Infertility treatment

Question 1

What is assisted conception treatment ACT

Answer 1

Any treatment involving the gametes meeting outside of the body

Question 2

What are the NHS Scotland criteria for up to 3 cycles of fertility treatment

Answer 2

unexplained infertility for at least 2 years
stable relationship for at least 2 years
one of the partners does not have a biological child
Female BMI 18.5-30
Female <40 y/o
Neither partner has undergone any sterilisation treatment
both non-smoking, no alcohol, or illicit drugs

Question 3

List indications for ACT

Answer 3

Endometriosis 
Male factor infertility 
Female factor infertility 
Tubal infertility 
Unexplained 
ovulating disorders 
preservation: cancer, chemo... 
inherited disorders 
blood borne viruses 
single parent 
surrogacy

Question 4

Factors to consider before beginning ACT

Answer 4

weight 
alcohol 
smoking 
rubella immunisation 
cervical smear 
FOLIC ACID 
blood borne viruses 
medications - teratogenicity, dosing, interactions 
ovarian reserve testing - levels of AMH 
counseling 
Occupational hazards

Question 5

What doses of folic acid are required

Answer 5

400ug - normally
5mg if history of NTD or obese
Taken 3 months pre conception and 3 months gestation

Question 6

What types of ACT are available

Answer 6

donor insemination 
intra uterine insemination IUI 
in vitro fertilisation IVF 
intra cystoplasmic sperm injection ICSI 
fertility preservation 
surrogacy

Question 7

What are the stages of IVF

Answer 7

1. Down regulation - give GnRH analogue nasal spray to dampen down everything
2. Ovarian stimulation - SC FSH+-LH injections to induce follicular growth and thickens endometrial lining
3. Oocyte collection in theatre - done under sedation with USS guidance
4. Fertilisation - 2 pronuclei are left in petri dish to allow fertilisation
5. Embryo transfer - 1 embryo is transferred, luteal support given as progestogen suppositories for 2 weeks

Question 8

Side effects of GnRH analogue nasal spray

Answer 8

Nasal irritation

Temporary post menopausal state: flushes, mood changes, headaches

Question 9

What should be seen on the scan in the down regulation stage of IVF

Answer 9

No follicular development in ovaries

Thin endometrium lining

Question 10

What should be seen on the scan in the ovarian stimulation stage

Answer 10

Follicular development in the ovaries

Thickened endometrium

Question 11

What is the purpose of the scan in the ovarian stimulation stage of IVF

Answer 11

To plan when to give the HCG injection (LH surge mimic) - should be done 36 hours before oocyte collection

Question 12

Outline the process of semen collection

Answer 12

Done alongside the ovarian stimulation stage
Man should abstain for 72 hours beforehand and deliver the sample WITHIN 1 hour
Fresh sperm is better

Question 13

What are some complications of oocyte retrieval in theatre

Answer 13

Infection
Failure to collect oocyte
Bleeding

Question 14

What are the HFEA regulations with regards to embryo transfer in IVF

Answer 14

Only 1 embryo can be transferred to limit multiple pregnancy rates

Question 15

When is a pregnancy test done in IVF

Answer 15

16 days after oocyte recovery

Question 16

When is ICSI used

Answer 16

After failed IVF

in severe male infertility factor

Question 17

When is surgical sperm aspiration needed

Answer 17

In azoospermia (semen contains no sperm) 
if obstructive - from epididymis 
if non-obstructive - from testicular tissue

Question 18

What are complications of ACT

Answer 18

Ovarian hyperstimulation syndrome 
Multiple pregnancy 
Ectopic pregnancy 
Miscarriage 
Failed ACT 
Surgical risks

Question 19

What is ovarian hyperstimulation syndrome OHSS

Answer 19

exaggerated response of ovaries to excess hormones resulting in them becoming swollen and painful

Question 20

What are risk factors for developing OHSS

Answer 20

PCOS
^ AMH in ovarian reserve testing
^ follicle numbers