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REI Written Boards SKORY > Infertility/RPL > Flashcards

Infertility/RPL Flashcards

1
Q

Describe findings of peritoneal fluid in women with endometriosis

A
  • Increased macrophages
  • Decreased cytotoxicity of NK cells
  • Increased cytotoxic and helper T cells increased
  • Increased COX-2
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2
Q

What are the epigenetic changes found in endometriotic implants?

A
  • Increased aromatase (increased E2)
  • Reduced 17BHSD activity (less conversion of E2 to E1)
  • Higher levels of ER-beta (hypomethylation in CpG islands of gene promoter)
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3
Q

Which implants have the highest level of aromatase?

A

Red implants (relative to black and cyst capsule)

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4
Q

Describe laboratory findings of OHSS

A

Hyponatremia, hyperkalemia, increased creatinine, hemoconcentration

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5
Q

What is the least likely medication to cause OHSS?

A

Recombinant LH (does not result in increased VP and VEGF)

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6
Q

Describe the benefits and evidence of efficacy of presacral neurectomy (PSN)

A
  • May be effective for the treatment of midline pain associated with menses
  • Success of the procedure depends on surgeon experience
  • long-term efficacy has not been demonstrated
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7
Q

What is LUNA used to treat and what is its efficacy?

A

Laparoscopic uterosacral nerve ablation (LUNA)

  • Used to treat pelvic pain caused by endometriosis after failed surgical management
  • Limited data suggest that LUNA is not effective
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8
Q

How does use of ICSI affect imprinting and epigenetic modifications?

A

Higher rates of genomic imprinting/epigenetic modifications (likely related to infertility > ART)

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9
Q

Name 3 disorders associated with use of ICSI

A

Beckwith-Weidemann, Angelman syndrome, and retinoblastoma

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10
Q

Does ICSI affect rate of Prader-Willi syndrome?

A

No

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11
Q

What are the best indications for use of ICSI?

A

PGD, morphology <4%, prior failed IVF despite normal semen parameters, TMS <5 million, previously frozen eggs

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12
Q

What are the indications for assisted hatching?

A

Age > 36, thick zona, prior failed IVF cycle, poor embryo morphology

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13
Q

What are positive predictors associated with pregnancy after ET?

A

US-guidance, distance from fundus, experience of MD, ease of procedure, soft catheter

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14
Q

What are negative predictors associated with pregnancy after ET?

A

Uterine contractions, blood on catheter

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15
Q

Risk factors for monozygotic twinning

A

D5 SET more monozygotic twins than D3 SET

Increased risk with AH

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16
Q

Most common adverse outcome of IVF singleton pregnancy

A

LBW (11% vs 8% in general population) vs PTD

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17
Q

What is the hardest part of creating rFSH?

A

Adding glycosylation/carbohydrates

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18
Q

What is most likely to be similar between recombinant and endogenous gonadotropins?

A

AA sequence

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19
Q

What medications are FSH only?

A

Bravelle, fertinex (menopausal urine), Gonal-F, Follistim (recombinant)

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20
Q

Name example medications of HMG (human menopausal gonadotropin)?

A

(FSH/LH): pergonal, repronex, menopur, humegon [all from menopausal urine]

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21
Q

What are required FDA labs for both partners?

A

HIV, HepBsAg, HepBcAb, HepC ab, Treponema Pall, CG/CT

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22
Q

What are required labs for egg donors?

A

HIV, Hep B, Hep C, Syphilis, GC/CT

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23
Q

What are labs required only for male partners?

A

HTLV, CMV IgG and IgM - different because sperm is leukocyte rich tissue

24
Q

What is a Robertsonian translocation?

A

Occur in the five acrocentric chromosome pairs (chromosome pairs where the short arms are fairly short), and participating chromosomes break at centromeres and the long arms fuse to form a single, large chromosome with a single centromere.

