Lecture 13: Infertility and Assisted Reproductive Technology Flashcards
What is the definition of “infertility?”
inability to achieve pregnancy after 12 months of unprotected intercourse
Infertility affects how many people?
12%
What are the 4 major categories of Infertility and what is their percentage affected?
Female Factors: 40-50%
Male Factors: 30-40%
Combined female/male factors: 30%
Idiopathic: 20%
FSH measured on Day\_\_\_\_\_ of menstrual cycle. A) 2 B) 3 C) 5 D) 4
B) 3
If FSH is less than ______ mlU/mL, it indicates_____ prognosis
10; poor
What is “Hysterosalpingogram?” (HSG)
An x-ray with contrast dye to determine whether tubes are open or blocked
How can you tell if a tube is blocked?
If they dye does not highlight the area
How can you tell if sperm is good using a Sperm Analysis?
Volume: greater than 2.0mL Liquefaction: less than 60 mins Viscosity: Moderate to Low Concentration: greater than 20 x 10^6 mL Motility: greater than 50% WHO Morphology: greater than 15%
How is infertility treated?
Conventional medical therapies such as:
- Dietary modifications
- Exercise
- Medication
- Surgery
Define “Polyp?”
Non-cancerous growth attached to endometrium extending into uterine cavity
Define “Septum?”
Wedge-like partition within uterine cavity
What are the 4 steps with Intrauterine Insemination (IUI)?
- Controlled Ovarian Stimulation
- Transvaginal Ultrasound
- Trigger Ovulation at appropriate time
- Intrauterine Insemination
What is happening during step 01 in IUI (Controlled Ovarian Stimulation)?
- Increase FSH and LH secretion during early to mid follicular stage
- Stimulate follicle growth
- Permit more than one follicle to mature
What 3 hormones play a factor in Step 01 of IUI?
- Clomiphene Citrate (Clomid)
- Letrozole (Femara)
- Follicle Stimulating Hormone (FSH)
What is the goal of Clomiphene Citrate?
- Blocks negative FB by Estradiol and stimulates FSH and LH secretion
- May change the quality of cervical mucus and reduce endometrial proliferation
what is SERM?
Selective Estrogen Receptor Modulator
What is the goal of Letrozole?
Aromatase inhibitor
- Prevents ovarian peripheral conversion of andeogens to estrogens
- Lower estradiol permits more FSH and LH secretion
What is the goal of FSH?
- Directly stimulates follicle development
- Low doses stimulate growth of 2-3 follicles
What is the goal amount of the follicles for IUI?
around 2-3 good follicles
What does the transvaginal ultrasound accomplish?
this is step 02
- Determine # and size of lead follicles
- Cancel cycle if there are too many follicles
What id the ideal conditions for LH surge?
- Lead follicle: around 15-18 mm
- Endometrium around 6-10 mm
What is the goal of step 03 (trigger ovulation at appropriate time)?
1) Mimic LH surge to simulate ovulation by:
- Human Chorionic Gondaotropin (hCG)
2) Ovulation occurs approx. 36 h after hCG injection
What is the goal if step 04 (IUI)?
Washed sperm are placed in the uterus by catheter just prior to expected time of ovulation
Washing the sperm removes_______.
Prostaglandins
What is the definition of “ART?”
Any procedure where both sperm and oocytes are handled outside body
ART DOES include treatments in which sperm are handled or ovarian stimulation w/o egg retrieval.
T/F
False; It DOES NOT
What is the basic step to IVF?
- Sperm and Egg are combined in a laboratory dish
- If fertilization occurs, embryos are transferred to uterus where one or more may implant and develop
When was the first “test tube” baby born and where?
When was the first one born in the US?
1978 in Great Britain (Louise Brown)
1981
What are the 6 steps of IVF?
1) Controlled ovarian stimulation
2) Prevention of Premature Ovulation
3) Egg Retrieval
4) Fertilization
5) Embryo Culture
6) Fresh Embryo Transfer
What is the goal of step 01 of IVF (controlled ovarian stimulation)?
To have 8-15 good follicles
What is the goal of step 02 of IVF (prevention of premature ovulation)?
1) GnRH antagonist
2) GnRH agonist
What does the GnRH antagonist do for step 02 of IVF?
- Administered in late follicular stage
- Blocks action of GnRH on gonadotrope secretion of LH (and FSH) to prevent LH surge
- Immediately inhibits LH and FSH production and secretion
What does the GnRH agonist do for step 02 of IVF?
Prevent early ovulation- but takes more time
- Initially stimulates pituitary gland to release all stored gonadotropins (LH and FSH). Last 10 days prior to ovarian stimulation
- GnRH agonist suppresses production of new LH and FSH
What is the goal of step 03 of IVF (egg retrieval)?
- hCG is administered approx. 34 hours prior to retrieval
- transvaginal ultrasound aspiration under anesthesia in minor outpatient surgery.
What is the goal of step 04 of IVF (fertilization)?
Hint: there are 2 alternatives
1) Standard IVF
2) Intracytoplasmic sperm injection (ICSI)
What is happening during Standard IVF?
- MII oocytes are placed in culture medium
- Motile sperm introduced to oocytes and stored in incubator where fertilization occurs within 24hrs
What is happening during ICSI?
- Used in rates where fertilization are expected to be poor (e.g. oligospermia)
- single sperm is injected into oocyte
- Bypasses sperm capaciation process
In step 5 of IVF (Embryo culture):
A) Retrieval shows _____ with polar body
B) after ____ hours, Day 01 shows fertilized oocyte with ____ pro nuclei.
C) ___days later, Day 03 shows ______ (or 8-cell stage).
D) _____ days later, Day 05 shows______.
A) Unfertilized Oocyte
B) 16; 2
C) 2; cleaved embryo
D) 2-3; Blastocyst
What is the goal in stage 06 of IVF (Fresh Embryo Transfer)?
One or more embryos is suspended in culture medium and transferred to uterus with a catheter
Embryos are usually transferred on either day__ or day___
3; 5
Extra embryos may be _____ and stored for future transfer. This is called ______
Cyropreserved; Frozen Embryo Transfer.
When was the first frozen embryo born?
1983
Recipient canidates include women who are ____, have _____ ovarian reserve, or are carriers of_______
older; ovarian reserve; genetic abnormalities
Surrogacy has 2 options, which are:
1) Traditional
2) Gestational
What is “traditional” surrogate?
- Surrogate is inseminated with sperm from male to infertile couple (no IVF involved)
- Surrogate is GENERTICALLY related to child
What is “Gestational” surrogate?
- Carries embryo created by egg and sperm to two other individuals (requires IVF)
- Intended parents require both egg and sperm
- Gestational carrier is NOT GENETICALLY related to child
