IVF

Question 1

indications for IVF

Answer 1

tubal factor (blocked or absent FT)
male factor (severe male oligospermia <5M, astheno <5-10M, NOA/OA)
anovulatory resistant to Oral OI
unexplained
endometriosis rASRM III/IV
advanced maternal age >/=40
fertility preservation
PGT

Question 2

protocols

Answer 2

natural IVF cycle (7%)
modified natural cycle (14%)
minimal (CC)
mild (CC+Gn)
GnRH Long Agonist
GnRH Flare Protocol
Antagonist Protocol
Random Start protocol

Question 3

IVF trigger

Answer 3

2 x 17-18mm lead follicle, the rest 14-16mm with estradiol level compatible

8-9mm trilaminar EM

Question 4

components of IVF

Answer 4

multifollicular growth with exogenous gonadotropins

gnrh analogues to prevent premature luteinization

hcg trigger for final oocyte maturation

Question 5

progesterone in ivf

Answer 5

dec pregnancy rate if P >/= 1.5ng/ml with </=4 oocytes

Question 6

MOA GnRH agonist vs GnRH antagonist

Answer 6

agonist - works on GnRH receptors, it causes pituitary desensitization (sustained stimulation) then downregulation, initial flare effect

antagonist - direct GnRH receptor antagonist (competitive inhibitor), immediate effect with no flare, easily reversible

Question 7

HCG effects due to long half life

Answer 7

Long half life:
Sustained luteotropic effect

Multiple corpora lutea – OHSS and multiple pregnancy

Supraphysiologic estradiol and progesterone levels

Question 8

indications for GnRH agonist trigger

Answer 8

high risk for OHSS
donor oocyte
FP (PGT, oocyte/embryo cryopreservation

Question 8

ivf fertilization media

Answer 8

37 deg
5-20% O2
407% CO2
94-98% humidity

x 12-18 hrs

50-100k motile sperm

Question 9

ICSI indicationsc (speroff)

Answer 9

<5M/ml sperm
<5% progressive motility
<4% normal forms by strict criteria
surgical sperm retrieval
failed conventional method fertilization

from CPG
<5-10M total motile count
NOA/OA

Question 10

advantage if D5 blastocyst

Answer 10

PGT
better synchronization of EM and embryo
better assesment of viability
higher implantation rate (30-60% v 12-20%)

disadvantages: baka wala ka na matrandfer

Question 10

Assisted hatching

Answer 10

artificially thinning of ZP to improve implantation

zona drilling
acid tyrode solution
microneedle
laser photoablation
enzymatic thinning
piezomicromanipulator

Question 10

good prognosis for FET

Answer 10

> 1 high quality embryo
euploid embryo
previous LB after IVG

Question 11

indications for PGTA

Answer 11

AMA
RPL
severe male factor infertiity
RIF

Question 12

FET regimen

Answer 12

natural cycle
artificial cycle (give E2V + progesterone + trigger)

Question 13

slow freeze vs vitrification

Answer 13

2 step process - cooled to -30 to -110 then stored in liquid nitrogen

v

flash frozen in liquid nitrogen
90-100% survival rate

Question 14

LPS

Answer 14

Duphaston Dydrogesteron 10mg TID
Crinone 8% 90 mg BID
Micronized progesteron 200mg TID
17OHP caproate - 25-50mg OD (250mg IM yung proluton in oil)
Endometrin 100mg BID-TID

until 8-10 weeks

Question 15

3 ways why CL production is disrupted in ART

Answer 15

1) supraphysiologic levels of estradiol
2) gnrh agonist used as trigger
3) use of GnRH antagonist/agonist for LH suppression

Question 16

lifestyle factors negative predictor for IVF success

Answer 16

alcohol intake
smoking
caffeine

Question 17

complications of IVF

Answer 17

OHSS
multiple pregnancy
infection/TOA
hemorrhage
hematoma/injury to vessels

Question 18

why is LPS needed

Answer 18

due to prolonged LH suppression, it results to inadequate maturation of the EM for implantation
there is insufficient production of progesterone by the corpus luteum due to:

GnRH analogue use
supraphysiologic E2 levels from COS
use of HCG as a trigger (shorter)

progesterone started on day of OPU

Question 19

slow-freeze

Answer 19

cooled to -30 and -110 then stored in liquid nitrogen

Question 20

vitrification

Answer 20

flash frozen in liquid nitrogen

Question 21

why monitor IVF cycles

Answer 21

predict response (risk for OHSS or POR)

adequate pituitary downregulation

dose adjustment

when to trigger

when to transfer

Question 22

how to monitor IVF cycles

Answer 22

serum estradiol levels

TV-UTZ and AFC/follicle monitoring