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YEAR 3 REPRO > Infertility, spermatogenesis and ACT > Flashcards

Infertility, spermatogenesis and ACT Flashcards

1
Q

what is ACT

A

any treatment that involves gametes outside the body

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2
Q

how many couples in the UK require assessment of fertility

A

1/6

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3
Q

of those getting fertility assessments how many will require ACT

A

half

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4
Q

before treatment begins: limit alcohol to _____

A

4 units per week

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5
Q

before treatment begins: aim to have BMI between what

A

19-29

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6
Q

before treatment begins: stop

A

smoking

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7
Q

what supplements are women given before ACT

A

folic acid

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8
Q

what is the dose of folic acid given

A

0.4mg/day pre-conception to 12 weeks gestation

or 5mg if high risk of NTD

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9
Q

what vaccine should women get if they dont alreddy have it

A

rubella

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10
Q

what can rubella cause to a fetus

A

congenital blindness
heart defects
miscarriage/still birth

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11
Q

before treatment begins women should have a ___

A

cervical smear

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12
Q

before treatment begins women should be screened for what BBVs

A

Hep B and C

HIV

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13
Q

how is ovarian reserve assessed

A

antral follicle count or AMH (anti-mullerian hormone)

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14
Q

what is the biggest risk factor for determining IVF success

A

maternal age

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15
Q

what are the 6 types of ACT

A 
donor insemination
ICSI
IUI
IVF
freezing
surrogacy
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16
Q

how is IUI carried out

A

natural or stimulated cycle (latter improves success), prepared semen inserted into uterine cavity around ovulation

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17
Q

what is the criteria for getting IVF on NHS

A

infertility
one partner doesnt have a child
up to 3 rounds per couple

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18
Q

what is primary infertility

A

never conceived

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19
Q

what is secondary infertility

A

have conceived before, regardless of outcome

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20
Q

age over what is a RF for infertility

A

35

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21
Q

BMI of what is a RF for infertility

A

< 20 or > 30

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22
Q

when is IVF indicated (4)

A
  • pelvic disease (endometritis, tubal disease, fibroids)
  • unexplained infertility > 2 years
  • anovulatory infertility (after failed ovulation induction)
  • failed IUS (after 6 cycles)
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23
Q

how long does a cycle of IVF last

A

6 weeks

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24
Q

when is ICSI indicated

A
  • severe male factor infertility (below 1x10^6 motile sperm)
  • previous failed IVF
  • preimplantation genetic diagnosis
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25
Q

if azoospermia what is required for ICSI

A

surgical sperm aspiration

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26
Q

where is sperm aspirated from in obstructive azoospermia

A

epididymus

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27
Q

where is sperm aspirated from in non-obstructive azoospermia

A

testicular tissue

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28
Q

outline ICSI

A

each egg is stripped, sperm immobilisation, single sperm injected, incubated at 37 degrees overnight

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29
Q

how long does ovarian folliculogenesis last

A

85 days

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30
Q

what are the 2 phases of ovarian folliculogenesis

A

tonic phase and growth phase

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31
Q

how long is the tonic phase

A

65 days

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32
Q

how long is the growth phase

A

20 days

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33
Q

what happens in the tonic phase

A

antral follicles formed

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34
Q

what happens in the growth phase

A

antral follicles –> pre ovulatory follicle (graafian)

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35
Q

the growth phase is dependent on ____

A

gonadotrophin

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36
Q

in a stimulated cycle, what does giving gonadotrophins during early follicular phase result in

A

synchronised growth of all follicles

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37
Q

what are the 5 stages to IVF

A 
down regulation
ovarian stimulation
oocyte collection
fertilisation
embryo transfer
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38
Q

what is the purpose of down regulation in IVF

A

puts woman into menopause so the IVF can be precisely timed with no spontaneous ovulation

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39
Q

how is down regulation achieved

A

synthetic gonadotrophin releasing hormone analogue

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40
Q

give an example of a synthetic gonadotrophin releasing hormone analogue

A

Buserelin

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41
Q

how is buserelin administered

A

nasal spray or injection

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42
Q

what are some side effects of the down regulation stage

A

hot flushes
mood swings
nasal irritation
head aches

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43
Q

what is involved in the ovarian stimulation phase

A

synthetic/urinary gonadotrophins (FSH +/- LH) given as a SC injection

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44
Q

what is given after gonadotrophins and why

A

HCG injection - mimics spontaneous LH surge

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45
Q

what are some SEs to ovarian stimulation

A

mild allergic reactions

ovarian hyperstimulation syndrome

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46
Q

when is oocyte collection done and where

A

36 hours after ovarian stimulation in theatre

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47
Q

what are some risks of oocyte collection

A

bleeding
infection
failure to obtain oocytes

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48
Q

when the egg and surrounding mass of cells is collected where is it placed

A

in cell culture medium and incubated at 37 degrees

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49
Q

after fertilisation, how many embryos are transferred to the uterus

A 
1 embryo 
(maximum 3 in exceptional circumstances)
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50
Q

