The Lab Flashcards
Units of TSH
mIU/mL
Units of Estrogen
pg/mL
Units of Testosterone
ng/dL
Normal range 20-80
Liquid chromatography and mass spec
What do day 3 embryo media need?
lactate, pyruvate, non essential AA, Ca chelator (EDTA), no glucose
What do blast media need?
non essential and essential AA, glucose
Benefits of extended blastocyst culture?
1) Blastocyst transfer is associated with a shorter time to pregnancy - emotional value and reduced cost to patients
2) LBR was significantly improved in day 5 / 6 (39.1 vs 30.3)
3) Embryonic genome activates on day 3 - so those that dont activate dont make it to day 5-6 ; aka Fewer embryos in cryo that would not end up being viable / end in a viable pregnancy → better quality blasts are the ones making it to day 5
4) Better uterine receptivity and environment with day 5 transfers
Cons of day 5 include obstetric outcomes as above and potential increase in MZT
If a patient has poor quality blasts that are not going to make it to day 5 - better to put back in the uterus with appropriate counseling of lower success rates than to discard / die off in the lab?
Units of progesterone
ng/dL
Normal volume of SA
1.5-5.5 mL
What is hypospermia?
Low volume < 1.5
Normal pH of semen
7.2-7.8
What are round cells in an SA?
Either immature germ cells or WBC
Purpose of eosin staining?
Differentiate dead cells from living non motile cells eg. necrozoospermia versus motile dyskinesis from immotile cilia syndrome (Eg. Kartageners)
Consider doing vital staining if motility is less than 40%
Asthenozoospermia
Decreased motility
Polyzoospermia
> 250 x 10^6
Azoospermia
No sperm
Post centrifugation (1000 g x 15 min) wet prep
Crypotozoospermia
so few sperm only noted in the post centrifugation sample
Aspermia
no ejaculate volume
Evaluation post vasectomy
2 months post op and after 10 ejaculations
Also perform centrifugation
Patient considered sterile if no sperm in SA/centrifugation sample 1 month apart
Normal vaginal pH
3-5
Purpose of cervical mucus
Vaginal mucus protects sperm from hostile, acidic vaginal environment
Provide energy
Filters sperm
Acts as a reservoir to store sperm in the crypts
Initiate sperm capacitation
**Estradiol stimulates cervical mucus production that is copious, thin, acellular, and alkaline
Clinical exam of cervical mucus
Volume (peaks at 500 uL), viscosity (watery at ovulation versus high viscosity premenstrual), ferning (want teriatry or quaternary ferns), spinnbarkeit (stretchiness of mucus and measuring length before it breaks), cellularity
Score > 10 favorable for sperm penetration
pH not measured, but ideal is 7-8.5
Post coital test
Evaluate cervical mucus 9-24 hours after intercourse
Unlubricated speculum and sample discharge in posterior fornix
Evaluate number and motility of sperm
Cause of antisperm antibodies in men?
Autoimmunization to sperm antigens should not happen because of the blood testes barrier and epididymis from tight junctions, but anything that disrupts this can result in ASAB
Vasectomy, congenital anomaly, CBAVD, CF, trauma
50-70% of men with vasectomy have ASAB
Theoretical effects of ASAB?
Cause agglutination and clumping that would prevent sperm motility and cervical mucus penetration