is meant by Assisted Conception Treatment (ACT)?

A

any treatment in which involves gametes outside the body

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2
Q

How many couples require assessment of infertility in UK and how many of these then go on to require ACT?

A

1 in 6 require assessment

half of these will require ACT

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3
Q

What percentage of live births in the UK come from ACT?

A

2%

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4
Q

Why is demand for ACT increasing?

A
  • increasing parental age
  • increasing chlamydia infection
  • male factor infertility,
  • increasing range of ACT
  • improved success rates
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5
Q

In 2016, Scottish legislation changed so that patients are waiting no longer than how many months for ACT?

A

Aim for all patients to be waiting <12 months for treatment

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6
Q

How many cycles of ACT are patients offered on the NHS in Scotland?

A
  • up to three cycles of IVF/ICSI

- where there is a reasonable expectation of a live birth

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7
Q

What type of ACT is commonly used if male factor infertility is causing difficulty getting pregnant?

A

Intra-cytoplasmic Sperm Injection (ICSI)

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8
Q

What type of ACT is more popular if couples have unexplained infertility?

A

IVF

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9
Q

How have the indications for ACT treatment changed in recent years? i.e. who is now included in the guidelines to be treated?

A
  • Increase single (female/male) and same sex couples
  • Increase in treatment with surrogate
  • Increase in transgender referral
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10
Q

What other services can be offered alongside ACT for specific patient groups?

A
  • Fertility preservation in cancer/ transgender patients/ social reasons
  • Tx to avoid transmission of blood born viruses (BBV)
  • Pre-implantation diagnosis of genetic disorders
  • Treatment with surrogacy when absent /abnormal uterus
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11
Q

What criteria should be discussed prior to beginning treatment?

A
  • Alcohol: females limit <4 units per week
  • Drugs: prescribed, OTC and recreational
  • BMI: 19-29 optimal both male and female
  • Stop smoking
  • Folic acid: 0.4mg/day
  • Immunise mother against Rubella
  • Check last cervical smear
  • Avoid exposure to hazards (e.g. occupation)
  • Screen for BBV
  • Assess ovarian reserve
  • Offer supportive counselling
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12
Q

What different forms of ACT are available?

A
  • Donor insemination
  • Intra-Uterine Insemination (IUI)
  • In Vitro Fertilisation (IVF)
  • Intra-Cytoplasmic Sperm Injection (ICSI)
  • Fertility Preservation
  • Surrogacy
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13
Q

When would intra-uterine insemination be indicated?

A
  • sexual problems
  • same sex relationships
  • BBV
  • abandoned IVF
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14
Q

How is an intra-uterine insemination carried out?

A
  • Can be a natural OR stimulated cycle

- Prepared semen inserted into uterine cavity around time of ovulation

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15
Q

What are the indications for IVF?

A
  • Unexplained Infertility (> 2 years)
  • Pelvic disease (endometriosis, tubal disease, fibroids)
  • Anovulatory infertility (after failed ovulation induction)
  • Failed Intra-uterine insemination (after 6 cycles)
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16
Q

What are the main stages of IVF treatment?

A 
1 - Down Regulation
2 - Ovarian Stimulation
3 - Oocyte collection - theatre
4 - Fertilisation
5 - Embryo Transfer
17
Q

What is involved in the process of down regulation in IVF and what is the function of this?

A
  • Synthetic GnRH analogue given (Buserelin) nasal spray

FUNCTION:

  • Reduces cancellation from ovulation
  • improves success rates
  • Allows precise timing of oocyte recover by using HCG trigger
18
Q

What side effects do women experience from the GnRH analogues given to down regulate them before IVF?

A
  • Hot flushes and mood swings (like menopausal symp.)
  • Nasal irritation
  • Headaches
19
Q

How are the ovaries stimulated in preparation for IVF?

A
  • Given synthetic FSH/LH
  • usually a self-administered s/c injection
  • Causes follicular development (usually multiple)
20
Q

What is used in IVF to simulate the LH peak which usually causes ovulation?

A

HCG injection - given 36 hours before oocyte recovery

21
Q

When does semen need to be produced for an IVF treatment, and what should be assessed on semen analysis before this?

A

Abstinence for 72 hours
Then produced in ‘Men’s room’ or at home (within 1 hour before)

Analyse for:

  • volume
  • density
  • motility
  • progressive motility
22
Q

What risks are associated with oocyte collection in theatre?

A
  • Bleeding
  • Pelvic infection
  • Failure to obtain oocytes
23
Q

How many embryos are normally transferred in IVF?

A

Normally transfer 1 embryo (max 3 in exceptional circumstances)

risk of multiple pregnancy with multiple embryo transfer

24
Q

What medication must be given after embryo transfer in IVF?

A 
Luteal Support (as no corpus luteum has developed to do this)
=> progesterone suppositories for 2 weeks
25
Q

How soon after egg retrieval can a pregnancy test be taken?

A

16 days after oocyte recovery

26
Q

What are the indications for the use of ICSI?

A
  • Severe male factor infertility
  • Previous failed fertilisation with IVF
  • Pre-implantation genetic diagnosis
27
Q

Where is sperm surgically aspirated from in an obstructive cause of azoospermia?

A

extracted from epididymis

28
Q

Where is sperm surgically aspirated from in a patient with non-obstructive azoospermia?

A

testicular tissue (non-obstructive)

29
Q

Describe what happens during ICSI

A

Each egg is stripped
Sperm immobilised
Single sperm injected
Incubate at 370C overnight

30
Q

How is ovaran hyperstimulation syndrome prevented?

A

Prevention:

  • Low dose protocols
  • Use of antagonist for suppression
31
Q

How is ovarian hyper-stimulation treated BEFORE an embryo is transferred to the mother?

A
  • Elective freeze

- Single embryo transfer

32
Q

How is Ovarian hyper-stimulation treated AFTER an embryo is transferred to the mother?

A
  • Monitor with scans and bloods
  • Reduce risk of thrombosis
    => Fluids, TED stockings and fragmin
  • Analgesia
  • Hospital admission if IV fluids/more intensive monitoring req’d
33
Q

What are the main complications of ACT?

A

Ovarian hyperstimulation

Multiple pregnancy

34
Q

The UK aim to have a rate of multiple pregnancy under what percentage?

A

10%

35
Q

What are the overall success rates for IVF/ICSI?

A

35% (roughly 1 in 3)

36
Q

What are the HFEA responsible for with regards to all ACT?

A
  • Regulate all treatment and research
  • Consider welfare of child
  • Rights of people seeking treatment to appropriate care
  • Respect for human life at all stages of development

REPRODUCTION & GYNAECOLOGY (58 decks)

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