what day is an embryo transferred

A

blastocyst stage - day 5

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51
Q

what is given to a woman following embryo transfer

A

luteal support

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52
Q

what is luteal support

A

progesterone suppositories for 2 weeks (cyclogest)

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53
Q

what is done 16 days after oocyte recovery

A

pregnancy test

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54
Q

if pregnancy test is positive what is done

A

TVUS 5 weeks after embryo transfer

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55
Q

what are the 4 types of OHSS

A

mild
moderate
severe
critical

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56
Q

what are the symptoms of mild OHSS

A

abdominal bloating
mild abdominal pain
ovarian size usually < 8cm^3

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57
Q

what are the symptoms of moderate OHSS

A

moderate abdominal bloating
N+V
US evidence of ascites
ovarian size 8-12 cm^3

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58
Q

what is the management of OHSS before embryo transfer

A

single embryo transfer or elective freeze

59
Q

what is the management of OHSS after embryo transfer

A

monitor with scans and bloods
analgesia
reduce risk thrombosis - fluids, TED stockings, fragmin

60
Q

give 3 complications of ART

A

OHSS
multiple pregnancy
ectopic pregnancy

61
Q

before semen collection for IVF how long should the main abstain

62
Q

what is the window between sample production and delivering it

63
Q

what is the sperm sample assessed for

A

volume
density
motility
progression

64
Q

what is sperm density

A

no of sperm

65
Q

what is sperm motility

A

what proportion are moving

66
Q

what is sperm progression

A

how well sperm moves

67
Q

how is the semen prepared

A

prepared to remove seminal plasma and concentrate

68
Q

how is the semen prepared

A

prepared to remove seminal plasma and concentrate

69
Q

what is the inheritance of androgen insensitivity syndrome (testicular feminisation)

A

X linked recessive

70
Q

what is the karyotype of AIS / TF

71
Q

do testes develop in AIS

A

yes but don’t descend

72
Q

what does AIS look like phenotypically

A

external female genitalia
absent uterus/ovaries
short vagina

73
Q

people with AIS are often brought up ____

74
Q

what happens when people with AIS reach puberty

A

primary amenorrhoea and lack of pubic hair

75
Q

what causes AIS

A

end organ resistance to testosterone - induction of wolffian duct doesnt occur but mullerian inhibition does occur

76
Q

why do the testes live outside the body

A

lower temperature for spermatogenesis

77
Q

where do the testes develop in utero

A

abdominal cavity and drop into scrotal sac before birth

78
Q

what muscle contracts to raise and lower scrotum depending on temperature

A

dartos muscle

79
Q

what is the name for undescended testes

A

cryptoorchidism

80
Q

are people with cryptoorchidism infertile

A

reduces sperm count but usually fertile if unilateral

81
Q

when should an orchidoplexy be performed and why

A

before age 14 to reduce risk of testicular germ cell cancer

82
Q

if undescended as an adult what should be considered

A

orchidectomy (6 x increase risk of cancer)

83
Q

where is the sperm made

A

seminiferous tubules

84
Q

where is the sperm stored

A

epididymus

85
Q

what produces testosterone

A

leydig cells

86
Q

what is the function of the sertoli cells

A

form a blood testes barrier
provide nutrients for developing cells
phagocytosis
secretions

87
Q

what 4 things do sertoli cells secrete

A

seminiferous tubule fluid
androgen binding globulin
inhibin
activin

88
Q

what is the purpose of the blood testes barrier

A

protects sperm from antibody attack

provides a suitable fluid composition which allows later stages of development of sperm - very different from blood

89
Q

what is the nick name for sertoli cells

A

nurse cells - supportive role

90
Q

what do sertoli cells phagocytose

A

surplus cytoplasm from packaging process and destroy defective cells

91
Q

what is the function of the seminiferous tubule fluid

A

carries cells to epididymus

92
Q

what is the function of androgen binding globulin

A

binds to testosterone so concentration remains high in lumen

93
Q

what does FSH stimulate

A

spermatogenesis

94
Q

FSH acts on what

A

sertoli cells

95
Q

LH stimulates what

A

testosterone secretion

96
Q

LH acts on what

A

leydig cells

97
Q

inhibin _____ FSH

activin ____ FSH

A

inhibin decreases FSH

activin stimulates FSH

98
Q

what effect does testosterone have on release of GnRH and LH

A

negative feedback

99
Q

what enlarges male sex organs and is responsible for secondary male characteristics

