Safety and Efficacy of ART Flashcards
define Assisted Reproductive Technologies (ART)
- all interventions that include in vitro handling of both human oocytes and sperm or of embryos for purpose of reproduction
define In Vitro Fertilsation (IVF)
- example of an ART
- a sequence of procedures
- that involves fertilisation of gametes external to body (in vitro)
- includes conventional in vitro insemination (combination of sperm and eggs for natural fertilsation in dish in lab)
- includes intracytoplasmic sperm injection (ICSI) (direct injection of a single spermatozoon into oocyte; common for male factor infertility)
what is ovulation induction
- requires pharmacologic treatments to induce ovulation
what is ovulation induction and ovarian stimulated used to treat
infertility
examples of ovulation induction medcaitions
clomiphene, letrozole
what is ovarian stimulation
- administration of gonadotrophins (FSH, LH) to stimulate growth and maturation of multiple follicles / oocytes
- exogenous trigger (hCG) to stimulate ovulation
what can be used after ovulation induction or ovarian stimulation
intrauterine insemination (IUI)
what is intrauterine insemination (IUI) used for
- fertilisation of ovulated oocytes (single or multiple)
(ovulated oocytes due to ovulation induction or ovarian stimulation)
what is involved with IUI
- sperm placement into uterus 24-36 hrs post-ovulation trigger
what cases is fertility treatment of ovulation induction commonly used for
- anovulation cases
- to specifically induce ovulation alone
chance of patient having a live birth within 3 cycles on clomiphene for ovulation induction if they have unexplained infertility
24-31%
chance of patient with PCOS having a live birth within 5 cycles on clomiphene for ovulation induction if they have unexplained infertility
19.1%
chance of patient with PCOS having a live birth within 5 cycles on letrozole for ovulation induction if they have unexplained infertility
27.5%
ie/ letrozole may have a higher success rate for live births for people with PCOS
chance of patient having a live birth within 4 cycles using ovarian stimulation if they have unexplained infertility
32-33%
what is ovarian stimulation simple
- production of multiple follicles and oocytes
- followed by ovulation induction
is % cumulative live birth rate higher in ovulation induction methods or ovarian stimulation methods
ovarian stimulation
[safety of ovulation induction] adverse effects of clomiphene
- hot flushes
- headache
- fatigue
- dizziness
- irritability
- thin endometrium (can impact success of implantation -> resultant embryo)
- visual disturbances
- multiple pregnancy (up to 12.5%) - steps to try to avoid
what are the complications to the foetus from multiple pregnancy
higher risk of:
- premature birth
- intrauterine growth restriction
- prenatal death
what are the complications to maternal from multiple pregnancy
increased risk of developing pregnancy complications such as:
- preeclampsia
- gestational diabetes
- haemorrhage during delivery
[safety of ovulation induction] adverse effects of letrozole
- hot flushes
- headache
- fatigue
- dizziness
- irritability
- multiple pregnancy (up to 14.3%) - steps to try to avoid
[safety of ovulation induction] is chance of multiple pregnancy higher in letrozole or clomiphene & then compare with gonadotropins with ovarian stimulation
- letrozole in ovulation induction
- between all, gonadotropins
[safety of ovulation induction] what are differences in adverse effects between clomiphene and letrozole
same except letrozole:
- does not adversely affect endometrial thickness
- no visual disturbances
[safety of ovarian stimulation] adverse effects of gonadotrophins:
- injection site reaction
- abdominal bloating / discomfort
- ovarian hyperstimulation syndrome (chance 1%-5% in each cycle)
- multiple pregnancy (up to 36%)
[safety of ovarian stimulation] what can ovarian hyperstimulation syndrome lead to
- serious complication
- can lead to: ascites, electrolyte imbalance, hypercoagulability (-> risks)
what is the trade off regarding ovarian stimulation
- ovarian stimulation gives you higher rate of live birth rate
- but higher chance of multiple pregnancy due to potential for producing multiple oocytes
overview of an IVF cycle
- ovarian stimulation (administration gonadotropins to produce multiple follicles and oocytes + ovulatory trigger hCG)
- collection of mature oocytes using US guided needle aspiration
- oocytes can be fertilised in vitro with collected sperm: either by conventional in vitro (combination) or intracytoplasmic sperm injection (direct)
- result embryos cultured in vitro until blastocyst stage
- embryo can be transferred back into uterus
- hopefully establish pregnancy and live birth
what are the conditions like in vitro and why
- optimised conditions and temperature to mimic maternal env
efficacy of IVF in A&NZ
- 18% success
- chance of taking home baby from an initiated ART cycle in A&NZ is ~1 in 5 cycles
- despite continual increase demand of assisted reproductive cycles in A&NZ, success rate of IVF has not changed
many ARTs added which can improve success of
IVF
[safety of ovarian stimulation with IVF] compared to ovarian stimulation with intrauterine insemination, what are risks with IVF
- IVF reduces chance of multiple pregnancy as able to transfer single embryo back into uterus
success of (different) fertility treatments relative to age
decreases as age increases
guides clinical decision making - which treatment use
which has higher live birth rates - ovulation induction / ovarian stimulation with IUI or ovarian stimulation w IVF
- ovarian stimulation w IVF
if have very diminished ovarian reserve, what should be considered to do
- oocyte donation
if older, patient may need to consider doing ___ as first course based on success rates
IVF
is there risk of birth defects with use of IVF
- significant increased risk of birth defects in children conceived w IVF
was the risk of birth defects in the use of IVF different for whether conventional in vitro insemination and intracytoplasmic sperm injection (ICSI)
no
when adjusted for parental factors, what was the change in findings for risk of birth defects with IVF use
- that IVF with conventional in vitro insemination did not increase risk of birth defects
- but that IVF with intracytoplasmic sperm injection (ICSI) did significantly increase birth defects even after adjusting for parental factors
children born via natural conception vs ovulation induction show differences in congenital malformations - T or F
F
multiple pregnancies resulting from ART are associated with what risk of congenital malformation
small but increased risk
success rates for (different) fertility treatments vary depending on the
infertility diagnosis
helps guide clinical decision making - which treatment should be used
risk of multiple births following ART vs natural conception
increased
-> lead to risk of adverse outcomes (neonate / maternal)
