Treatment of Infertility

Question 1

what is assisted conception treatment (ACT)?

Answer 1

any treatment for infertility which involves gamates outside the body
main types
- donor insemination
- intra-uterine insemination
- IVF
- intra-cytoplasmic sperm injection

Question 2

indications for ACT?

Answer 2

couples with infertility who wish to conceive where at least one partner has no biological children
same sex couples in the absence of infertility diagnosis
can be done to preserve fertility in cancer patients, patients undergoing gender reassignment
can be used to prevent transmission of blood viruses like HIV
can be used to allow pre-implantation diagnosis of certain inherited disorders

Question 3

look at criteria for IVF/ICSI.

Answer 3

..

Question 4

how many cycles of IVF/ICSI can you get on the NHS?

Answer 4

3

“where there is a reasonable expectation of a live birth”

Question 5

age limit on IVF/ICSI?

Answer 5

treatment cycles must be started by females 40th bday and all subsequent frozen transfers completed before 41st bday

Question 6

can you get IVF/ICSI if youre over 40?

Answer 6

one full cycle will be offered if theyve never had IVF before and theres no evidence of poor ovarian reserve

Question 7

what is HFEA?

Answer 7

government regulator responsible for regulating treatment and research around assisted conception and use of embryos

Question 8

types of ACT available?

Answer 8

intrauterine insemination
IVF
ICSI
surgical sperm aspiration

Question 9

what is intra-uterine insemination and when can it be done?

Answer 9

sperm is directly placed into uterus to facilitate fertilisation
only possible when sperm and semen are healthy and ovulation is taking place and no tubal disease

Question 10

how is IUI performed?

Answer 10

cycle can be natural or hormonally stimulated

prepared semen in inserted into uterine cavity at time of ovulation

Question 11

indications for IUI?

Answer 11

sexual disorders (ED, ejaculation disorders, sexual pain)
female same sex relationships (donor sperm)
male same sex relationships (surrogacy)

Question 12

what is IVF?

Answer 12

number of sperm are placed into petri dish with the oocyte
successful sperm undergoes capacitation and fuses with zone pellucida eventually fertilising the ovum and creating a zygote

Question 13

indications for IVF?

Answer 13

unexplained infertility for >2 years
pelvic disease (tubal disease, endometriosis, fibroids etc)
anovulatory infertility

Question 14

what is ICSI?

Answer 14

one sperm cell is immobilised and injected directly into the cytoplasm of oocyte
bypasses stages of sperm travelling to ovum, capacitation etc

Question 15

when is ICSI the preferred option over IVF?

Answer 15

in cases where there are low numbers of sperm, reduced sperm motility or abnormal sperm morphology

Question 16

indications for ICSI?

Answer 16

severe male factor infertility
previous failed IVF
pre-implantation genetic diagnosis needed

Question 17

when is surgical sperm aspiration used?

Answer 17

male infertility where there is little or no sperm in the semen (azzospermia)

Question 18

where is sperm extracted from in surgical sperm aspiration?

Answer 18

sperm is extracted directly from epididymis if obstructive cause
extracted from testicular tissue if non-obstructive cause

Question 19

step 1 in IVF/ICSI?

Answer 19

down regulation
synthetic GnRH analogues/agonists given to shut down menstrual cycle
this allows IVF cycles to be scheduled and managed better
can take a few weeks can causes menopause symptoms
transvaginal US scan done here to ensure thin endometrium and inactive ovaries

Question 20

step 2 in IVF/ICSI?

Answer 20

ovarian stimulation
gonadotrophin hormone injection given to induce ovarian follicular development and oocyte maturation
usually happens over 10-14 days
US done again to assess growth of ovarian follicles and thickness of endometrium
US helps plan for timing of HCG injection
HCG administered to stimulate the final stage of oocyte maturation