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Ob/Gyne 2 > Module 4 : Fertility Management > Flashcards

Module 4 : Fertility Management Flashcards

1
Q

what is infertility

A
  • inability to conceive after 12 months of unprotected intercourse
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2
Q

what is the #1 reason for infertility

A
  • postponement of pregnancy until the later years
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3
Q

what percentage does infertility in women account for

A
  • 40%
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4
Q

4 areas of infertility in women

A
  • ovarian
  • uterine
  • cervical
  • immunologic
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5
Q

two types of ovarian infertility

A 
- primary
 \+ ovulatory dysfunction 
- secondary 
 \+ inability to transport ova/embryo 
 \+ blocked fallopian tube
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6
Q

3 reasons for uterine infertility

A
  • congenital abnormalities
  • fibroids
  • asherman’s
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7
Q

immunologic reasons for infertility in women

A
  • hostile cervix

- reproductive organs kill all the sperm

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8
Q

what percentage does infertility in men account for

A

40%

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9
Q

three areas of infertility in men

A
  • varicocele
  • testicular failure
  • tubular obstruction
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10
Q

6 reasons for testicular failure

A
  • mumps
  • torsion
  • orchitis
  • testicular cancer
  • frequent marijuana use
  • undescended testes (cryptorchidism)
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11
Q

what is tubular obstruction

A
  • vas deferens not connecting to sperm
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12
Q

what accounts for the other percent of infertility

A
  • 20% idiopathic
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13
Q

what does ART stand for

A
  • assists reproductive technology
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14
Q

what are the four services in ART

A
  • ovulation induction
  • intrauterine insemination (IUI)
  • in vitro fertilization (IVF)
  • intracytoplasmic sperm insertion (ICSI)
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15
Q

what is the first step of ART for sonography

A
  • ovulation induction

+ fertility drugs are used to ensure ovulation occurs

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16
Q

what is ovulation impairment

A
  • no Graafian follicle produced
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17
Q

what is our role in ovulation induction

A
  • monitor the cycle with ultrasound

+ trying to achieve only one Graafian follicle

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18
Q

what is step 2 of ART for sonography

A
  • intrauterine insemination (IUI)
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19
Q

for what circumstances is IUI usually down

A
  • male infertility
  • unexplained infertility
  • donor insemination
  • same sex couples
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20
Q

what is the third step in ART for sonography

A
  • in vitro fertilization
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21
Q

definition of IVF

A
  • fertilization in a glass or lab

- egg and sperm are fertilized outside the body

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22
Q

4 reasons for IVF

A
  • blocked fallopian tubes
  • impaired eggs
  • impaired sperm
  • unexplained infertility
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23
Q

6 steps to IVF

A

1) initial lab and ultrasound investigations
2) ovarian suppression
+ stopping normal ovulatory cycle
3) ovarian stimulation
+ gonadotropins administered to hyper stimulate ovaries
+ more than one egg is produced
4) egg or oocyte retrieval
5) insemination
6) embryo transfer

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24
Q

what are the 5 investigations done before IVF

A
  • lab blood work
  • ultrasound
  • hysterosalpingogram
  • sonohysterogram
25
Q

what blood work is done before IVF

A
  • ovarian reserve testing
26
Q

what hormone does ovarian reserve testing look at and what does is giver information on

A
  • tests for FSH

- insight into number of eggs left or ovarian age

27
Q

what number of FSH indicated that eggs are present

A

< 10 indicates eggs

28
Q

what is ultrasounds role in investigating before IVF

A 
- assess uterus 
  \+ fibroids 
  \+ congenital abnormalities 
- asses adnexa
  \+ hydrosalpinx 
- assess ovaries
  \+ cysts PCOS
  \+ ovarian cysts 
  \+ baseline astral follicle count
29
Q

what is the basal antral follicle count

A
  • number of small antral follicles observed at the beginning of the menstrual cycle
30
Q

what is a poor BAFC

A
  • < 10 poor ovarian response
31
Q

hysterosalpingogram (HSG) role pre IVF

A
  • dye or contrast is injected into the uterus
  • assessing uterine cavity for congenital abnormalities
  • assess patency of Fallopian tubes
    + contrast spilling into the posterior culdesac indicates one Fallopian tube patent
32
Q

sonohysterogram (SHG) role pre IVF

A
  • saline injected into uterus
  • ultrasound guided
  • assess uterine cavity
  • patency of Fallopian tubes
33
Q

