Infertility/RPL Flashcards
Describe findings of peritoneal fluid in women with endometriosis
- Increased macrophages
- Decreased cytotoxicity of NK cells
- Increased cytotoxic and helper T cells increased
- Increased COX-2
What are the epigenetic changes found in endometriotic implants?
- 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)
Which implants have the highest level of aromatase?
Red implants (relative to black and cyst capsule)
Describe laboratory findings of OHSS
Hyponatremia, hyperkalemia, increased creatinine, hemoconcentration
What is the least likely medication to cause OHSS?
Recombinant LH (does not result in increased VP and VEGF)
Describe the benefits and evidence of efficacy of presacral neurectomy (PSN)
- 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
What is LUNA used to treat and what is its efficacy?
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
How does use of ICSI affect imprinting and epigenetic modifications?
Higher rates of genomic imprinting/epigenetic modifications (likely related to infertility > ART)
Name 3 disorders associated with use of ICSI
Beckwith-Weidemann, Angelman syndrome, and retinoblastoma
Does ICSI affect rate of Prader-Willi syndrome?
No
What are the best indications for use of ICSI?
PGD, morphology <4%, prior failed IVF despite normal semen parameters, TMS <5 million, previously frozen eggs
What are the indications for assisted hatching?
Age > 36, thick zona, prior failed IVF cycle, poor embryo morphology
What are positive predictors associated with pregnancy after ET?
US-guidance, distance from fundus, experience of MD, ease of procedure, soft catheter
What are negative predictors associated with pregnancy after ET?
Uterine contractions, blood on catheter
Risk factors for monozygotic twinning
D5 SET more monozygotic twins than D3 SET
Increased risk with AH
Most common adverse outcome of IVF singleton pregnancy
LBW (11% vs 8% in general population) vs PTD
What is the hardest part of creating rFSH?
Adding glycosylation/carbohydrates
What is most likely to be similar between recombinant and endogenous gonadotropins?
AA sequence
What medications are FSH only?
Bravelle, fertinex (menopausal urine), Gonal-F, Follistim (recombinant)
Name example medications of HMG (human menopausal gonadotropin)?
(FSH/LH): pergonal, repronex, menopur, humegon [all from menopausal urine]
What are required FDA labs for both partners?
HIV, HepBsAg, HepBcAb, HepC ab, Treponema Pall, CG/CT
What are required labs for egg donors?
HIV, Hep B, Hep C, Syphilis, GC/CT
What are labs required only for donor sperm?
HTLV, CMV IgG and IgM - different because sperm is leukocyte rich tissue
What is a Robertsonian translocation?
Occur in the five acrocentric chromosome pairs (chromosome pairs where the short arms are fairly short - 13, 14, 15, 21, and 22), and participating chromosomes break at centromeres and the long arms fuse to form a single, large chromosome with a single centromere.
What are the 5 acrocentric chromosomes?
13, 14, 15, 21 and 22
What proportion of RPL is idiopathic?
50%
What is the prevalence of uterine septums among patients with RPL?
6-7%
What is the prevalence of any uterine anomaly among patients with RPL?
10-50%
What is the incidence of chromosomal abnormalities in SAB?
50-75%
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)
What is the prevalence of Anti-phospholipid antibody syndrome among patients with RPL?
3-5% among RPL patients
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)