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RDA > Lecture 8 - 2018 > Flashcards

Lecture 8 - 2018 Flashcards

1
Q

Define infertility?

A

Failure to conceive after 12 months of unprotected sex.

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2
Q

How many couples are infertile?

A

1 in 4.

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3
Q

What impact does infertility have?

A

It has an impact on multiple things:
female, partner, emotional toll. In third world countries there can be very serious consequences of infertility - ostracised, disinherited, poverty and death.

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4
Q

What is the fertility myth?

A

The myth that getting pregnant and having a baby is easy and that IVF can significantly help to get pregnant. They also underestimated that fertility declines with age.

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5
Q

What is childlessness by choice?

A

This is when women and/or men choose to be childless by choice or chose to have their children later. It can be due to many factors.

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6
Q

What are the causes of infertility?

A

Females - 30%.
Males - 30%.
Unexplained - 20%.
Both - 20%.

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7
Q

What is the assessment of male fertility?

A

Semen analysis (lower reference limit):

  1. Count - 15million/ml.
  2. Motility - 40%.
  3. Volume - 1.5ml.
  4. total sperm count - 39 million in ejaculate.
  5. Morphology - 4%.
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8
Q

What is the assessment of female fertility?

A
  1. Estrogen at day 12.
  2. Progesterone at day 21.
  3. FSH at day 2-4 (need to see if it is <10IU/I.
  4. AMH.
  5. Timing of intercourse - when the couple are having sex.
  6. STI.
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9
Q

What is AMH?

A

Anti-Mullerian Hormone. It is produced by granulosa cells in primary follicles. It can be used to measure the ovarian follicular reserve - how many follicles you have left.

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10
Q

What happens to your AMH levels when you get older?

A

Decrease.

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11
Q

What happens to your AMH levels if you have polycystic ovarian syndrome?

A

High AMH levels.

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12
Q

What are causes of infertility in females?

A
  1. Anovulation.
  2. PCOS.
  3. Tubal disease.
  4. Cervical problems.
  5. Endometriosis.
  6. Premature menopause OR rising FSH and decreasing AMH with age.
  7. No uterus.
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13
Q

What is anovulation?

A

This is when a woman does not release an egg/ovulate. Typically it is due to weight gain or weight loss.

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14
Q

How do you treat anovulation?

A
  1. Getting a woman’s weight back into balance.
  2. GnRH.
  3. Clomiphene citrate.
  4. FSH.
  5. Letrozole.
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15
Q

Describe clomiphene citrate?

A

Estrogen receptor blocker on the hypothalamus. It inhibits the negative feedback of estrogen on GnRH release which leads to the up-regulation of the HPO axis - increase in FSH and LH levels. This can cause the release of a few follicles. There is an increased chance of having twins.

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16
Q

When is clomiphene citrate taken?

A

Around day 3-5 and the woman takes it for five days.

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17
Q

How does FSH help in the treatment of anovulation?

A

Only fertility clinics will give FSH and it is via an injection.

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18
Q

Describe letrazole?

A

Aromatase inhibitor that stops androgens from converting to estrogen. Thus the decrease in estrogen causes a rise in FSH levels, hence follicle is released. It is used more commonly than clomiphene citrate as it reduces the chance of multiple pregnancy (twins).

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19
Q

What is polycystic ovarian syndrome?

A

PCOS is where there are many follicles being produced however none are being released from the ovary.

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20
Q

What causes there to be irregular and heavy periods in PCOS?

A

Because many follicles are being produced, there is a continuous increase in estrogen - proliferation of endometrial lining as no egg is being released so periods are irregular and heavy.

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21
Q

What else goes wrong in PCOS?

A

There is an increase in androgens and women also have high levels of insulin. Because it is a metabolic disease it affects weight and weight can affect PCOS as well.

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22
Q

How do you treat infertility caused by PCOS?

A
  1. Losing weight.
  2. Metformin.
  3. Clomiphene citrate.
  4. IVF.
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23
Q

What is a tubal disease?

A

This is a disease in which the fallopian tubes are blocked or damage.

24
Q

What can cause tubal disease?

A
  1. Cyst/tumour.
  2. Ectopic pregnancies.
  3. Adhesions.
  4. Endometriosis.
  5. Fibroid.
25
Q

How do you treat tubal disease?

A
  1. Surgery.

2. IVF (treat infertility caused by tubal disease).

26
Q

How do you treat cervical problems?

A

Treat them with intrauterine insemination (IUI). This is where you place sperm inside the uterus to help fertilisation.

27
Q

What is endometriosis?

A

Endometrial tissue grows outside of the uterus.

28
Q

How do you treat endometriosis?

