IVF treatment Flashcards
What drug is used first line for ovulation induction in women with PCOS?
Clomiphene Citrate
What is the ideal amount of eggs you want to get at collection?
8 - 15
What would be the first line test to confirm ovulation?
Mid luteal progesterone
What would be the first line test to assess tubal patency?
HSG
Describe the classifications of sperm motility?
Grade A: Progressively motile
Grade B: Slow/Sluggish but progressive motility
Grade C: Minimal progression
Grade D: No motility
Aspermia?
No ejaculate
Azoospermia?
No sperm in ejaculate
Hypospermia?
Low semen volume
Oligozoospermia?
Low sperm count
Asthenozoospermia?
Poor motility
Teratozoospermia?
Abnormal morphology
Necrozoospermia?
Dead sperm
Globozoospermia?
Round head, no axonne
Oligoteratoasthenoozoospermia?
Low count, poor motility, poor morphology
What are the current WHO semen analysis limits?
Volume: 1.5ml
Concentration: 15 million/ml
Progressive motility: 32%
Normal forms: 4%
What is the normal range of testicle size?
12 - 30 ml
What are the testis like in klinfelters syndrome?
Small and firm
What condition has the genetic profile 47 XXY?
Klienfelters
What value of mid luteal progesterone is considered normal?
Over 25mnol/L
How many peptides does endogenous GnRH contain? How long is its half life?
- Half life is a few minutes
Is the half life of exogenous GnRh longer or shorter that endogenous?
Longer
Describe the flare protocol
- GnRH agonist started on day 1 of the cycle. This causes flare of exogenous gonadotrophins.
- Exogenous gonadotrophins started on day 2
- Agonist continued until day of HCG
Who is given the flare protocol in general?
Women with poor ovarian reserve
What happens when you give someone a GnRH agonist?
Initial hypersecretion of LH and FSH. This is followed, after around 10 days, by desensitisation of the pituitary and profound suppression of LH and FSH. This results in inhibition of sterioidogenesis and follicular growth.
Describe the long protocol
- GnRH agonists are given either on day 21 or day 1 by depot injection, daily SC or daily nasal spray.
- Suppression generally achieved between 14 - 21 days and this is confirmed by the presence of a withdrawal bleed.
Discuss the normal and abnormal values for antral follicle count
Less than/Equal to 4 = Likely to be a low response to stimulation
Greater than/Equal to 16 = Likely to have a high response
Discuss the normal and abnormal values for AMH
Less than/Equal to 5.4pmol/l = Low response
Greater than/Equal to 25 = High response
Discuss the normal and abnormal values for FSH
Greater that 8.9IU/l = Low response
Less than 4IU/l = High response
What three measurements are used to assess ovarian reserve?
AFC
AMH
FSH
What test is done to confirm ovulation?
Mid luteal progesterone
Below what viral load is the risk of HIV transmission thought to be negligable?
Less than 50 copies/ml for more than 6 months
What treatment can be offered to an HIV positive male to reduce chances of transmission during fertility treatment?
Sperm washing
If a women has to have a rubella vaccine how long should she wait before attempting to conceive?
1 month
Above what thickness should the endometrium be for there to be a chance of implantation?
5mm
Why is the luteal phase deficient in ART cycles?
LH levels are lowered by the high steroid levels (produced by multiple corpus lutea)
This causes a negative feedback on the pituitary gland that lowers the LH levels. This causes the length of the luteal phase to be shortened and the chances of a pregnancy are reduced
How is luteal phase support given?
- Progesterone given either IM, oral, vaginal or rectal
-hCG given IM or SC
GnRH agonists given nasally, I or SC
What is the current recommended practice for luteal phase support?
Progesterone for 8 weeks