25
What are the 5 acrocentric chromosomes?
13, 14, 15, 21 and 22
26
What proportion of RPL is idiopathic?
50%
27
What is the prevalence of uterine septums among patients with RPL?
6-7%
28
What is the prevalence of any uterine anomaly among patients with RPL?
10-50%
29
What is the incidence of chromosomal abnormalities in SAB?
50-75%
30
Describe the 3 main types of chromosomal aneuploidies seen in abortus
- 90% numerical aneuploidy (trisomies, monosomies, polyploidies) - 10% structural abnormalities (need FISH to detect – NOT CGH) - Balanced translocation – 5% of RPL (usually non-homologous chromosomes)
31
What is the prevalence of Anti-phospholipid antibody syndrome among patients with RPL?
3-5% among RPL patients
32
What are clinical events defining APLS?
Need 1 or more: - Vascular thrombosis - 3 or more losses <10 weeks (issue with trophoblast invasion) - 1 or more loss >10 weeks (due to thrombosis) - PTD < 34 weeks associated with pre-ecclampsia or placental insufficiency)
33
What are laboratory findings of APLS?
- Lupus Anticoagulant (LAC) – DELAYED CLOTTING in phospholipid dependent coagulation tests – (aPTT, kaolin clotting time, dilute Russell’s Viper venom [dRVVT]); this is corrected by addition of excess phospholipid but not by platelet-poor plasma) - Anticardiolipin antibodies (IgG or IgM) – moderate to high levels - High titer of antibodies to beta2 Glycoprotein 1
34
How should labs be confirmed when diagnosing a patient with APLS?
Two separate values of same test repeated 12 weeks apart
35
Can treatment of PCOS patients with metformin change their risk of RPL?
No
36
Describe association of HgbA1c and risk of RPL among diabetic patients?
Directly related to A1C level
37
Does subclinical hypothyroidism increase risk of RPL?
Yes
38
What is the least likely cause of RPL?
Arcuate | Lower risk than septum, translocation, APLS, toxic factor maternal serum
39
What is most likely to be associated with 3rd trimester loss?
Prothrombin mutation (not MTHFR or protein C)
40
What is the risk of SAB in next pregnancy with prior miscarriage and a history of a prior liveborn?
``` 0 prior miscarriages = 12 % 1 prior miscarriage = 24% 2 prior miscarriages = 26% 3 prior miscarriages = 32% 4 prior miscarriages = 26% (really, less?) 6 prior miscarriages = 53% ```
41
What is preferred management of a patient with 3 prior losses but RPL workup is complete negative and what is the change of live birth in next pregnancy?
Expectant management! | Chance of live birth in next pregnancy: ~60-70%
42
Does use of PGS improve outcomes for RPL patients?
Per Practice Committee guidelines, “available evidence currently does not support the use of PGS for patients with RPL; does not improve ongoing PR or LBR, and does not decrease SAB
43
What is the risk of SAB in next pregnancy with prior miscarriage and WITHOUT a history of a prior liveborn?
2 or more miscarriages – 45-50%
44
What can happen as a result of oocyte cryopreservation?
Meiotic spindle damage, ZP hardened (overcome with ICSI), cortical granule damage
45
What is the preferred cryopreservative for 2PN?
Propanediol (propylene glycol)
46
What are the advantages of extended embryo culture?
-Higher implantation rates -Better synchronization Opportunity for PGD -Fewer multiple pregnancy rates
47
What are the disadvantages of extended embryo culture?
- Failure to blastulate and no transfer - Fewer embryos for cryopreservation possibility of no embryos for transfer (not in good prognosis patients) - 2-5 x increased incidence of monozygotic twinning – controversial? - Possibility of favoring male embryos? (males develop faster??)
48
What is the most important substrate in extended media?
Glucose and essential AA
49
Between 0 and 72 hours, what is the primary embryo energy source?
Lactate and pyruvate
50
Between 0 and 72 hours, what is the oxygen consumption?
Low
51
Between 0 and 72 hours, what is the AA utilization?
Non-essential AA
52
Between 0 and 72 hours, are macromolecules required?
Yes
53
After 96 hours through blastocyst formation, what is the primary embryo energy source?
Glucose
54
After 96 hours through blastocyst formation, what is the oxygen consumption?
High, similar to active skeletal muscle
55
After 96 hours through blastocyst formation, what is the AA utilization?
More complex essential AA
56
After 96 hours through blastocyst formation, are macromolecules required?
Yes

REI Written Boards SKORY (20 decks)

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