100
Q

DHT is anabolic/catabolic

101
Q

FSH and LH release is cyclical/constant in males

A

constant

cyclical in females

102
Q

the release of GnRH from hypothalamus is

A

pulsatile - every 2-3 hour bursts

103
Q

when does release of GnRH begin

104
Q

testosterone is a steroid hormone derived from

A

cholesterol

105
Q

what does testosterone do before birth

A

masculinises reproductive tract and promotes descent of testes

106
Q

what does testosterone do at puberty

A

promotes puberty and male characteristics

107
Q

what does testosterone do in adulthood

A

controls spermatogenesis, secondary sexual characteristics, libido, erection, aggression

108
Q

inhibin and activin are secreted by what

A

sertoli cell

109
Q

sperm are liquified by enzymes from ____

110
Q

what is capacitation

A

series of biochemical and electrical events before fertilisation - hyperactive mobility, ability to bind zona pellucida and acrosome reaction

111
Q

after ejaculation how do sperm reach the egg and what do they do when there

A

chemo attraction to oocyte
bind to and digest ZP
penetration and fusion with oocyte membrane

112
Q

what is an acrosome reaction

A

sperm uses acrosome enzymes to digest ZP of egg

113
Q

what is the purpose of zonal reaction

A

prevents multiple fertilisations of egg

114
Q

exit route from testes to urethra, concentrate and store sperm, site for sperm maturation

A

epididymus and Vas deferens

115
Q

what is the function of the seminal vesicles

A

produce semen into ejaculatory duct, supply fructose for energy, secrete prostaglandins and fibrinogen

116
Q

what is the purpose of prostaglandins in semen

A

stimulate motility

117
Q

what is the purpose of fibrinogen in semen

A

clot precursor

118
Q

what is the function of the prostate gland

A

produces alkaline fluid and enzymes

119
Q

why does the prostate gland produce alkaline fluid

A

neutralise vaginal acidity

120
Q

why does the prostate gland produce enzymes

A

to clot semen within female

121
Q

what is the function of the bulbourethral glands

A

secrete mucus to act as lubricant

122
Q

what happens in an erection

A

parasympathetic control

blood fills corpus cavernosa

123
Q

what happens in emission

A

contraction of accessory sex glands and vas deferens so semen expelled to urethra

124
Q

what happens in ejaculation

A

contraction of smooth muscle of urethra and erectile muscles
sympathetic control

125
Q

male infertility is _____

A

increasing

126
Q

what is the most common cause of male infertility

A

idiopathic

127
Q

what are 3 causes of obstructive infertility

A

cystic fibrosis
vasectomy
infection

128
Q

mutations in the CFTR gene can cause

A

absent vas deferens

129
Q

what is a congenital cause of non-obstructive infertility

A

cryptorchidism

130
Q

what is an infectious cause of non-obstructive infertility

A

mumps orchitis

131
Q

what is an iatrogenic cause of non-obstructive infertility

A

chemo/radio therapy

132
Q

what are 3 genetic causes of cause of non-obstructive infertility

A

klinefelters
microdeletions of Y chromosome
robertsonian translocation

133
Q

what is the karyotype of klinefelters

134
Q

what are 2 environmental factors that might influence fertility

A

excessive heat on testes

pesticides

135
Q

how is testicular volume measured

A

orchidometer

136
Q

what is normal testicular volume

A

12-25 mls in adult

137
Q

what is normal testicular volume pre-pubertal

138
Q

sperm reflects health of the man _ months earlier

139
Q

what are the clinical features of obstructive infertility

A

normal testicular volume
normal secondary sexual characteristics
VD may be absent
LH, FSH and T all normal

140
Q

what are the clinical features of non-obstructive infertility

A 
low testicular volume
reduced secondary sexual characteristics 
vas deferens present
high LH, FSH
low/normal testosterone
141
Q

what is the treatment for hyperprolactinaemia

A

cabergoline

142
Q

surgical sperm aspiration is required if what

A

azoospermia

143
Q

____ decreases semen quality and health

144
Q

men should avoid

A

tight fitting underwear and prolonged hot bath/sauna

YEAR 3 REPRO (11 decks)

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