4 complications associated with HSG and SHG

A
  • infection
  • fainting
  • HSG
    + radiation
  • spotting
34
Q

how are the ovaries suppressed in the second step of IVF

A
  • down regulation
35
Q

what is down regulation

A
  • GnRH agonist is given to stop natural ovulation
  • temporary state of menopause
  • prevents premature ovulation
  • CONTROLS TIMING OF IVF CYCLE
36
Q

what is the ovarian suppression check

A
  • ultrasound to ensure no new finding such as ovarian cyst has occurred
37
Q

what is step 3 of IVF trying achieve

A
  • trying to achieve super ovulation

- medication injected for 9-14 days

38
Q

when is ultrasound performed during step 3 of IVF and what is for

A
  • day 4 day 7
  • every 2nd day after day 7 while on FSH
  • to monitor size and number of follicles on each ovary
39
Q

what is done during step 4 of IVF

A
  • oocyte retrieval
  • patient is sedated
  • done under EV guidance
  • a needle is inserted through the vaginal wall
  • follicular fluid cells and egg are aspirated into a test tube
  • eggs are examined under a microscopic for quality
40
Q

when is the semen sample collected for insemination

A
  • 1-3 hours after egg retrieval
    + conventional insemination in a Petri dish
    + intracytoplasmic sperm injection
41
Q

what 5 things does the embryologist assess the zygotes for

A
  • cell division
  • timing of division
  • cell size
  • cellular components
  • any fragmentation
42
Q

when are the embryos transferred

A
  • day 3 or 5 after retrieval
43
Q

what stage are the embryos at by day 5

A
  • blastocyst stage
  • better assessment of implantation abilities
  • usually only ONE embryo is transferred
44
Q

what three factors determine number of embryos implanted

A
  • mothers age
  • quality of embryos
  • previous fertility history
45
Q

2 major sonographic contributions to IVF

A
  • confirmation of pregnancy and number

- 6-8 weeks gestation

46
Q

sonographic protocol

A
  • ovulation induction
    + follicular monitoring
  • routine pelvic ultrasound
  • track the growth of follicles
    + 3 dimensions of the 3 largest follicles on EACH ovary
  • check the pouch of Douglas for free fluid
    + indicates ovulation has occurred
47
Q

rules to EV with ART

A
  • DO NOT use a condom that has lubrication (spermicide)
  • DO NOT use gel or KY jelly on condom
  • WATER ONLY
48
Q

3 major hormone drugs

A
  • clomid
  • pergonal
  • hCG
49
Q

clomid characteristics

A
  • increase FSH
  • acts like a normal cycle
  • only one Graafian follicle
50
Q

pergonal characteristics

A
  • stimulates FSH and LH

- more than one follicle matures per cycle

51
Q

hCG characteristics

A
  • induces ovulation and encourages implantation
52
Q

what is ovarian hyper stimulation syndrome and what causes it

A
  • ovary creates a lot of follicles
  • occurs with drugs used in fertility management
    + PERGONAL AND HCG
  • results in
    + ascites
    + pleural effusion
    + possible thromboembolic states
    + shock and death
53
Q

chances of multiple gestation with pergonal

A
  • causes multiple follicles

- 35% - 60%

54
Q

chances of multiple gestation with pergonal and HCG

A

80% of all cases

55
Q

steps after transfer is complete

A
  • HCG is given on the day of transfer
  • given every other day for 3 more doses
  • encourages implantation
  • progesterone continued until 10 weeks gestation until placenta takes over
56
Q

most common reason for unsuccessful IVF

A
  • FAILURE TO IMPLANT
57
Q

what is cryopreservation

A
  • good quality zygotes cryopreserved in liquid nitrogen for later attempts at pregnancy
58
Q

what is gamete intrafallopian transfer GIFT

A
  • oocyte and sperm are injected into the ampulla of the Fallopian tube
  • done by laparoscopy
  • can be done using EV
  • done when couples unexplained infertility or endometriosis
59
Q

what is zygote intrafallopian tube transfer ZIFT

A
  • modification to IVF

- 1 day old zygotes are placed into the Fallopian tubes

Ob/Gyne 2 (19 decks)

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