A

To help women with endometriosis get pregnant you do the following:

  • IVF.
  • Ablation (destroy/surgically remove endometrial tissue).
  • Hormonal contraceptives.
29
Q

How do you treat no uterus?

A

Surrogacy.

30
Q

How do you treat premature menopause or rising FSH and decreasing AMH with age?

A

Donor egg (IVF).

31
Q

What are causes of infertility in males?

A
  1. Oligospermia.
  2. OATS - oligoasthenoteratospermia.
  3. CAVD - congenital absence of vas deferens.
  4. Azoospermia.
32
Q

What is oligospermia?

A

This is when there is low concentration of semen in sperm. Often those with oligospermia have significant abnormalities in sperm morphology and motility.

33
Q

How do you treat oligospermia?

A
  1. ICSI - intra-cytoplasmic sperm-injection. Single sperm is injected directly into an egg.
  2. Donor sperm.
34
Q

What is OATS?

A

Oligoasthenoteratospermia. This is when there is:

  • low concentration of sperm.
  • slow motility.
  • irregular shape of sperm.
35
Q

How do you treat OATS?

A
  1. ICSI.

2. Donor sperm.

36
Q

What is CAVD?

A

Congenital absence of vas deferens. The man is missing a vas deferens, thus he can’t store sperm/sperm can’t travel to urethra.

37
Q

How do you treat CAVD?

A

ICSI.

38
Q

What is azoospermia?

A

The semen contains no sperm.

39
Q

What can cause azoospermia?

A
  1. Kallmann syndrome.
  2. No spermatogenesis.
  3. Obstructive vas deferens.
  4. Vasectomy.
  5. Non-obstructive problems.
40
Q

What is kallmann syndrome?

A

This is failure to start or complete puberty. There is a failure of the hypothalamus to release GnRH at the appropriate time - GnRH releasing neurons do not migrate into the correct location during embryonic development.

41
Q

What are the steps to IVF?

A
  1. Ovarian stimulation.
  2. Egg retrieval.
  3. Sperm preparation and fertilisation.
  4. Embryo culture.
  5. Embryo transfer into uterus.
  6. Embryo freezing.
42
Q

What are the steps involved in ovulation stimulation?

A
  1. Stimulation.
  2. Control.
  3. Trigger.
  4. Luteal support.
43
Q

What happens in stimulation of follicles?

A

Stimulation of follicles via FSH or clomiphene citrate - lots of follicles will be produced (grow in one month).

44
Q

Why do they control ovulation?

A

Ovulation is prevented by GnRH antagonist to ensure that the woman ovulates when the clinic is ready.

45
Q

What happens when they trigger and stimulate ovulation?

A

The clinic will give the woman a GnRH agonist.

46
Q

Why is luteal support needed?

A

The woman is given progesterone in her luteal phase. This is because all the previous drugs she’s been given would have decreased her progesterone levels, thus without the exogenous progesterone a corpus luteum would not occur - hence no baby.

47
Q

What happens in egg retrieval?

A

The clinic will consistently do blood tests to see how much estrogen the woman has, as this is an indicator as to when to retrieve the egg. The clinic will time the egg pick up with the trigger injection of LH - they retrieve the egg exactly 36 hours after LH injection. They use a trans vaginal ultrasound probe to suck out each follicle.

48
Q

What happens in sperm preparation?

A

The sperm is separated from the seminal fluid - takes 2 hours to be washed. They then add around 50,000 sperm per egg. The sperm is then added to the egg and hopefully fertilisation will occur.

49
Q

What happens in sperm retrieval?

A

The clinic will put a needle into the testis to get a small sample of testicular tissue until you find sperm. If you can’t find sperm you use bigger chunks.

50
Q

Describe the relationship between age and IVF?

A

As you get older your chances of getting pregnant drop significantly even when using IVF.

51
Q

What are the problem with 40yo eggs?

A

Eggs of women who are 40yo are more likely to have more mitochondrial issues and chromosomal defects than women who are younger. Implantation rate also decreases but aneuplooidy rates increase as well.

52
Q

How do the clinic track the embryo?

A

The clinic use time lapse photography. This is where a machine takes a photo every 10 minutes.

53
Q

Why is time lapse photography helpful?

A

It allows for the clinic to look at the development of every single embryo without disturbing them. It also provides full information of the development of the embryo and it allows the clinic to see what embryo has the best potential in life.

54
Q

What is ICSI?

A

Intra-cytoplasmic sperm injection.

55
Q

What are the steps involved in ICSI?

A
  1. Select sperm with normal motility and morphology.
  2. Immbolise sperm.
  3. Aspirate the sperm tail first.
  4. Position the sperm in the needle.
  5. Insert the needle into the egg.
  6. Rupture the egg membrane by aspirating it.
  7. Expel the sperm.
  8. Culture overnight.

RDA (19 decks)

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