M4: Fertiliy Management Flashcards
define infertility
inability to conceive after 12 month of unprotected sex
1 reason for infertility
postponement of preg until later years
ovarian causes of infertility
primary: ovulatory dysfunction
secondary: inability to transport ova/embryo due to block tube
uterine causes of infertility
congenital abnormalities
fibroids (impair vascular supply or blocking tubes)
ashermans
other causes of infertility
cervical
immunologic
cause of infertility in men
varicocele testicular faliure tubular obstruction (vas deferens not connected to ED)
causes of testicular failure
mumps torsion orchitis cancer cryptorchidism (increased temp impairs sperm) marijuana use
what % of infertility is idiopathic
20%
when would ovulation induction be performed?
if the women has patent tubes w/ an ovulation impairment (doesnt produce a graafian follicle)
US roll in ovulation induction
- routine pelvic US to monitor the cycle
- track follicle growth (3 dimensions of the 3 largest follicles)
….trying to achieve 1 graafian follicle only
are fertility drugs used w/ ovulation induction
yes
if you see FF on the US, what does that typically mean in terms of the womans cycle
she has already ovulated
why is intrauterine insemination (IUI) typically done
due to male infertility issues
unexplained infertility
donor insemination
same sex couples
define in vitro fertilization
fertilization in a glass or lab, egg and sperm fertilized outside the body
reasons for IVF
blocked tubes
impaired eggs or sperm
unexplained infertility
steps for IVF
- lab and US investigation
- ovarian suppression of norm cycles
- ovarian stimulation (gonadotropins to hyperstimulate ovaries)
- egg retrieval
- insemination
- embryo transfer
is more than 1 egg produced w/ IVF
yes
what lab work is needed to IVF
bloodwork
Ovarian reserve testing… checks the FSH # which tells you about number of eggs left and ovarian age
FSH of < what number indicates eggs are present
<10
US use for IVF
assess uterus (fibroids, congenital abnorm)
adnexa (hydrosalpinx)
ovaries (PCOS, cysts, baseline antral follicle count)
what is baseline antral follicle count
BAFC < what # indicates poor ovarian response?
the number of sm antral follicles seen at the start of the menstrual cycle
<10
what is a hysterosalpingogram (HSC)
what does it assess
xray, where dye or contrast in injected into the uterus
assess the uterus for congenital abnorm. and patency of tubes
how can you tell the tubes are patent on a hysterosalpingogram
contrast will spill into the posterior cul de sac
what is a sonohysterogram (SHG)
what does it assess
ultrasound guided procedure where saline is injected into the uterus
assess uterine cavity
patency of tubes
is a sonohysterogram as reliable as a hysterosalpingogram for determining the patency of tubes
no
complications of HSC and SHG
infection
fainting
spotting
radiation (HSC)
describe ovarian suspension in IVF
downregulation - GnRH agonist is given to stop ovulation and creates a temp state of menopause… purpose is to prevent premature ovulation and controls timing of IVF cycle
what is an ovarian suppression check
US to see that there are no new follicles developing
how is the egg retrieved w/ IVF
under endovaginal guidance, needle inserted into vaginal wall and the egg is aspirated into a test tube…
… then examined for quality
insemination w/ IVF
occurs in a petri dish through intracytoplasmic sperm injection
w/ IVF, when is/are the embryo(s) transferred
day 3 or 5… day 5 is better to be able to assess implantation abilities
factors that determine # of embryos implanted
mothers age
quality of embryos
previous fertility Hx
why is ART often used?
due to previous ectopic that blocked a tube
US use post IVF
confirmation of preg and # @ 6-8 weeks
do you use any type of gel when doing an EV for ART
no, it may have spermicide
water only
what is clomid
- fertility drug that increases FSH and will simulate a norm cycle
- only 1 graafian follicle produced
what is pergonal
- fertility drug that stimulates FSH and LH
- more than 1 graafian follicle produced
what does a GnRH agonist do
shuts off pituitary
describe ovarian hyperstimulation syndrome
- can occur w/ fertility drug use… especially pergonal w/ hCG and pregnancy
- creates theca luteal cysts
what can ovarian hyperstimulation syndrome cause
ascites
pleural effusion
DVTs
shock or death
what fertility drugs increases the chances of multiple gestations
pergonal - because multiple follicles develop
pergonal and hCG together - even higher chance than pergonal alone
which drug is given on the day of, and immediately after, the transfer of the embryos w/ IVF
why
hCG, encourages implantation
after embryo implantation w/ IVF, which drug is taken until 10 weeks gestation
why
progesterone
given until the placenta takes over
why can IVF be unsuccessful
- ovaries dont respond to hormones, no egg is produced
- egg isnt fertilized or doesnt grow
- failure to implant
what is the most common reason that IVF is unsuccessful
failure to implant
can good quality eggs be cryopreserved for later preg
yes
what is GIFT
how does it work
gamete intrafallopian transfer
- egg and spem are injected into the ampulla of the tube
- done w/ EV or laparoscopy
when is GIFT usually done
unexplained infertility or endometriosis….. considered more natural than IVF
what is ZIFT
how does it work
zygote intrafallopian transfer
modified form of IVF
-1 day old zygotes placed in tubes
theoretical advantage of ZIFT
embryo develops in the tube
