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Reproductive System > Safety and Efficacy of ART > Flashcards

Safety and Efficacy of ART Flashcards

1
Q

define Assisted Reproductive Technologies (ART)

A
  • all interventions that include in vitro handling of both human oocytes and sperm or of embryos for purpose of reproduction
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2
Q

define In Vitro Fertilsation (IVF)

A
  • 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)
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3
Q

what is ovulation induction

A
  • requires pharmacologic treatments to induce ovulation
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4
Q

what is ovulation induction and ovarian stimulated used to treat

A

infertility

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5
Q

examples of ovulation induction medcaitions

A

clomiphene, letrozole

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6
Q

what is ovarian stimulation

A
  • administration of gonadotrophins (FSH, LH) to stimulate growth and maturation of multiple follicles / oocytes
  • exogenous trigger (hCG) to stimulate ovulation
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7
Q

what can be used after ovulation induction or ovarian stimulation

A

intrauterine insemination (IUI)

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8
Q

what is intrauterine insemination (IUI) used for

A
  • fertilisation of ovulated oocytes (single or multiple)

(ovulated oocytes due to ovulation induction or ovarian stimulation)

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9
Q

what is involved with IUI

A
  • sperm placement into uterus 24-36 hrs post-ovulation trigger
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10
Q

what cases is fertility treatment of ovulation induction commonly used for

A
  • anovulation cases
  • to specifically induce ovulation alone
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11
Q

chance of patient having a live birth within 3 cycles on clomiphene for ovulation induction if they have unexplained infertility

A

24-31%

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12
Q

chance of patient with PCOS having a live birth within 5 cycles on clomiphene for ovulation induction if they have unexplained infertility

A

19.1%

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13
Q

chance of patient with PCOS having a live birth within 5 cycles on letrozole for ovulation induction if they have unexplained infertility

A

27.5%
ie/ letrozole may have a higher success rate for live births for people with PCOS

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14
Q

chance of patient having a live birth within 4 cycles using ovarian stimulation if they have unexplained infertility

A

32-33%

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15
Q

what is ovarian stimulation simple

A
  • production of multiple follicles and oocytes
  • followed by ovulation induction
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16
Q

is % cumulative live birth rate higher in ovulation induction methods or ovarian stimulation methods

A

ovarian stimulation

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17
Q

[safety of ovulation induction] adverse effects of clomiphene

A
  • 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
18
Q

what are the complications to the foetus from multiple pregnancy

A

higher risk of:
- premature birth
- intrauterine growth restriction
- prenatal death

19
Q

what are the complications to maternal from multiple pregnancy

A

increased risk of developing pregnancy complications such as:
- preeclampsia
- gestational diabetes
- haemorrhage during delivery

20
Q

[safety of ovulation induction] adverse effects of letrozole

A
  • hot flushes
  • headache
  • fatigue
  • dizziness
  • irritability
  • multiple pregnancy (up to 14.3%) - steps to try to avoid
21
Q

[safety of ovulation induction] is chance of multiple pregnancy higher in letrozole or clomiphene & then compare with gonadotropins with ovarian stimulation

A
  • letrozole in ovulation induction
  • between all, gonadotropins
22
Q

[safety of ovulation induction] what are differences in adverse effects between clomiphene and letrozole

A

same except letrozole:
- does not adversely affect endometrial thickness
- no visual disturbances

23
Q

[safety of ovarian stimulation] adverse effects of gonadotrophins:

A
  • injection site reaction
  • abdominal bloating / discomfort
  • ovarian hyperstimulation syndrome (chance 1%-5% in each cycle)
  • multiple pregnancy (up to 36%)
24
Q

[safety of ovarian stimulation] what can ovarian hyperstimulation syndrome lead to

A
  • serious complication
  • can lead to: ascites, electrolyte imbalance, hypercoagulability (-> risks)
25
Q

what is the trade off regarding ovarian stimulation

A
  • ovarian stimulation gives you higher rate of live birth rate
  • but higher chance of multiple pregnancy due to potential for producing multiple oocytes
26
Q

overview of an IVF cycle

A
  • 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
27
Q

what are the conditions like in vitro and why

A
  • optimised conditions and temperature to mimic maternal env
28
Q

efficacy of IVF in A&NZ

A
  • 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
29
Q

many ARTs added which can improve success of

A

IVF

30
Q

[safety of ovarian stimulation with IVF] compared to ovarian stimulation with intrauterine insemination, what are risks with IVF

A
  • IVF reduces chance of multiple pregnancy as able to transfer single embryo back into uterus
31
Q

success of (different) fertility treatments relative to age

A

decreases as age increases
guides clinical decision making - which treatment use

32
Q

which has higher live birth rates - ovulation induction / ovarian stimulation with IUI or ovarian stimulation w IVF

A
  • ovarian stimulation w IVF
33
Q

if have very diminished ovarian reserve, what should be considered to do

A
  • oocyte donation
34
Q

if older, patient may need to consider doing ___ as first course based on success rates

A

IVF

35
Q

is there risk of birth defects with use of IVF

A
  • significant increased risk of birth defects in children conceived w IVF
36
Q

was the risk of birth defects in the use of IVF different for whether conventional in vitro insemination and intracytoplasmic sperm injection (ICSI)

A

no

37
Q

when adjusted for parental factors, what was the change in findings for risk of birth defects with IVF use

A
  • 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
38
Q

children born via natural conception vs ovulation induction show differences in congenital malformations - T or F

A

F

39
Q

multiple pregnancies resulting from ART are associated with what risk of congenital malformation

A

small but increased risk

40
Q

success rates for (different) fertility treatments vary depending on the

A

infertility diagnosis
helps guide clinical decision making - which treatment should be used

41
Q

risk of multiple births following ART vs natural conception

A

increased
-> lead to risk of adverse outcomes (neonate / maternal)

Reproductive System (21 decks)

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