IVF, GIFT and Ovulation Induction

Question 1

Outline the key steps in IVF

Answer 1

• Ovarian stimulation (GnRH agonist, FSH, HCG)
• Oocyte retrieval (laparoscopy, transvaginally)
• In vitro fertilisation
• Transfer to uterus (3 days after retrieval)
• Hormonal support (progesterone until pregnancy confirmed)

Question 2

What are some of the advantages and disadvantages of IVF?

Answer 2

• Advantages
  
  • Overcomes blocked tubes, multiple oocytes per cycle collected, only requires single sperm, allows preservation of fertility, relatively low cost
• Disadvantages
  
  • Gametes need collecting from both partners, OHSS, multiple pregnancy, ectopic pregnancy, increased pre-term, small-for-dates, low BW

Question 3

In what situations might an ovulation induction agent be used? What is the most common one? What are the main risks?

Answer 3

• Hypothalamic anovulation e.g. stress, PCOS
• Clomiphene
• Ectopic pregnancy, ovarian hyperstimulation syndrome

Question 4

How often does ovarian hyperstimulation syndrome occur? Why? How is it managed?

Answer 4

• Occurrence
  
  • 20% IVF cases (and severely in 5%) using GnRH agonists
• Pathophysiology
  
  • Increase in cytokines, capillary permeability, third spacing
  • Bloating, ascites, DVT, pleural effusions, renal failure, pulmonary oedema, cerebral oedema
• Management
  
  • Fluids and albumin as necessary
  • Thromboprophylaxis
  • Ascitic tap