ivf clinical correlations sengstacke Flashcards
infertility
inability to conceive 12 months w/o contraception
- 10-15% of pop affected
- 10-20% of couples have unexplained infertility
etiology
male: low/no sperm count
- quality and motility
- genetic mutation of sperm
female: failure to ovulate regularly or at all
- low supply of egg producing follicles
- blocked/damaged fallopian tubes
- endometriosis
- uterine problems
ovarian reserv
- peaks as fetus at 5-7 million gametes at 20 weeks
- 1-2 mil at birth
- 400,000 at uberty
- fertility starts to deciline at 27 number and qualtiy of eggs go down
- signiifcant decline at age 25 and beyond
- spontaneous pregnancies rare after 45
treatment for infertility
- ovulation induction via drugs like pulsatile GnRH or aromatase inhibitors or gonadotropins
- reproductive tract surgery for an obstructed fallopian tube
- intrauterine insemination-spermcleaned and concentrated and placed directly into ovary. woman does regular eggs cycle though
- assisted reproduction- INF, GIFT- gift is gamere intrafallopian tube transfer. eggs aspirated, mixed/ sperm, and then placed back into fallopian tube
IVF
- hypothalamic pituitary ovarian down regulation and supression: long protocol is GnRH agonist binding and intiial H and FSH released alot but then desensitized and internalized orr short protocol is GnRH antagonist
- controlled ovarian hyperstimulation- want to stimulate alot. collect some follicles
- oocyte egg retrival- take embryos at preimplantation stage and put them in uterine cavity
IVF procedures
- assistem embryo hatching
- intra cytoplasmic sperm injection (ICSI)
- preimplantation genetic diagnosis (PGD)– shouldnt be used for sex selection
- oocyte and embryo cryopreservation- freeze eggs for later use
- oocyte and embryo donation- ppl with frozen eggs who dont want anymore
- gestational carriers/surrogacy-for women who have eggs but cant use uterus or whatever
hypothalamic pituitary ovarian axis
LH stimulates thecal cells and makes androgens
FSH stimulates granulosa cells and makes estrogen. has aromatase
-a GnRH agonist initally has a flare of LH and FSH and then you eventually internalize and no longer express the GnRH receptor so no LH and FSH. long rptocol takes 2 weeks
-a GnRH antagonist is the short tpotocl and it takes immediately blocks LH and FSH releas ebc no GnRh can bind
controlled ovarian hyperstimulation
give them pain meds but they dont hurt usually. they put a needle in the ovary
- you have extrusion of an egg 12-24 hrs after the surge of LH. the dominant folicle in normal cycle prodcues estradiol and has the most FSH receptors.
- in IVF, you bombard the ocary with lots of FSH so you recruit lots of follicles. you give HCG to mimic LH since theyre so similar but LH has a shorter half life than HCG. HCG has a large sugar so it keeps from degrading too fast.
fertilization techniques
- standard oocyte insemination
- ICSI intra cytoplasmic sperm injection-injecting the sperm directly into oocyte to allow it to directly divide
- ocyte imsemination question is whether to transfer early on day 3 back into mom (you do this is you dont have too many eggs to work with) or to transfer later if you have alot of eggs
hatching
-the egg sperm fetus embryo expands and contracts and expands and contracts and extrudes from the zona pelucida and implants on the endometrium
embtryo transfer
- uses catheters
- number of embryos to transfer is a question. america doesnt have a rule but putting in too many is looked down on. in england they have rules based on age.
- if under 35, implant 2. multiple embryos have a chance of survival so be careful
- if above 40, implant up to 5.
- for patients with more than 2 failed IVF, or poor prognosis, can add more based on clinical judgement
options for the excess embryos
-they are stored in liquid nitrogen.
- you can freeze them, donate for research, stem cells
- give them up for adoption for people who cant make babies
- or dicard aka just thaw them out
- frozem embryo transfer: limiting factor is the age of the egg! you can have 25 yr old eggs implanted in a 40 yr old woman uterus and itll be fine.
oocyte donation
risk of over stimulating ovaries. you can produce VEGF and increase permeability fluid in pelvis
surrgocary medical indications
-uterus absent anatomically abnormal uterus medical contrainication to preganncy recurrant pregannacy loss repeated IVF failures w/ good embryos
PGD preimplantation genentic diagnosisi
-you can remove 1 cell from the blastocyst. all of the cells have the potential to be embryos, removing the one cell wont harm the embryo. you can analyse the cell genetically and decide whether or not to implant in the uterus Clinical inidations: -single gene defects -babalnced translocations -andanced maternal age -repeptiitve IVF failures -recurrant preganancy loss -embryo selection
