IVF and pre-natal diagnosis

Question 1

How does age affect embryo outcome in IVF?

Answer 1

Peak live-birth rate at age 30

Then decrease

Question 2

What is the probability of achieving a live birth per menstrual cycle?

Answer 2

25% - 30%

Question 3

What is the probability of pregnancy in normal couples?

Answer 3

80% in one year

90% in two years

Question 4

What is primary infertility?

Answer 4

No previous pregnancy

Question 5

What is secondary infertility?

Answer 5

Previous pregnancy

Question 6

What causes female infertility?

Answer 6

1. Endometriosis
2. PCOS
3. Tubal damage
4. Ovulatory failure
5. Uterus abnormalities
6. Urogenital infection
7. Endocrine disturbances

Question 7

What is oligoasthenoteratospermia?

Answer 7

OATS

1. Low number of sperm
2. Poor motility
3. Abnormal sperm morphology

Question 8

Which drugs are used in IVF?

Answer 8

1. GnRH agonists
2. Gonadotrophins
3. rhCG
4. Crinone/cyclogest/utrogestan

Question 9

What is the role of GnRH agonists in IVF?

Answer 9

1. Pituitary down-regulation

2. Shut down hypothalamic-gonadotrophin axis

Question 10

What is the role of gonadotrophins in IVF?

Answer 10

1. Ovarian stimulation

2. Induce multifollicular growth

Question 11

What is the role of rhCG in IVF?

Answer 11

Trigger to induce final oocyte maturation

Question 12

What is the role of crinone/cyclogest/utrogestan?

Answer 12

Luteal support

Progesterone to ensure endometrial receptivity for implantation of embryo

Question 13

How are oocytes collected?

Answer 13

Vaginal ultrasound

Question 14

How are oocytes prepared for intracytoplasmic sperm injection?

Answer 14

Treated with hyaluronidase to remove surrounding cells

Question 15

What are the major risks of artificial reproduction technology?

Answer 15

1. Ovarian hyperstimulation syndrome
2. Multiple pregnancy
3. Drug side-effects
4. Psychological impacts of infertility

Question 16

How are open neural tube defects detected?

Answer 16

Maternal serum alpha-fetoprotein levels

Question 17

How can risk of neural tube defects be reduced?

Answer 17

Increasing dietary folic acid

Question 18

What are the three viable chromosomal trisomies?

Answer 18

13, 18 and 21

Question 19

What is Edward syndrome?

Answer 19

Trisomy 18

90% die within one year

Question 20

What is Patau syndrome?

Answer 20

Trisomy 13

85% die within one year

Question 21

What is nuchal translucency?

Answer 21

Collection of fluid behind fetal neck

Question 22

What is increased nuchal translucency seen in?

Answer 22

1. Trisomy 21
2. Congenital heart disease
3. Fetal anaemia
4. Congenital infection
5. Abnormal development of lymphatic system
6. Venous congestion

Question 23

When is chorionic villus sampling performed?

Answer 23

11 weeks

Question 24

How fast is CVS chromosome analysis?

Answer 24

24 hours

No need for culturing

Question 25

When is amniocentesis performed?

Answer 25

16 weeks

Question 26

How fast is amniocentesis analysis?

Answer 26

2 week culture

Question 27

What are the advantages of chorionic villus sampling?

Answer 27

1. Earlier diagnosis

Question 28

What are the disadvantages of chorionic villus sampling?

Answer 28

1. Higher risk of miscarriages (1-2%)
2. Extra-embryonic tissue
3. Possibility of confined placental mosaicism

Question 29

What are the advantages of amniocentesis analysis?

Answer 29

1. Fetal material

2. Lower risk of miscarriage (0.5%)

Question 30

What are the disadvantages of amniocentesis?

Answer 30

Later analysis