IVF treatment

Question 1

What drug is used first line for ovulation induction in women with PCOS?

Answer 1

Clomiphene Citrate

Question 2

What is the ideal amount of eggs you want to get at collection?

Answer 2

8 - 15

Question 3

What would be the first line test to confirm ovulation?

Answer 3

Mid luteal progesterone

Question 4

What would be the first line test to assess tubal patency?

Answer 4

HSG

Question 5

Describe the classifications of sperm motility?

Answer 5

Grade A: Progressively motile
Grade B: Slow/Sluggish but progressive motility
Grade C: Minimal progression
Grade D: No motility

Question 6

Aspermia?

Answer 6

No ejaculate

Question 7

Azoospermia?

Answer 7

No sperm in ejaculate

Question 8

Hypospermia?

Answer 8

Low semen volume

Question 9

Oligozoospermia?

Answer 9

Low sperm count

Question 10

Asthenozoospermia?

Answer 10

Poor motility

Question 11

Teratozoospermia?

Answer 11

Abnormal morphology

Question 12

Necrozoospermia?

Answer 12

Dead sperm

Question 13

Globozoospermia?

Answer 13

Round head, no axonne

Question 14

Oligoteratoasthenoozoospermia?

Answer 14

Low count, poor motility, poor morphology

Question 15

What are the current WHO semen analysis limits?

Answer 15

Volume: 1.5ml
Concentration: 15 million/ml
Progressive motility: 32%
Normal forms: 4%

Question 16

What is the normal range of testicle size?

Answer 16

12 - 30 ml

Question 17

What are the testis like in klinfelters syndrome?

Answer 17

Small and firm

Question 18

What condition has the genetic profile 47 XXY?

Answer 18

Klienfelters

Question 19

What value of mid luteal progesterone is considered normal?

Answer 19

Over 25mnol/L

Question 20

How many peptides does endogenous GnRH contain? How long is its half life?

Answer 20

10. Half life is a few minutes

Question 21

Is the half life of exogenous GnRh longer or shorter that endogenous?

Answer 21

Longer

Question 22

Describe the flare protocol

Answer 22

• 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

Question 23

Who is given the flare protocol in general?

Answer 23

Women with poor ovarian reserve

Question 24

What happens when you give someone a GnRH agonist?

Answer 24

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.

Question 25

Describe the long protocol

Answer 25

- 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.

Question 26

Discuss the normal and abnormal values for antral follicle count

Answer 26

Less than/Equal to 4 = Likely to be a low response to stimulation Greater than/Equal to 16 = Likely to have a high response

Question 27

Discuss the normal and abnormal values for AMH

Answer 27

Less than/Equal to 5.4pmol/l = Low response | Greater than/Equal to 25 = High response

Question 28

Discuss the normal and abnormal values for FSH

Answer 28

Greater that 8.9IU/l = Low response | Less than 4IU/l = High response

Question 29

What three measurements are used to assess ovarian reserve?

Answer 29

AFC AMH FSH

Question 30

What test is done to confirm ovulation?

Answer 30

Mid luteal progesterone

Question 31

Below what viral load is the risk of HIV transmission thought to be negligable?

Answer 31

Less than 50 copies/ml for more than 6 months

Question 32

What treatment can be offered to an HIV positive male to reduce chances of transmission during fertility treatment?

Answer 32

Sperm washing

Question 33

If a women has to have a rubella vaccine how long should she wait before attempting to conceive?

Answer 33

1 month

Question 34

Above what thickness should the endometrium be for there to be a chance of implantation?

Answer 34

5mm

Question 35

Why is the luteal phase deficient in ART cycles?

Answer 35

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

Question 36

How is luteal phase support given?

Answer 36

- Progesterone given either IM, oral, vaginal or rectal -hCG given IM or SC GnRH agonists given nasally, I or SC

Question 37

What is the current recommended practice for luteal phase support?

Answer 37

Progesterone for 8 weeks