IVF Flashcards
indications for IVF
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
protocols
natural IVF cycle (7%)
modified natural cycle (14%)
minimal (CC)
mild (CC+Gn)
GnRH Long Agonist
GnRH Flare Protocol
Antagonist Protocol
Random Start protocol
IVF trigger
2 x 17-18mm lead follicle, the rest 14-16mm with estradiol level compatible
8-9mm trilaminar EM
components of IVF
multifollicular growth with exogenous gonadotropins
gnrh analogues to prevent premature luteinization
hcg trigger for final oocyte maturation
progesterone in ivf
dec pregnancy rate if P >/= 1.5ng/ml with </=4 oocytes
MOA GnRH agonist vs GnRH antagonist
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
HCG effects due to long half life
Long half life:
Sustained luteotropic effect
Multiple corpora lutea – OHSS and multiple pregnancy
Supraphysiologic estradiol and progesterone levels
indications for GnRH agonist trigger
high risk for OHSS
donor oocyte
FP (PGT, oocyte/embryo cryopreservation
ivf fertilization media
37 deg
5-20% O2
407% CO2
94-98% humidity
x 12-18 hrs
50-100k motile sperm
ICSI indicationsc (speroff)
<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
advantage if D5 blastocyst
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
Assisted hatching
artificially thinning of ZP to improve implantation
zona drilling
acid tyrode solution
microneedle
laser photoablation
enzymatic thinning
piezomicromanipulator
good prognosis for FET
> 1 high quality embryo
euploid embryo
previous LB after IVG
indications for PGTA
AMA
RPL
severe male factor infertiity
RIF
FET regimen
natural cycle
artificial cycle (give E2V + progesterone + trigger)
slow freeze vs vitrification
2 step process - cooled to -30 to -110 then stored in liquid nitrogen
v
flash frozen in liquid nitrogen
90-100% survival rate
LPS
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
3 ways why CL production is disrupted in ART
1) supraphysiologic levels of estradiol
2) gnrh agonist used as trigger
3) use of GnRH antagonist/agonist for LH suppression
lifestyle factors negative predictor for IVF success
alcohol intake
smoking
caffeine
complications of IVF
OHSS
multiple pregnancy
infection/TOA
hemorrhage
hematoma/injury to vessels
why is LPS needed
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
slow-freeze
cooled to -30 and -110 then stored in liquid nitrogen
vitrification
flash frozen in liquid nitrogen
why monitor IVF cycles
predict response (risk for OHSS or POR)
adequate pituitary downregulation
dose adjustment
when to trigger
when to transfer
how to monitor IVF cycles
serum estradiol levels
TV-UTZ and AFC/follicle monitoring
