L10: Assisted Reproducitve Treatments

Question 1

Where does fertilisation occur

Answer 1

In the ampulla of the uterine tube

Question 2

How does the fertilised egg go down to the uterus

Answer 2

Peristalsis

Question 3

What does the fertilised egg become at day 5

Answer 3

Blastocyst

Question 4

Explain the stages of cells the fertilised egg becomes during cleavage

Answer 4

Zygote 
Blastomere 
4 cell 
8 cell
16-32 cell = morula 
Blastocysts

Question 5

What happens to the blastocyst at day 6

Answer 5

Hatches away from the zona pellucida

Question 6

Describe what happens in intra-uterine insemination

Answer 6

1) male partner gives sperm
2) sperm is placed into a catheter with a syringe
3) catheter is passed into the uterine cavity
4) sperm is injected

Question 7

When is it important to carry out intrauterine insemination for fertilisation to occur

Answer 7

When ovulation has occurred

Question 8

How do we check if ovulation is going to occur

Answer 8

By LH surge

Question 9

Is the intra-uterine insemination NHS funded

Answer 9

No

Question 10

At what circumstances is intra-uterine insemination recommended

Answer 10

• partner cannot have a sexual intercourse
• male has HIV
• if partners are from same sex so donor sperm is required

Question 11

If the male patient has HIV what happens to the sperm

Answer 11

Washed

Question 12

To stimulate the ovaries what can we use

Answer 12

FSH

Question 13

To trigger an LH surge what hormone can we use

Answer 13

HCG trigger

Question 14

After the intra-uterine insemination what is required after 2 weeks to see if the patient is pregnant

Answer 14

Pregnancy test

Question 15

What are the disadvantages of intra-uterine insemination

Answer 15

Low success rate
Can result in multiple pregnancy as we aim for 3 dominant follicles with FSH
Expensive
Invasive method

Question 16

When might IVF be recommend

Answer 16

• tubal blockage: sperm cannot meet egg
• PCOS
• unexplained fertility: everything is normal
• endometriosis
• increased age
• no egg due to chemotherapy so egg donor with IVF
• patients with no uterus: IVF occurs in host surrogacy

Question 17

Describe the process that occurs in IVF

Answer 17

1) we turn the HPG axis off by suppressing the pituitary via GNRH antagonist
2) LH/FSH is not produced
3) we then develop multiple follicles at the same time
4) we give HCG to trigger LH surge to allow for final egg maturation
5) we use a needle to aspirate the fluid
6) examine fluid and collect the eggs
7) oocyte and sperm fertilised on a dish
8) sperm has to fertilise the egg by penetrating the zona pellucida
9) blastocyst forms
10) blastocyt in inserted to the uterus
11) mimic the function of corpus luteum so we give progesterone to cause secretory changes of the endometrium
12) do a pregnancy test after 2 weeks

Question 18

Why do we use HCG to cause an LH surge (think about its structure)

Answer 18

HCG is homologous in its structure to LH, using LH is expensive

Question 19

What is intracytoplasmic sperm injection (ICSI)

Answer 19

When the sperm is directly inserted into the cytoplasm of the oocyte instead of allowing it to penetrate the zona pellucida

Question 20

When is ICSI recommended

Answer 20

If the sperm has dysfunction in motility and number count to penetrate the the egg

Question 21

When we fertilise the egg why do we wait for 5 days before inserting it into the uterus straight away

Answer 21

To allow:
Embryonic genome switching
Figure out the best blastocyst

Question 22

What are the disadvantages of IVF

Answer 22

Multiple pregnancy 
Ovarian hyper stimulation syndrome 
Oocyte collection risk : injury to the bladder 
Expensive 
Invasive

Question 23

What is ovarian hyper stimulation syndrome

Answer 23

Overstimulating the ovaries that causes production of vasoactive substances

Question 24

If patients want to preserve sperm and eggs what liquid do we use

Answer 24

Nitrogen and cytoprotectant

Question 25

Which female patients would require an donated oocyte

Answer 25

Ovarian failure 
Turners syndrome (XO)
Loss of ovaries 
Premature menopause 
Menopause due to increased age

Question 26

Which patient would require sperm donor

Answer 26

Testicular failure
Obstructive
Klinefelters syndrome (XXY)
Deletion of Y chromosome