Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Week 1- assisted conception > Flashcards

Week 1- assisted conception Flashcards

1
Q

What is assisted conception treatment?

A

Any treatment which involves gametes outside of the body.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is demand for assisted conception treatment increasing?

A 
Increasing parental age
Increasing chlamydia
Male factor infertility 
ACT more successful
Bigger range of ACT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Other than parents struggling to have babies, when else may you use ACT?

A

Cancer patients- for preservation of eggs
Treatment to avoid transmission of blood borne viruses between patients
Treatment for single parents or same sex couples.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What advice is given to couples before they undergo ACT?

A

Females are limited to 4 units a week of alcohol.
BMI must be between 19-29
Stop smoking
Give 0.4mg folic acid from preconception-12 weeks gestation
Check if female is immune to rubella- if not immunise
Check cervical smears are up to date
Occupational factors- exposure to hazards
Drugs- prescribed, over the counter and recreational.
Screen for blood borne viruses
Assess ovarian reserve
Counselling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What ACT treatments are available?

A 
Donor insemination
Intra-uterine insemination
In-vitro fertilisation 
Intra-cytoplasmic sperm injection
Fertility preservation
Surrogacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What indications are there for intrauterine insemination?

A

Sexual problems, unexplained infertility, mild or moderate endometriosis, mild male factor infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the process of intrauterine insemination?

A

The sperm is inserted into the uterine cavity around the time of ovulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What indications are there for in-vitro fertilisation?

A 
Unexplained infertility (> 2 years)
Pelvic disease (endometriosis, tubal disease, fibroids)
Anovulatory infertility (after failed ovulatory induction)
Male factor infertility (if greater than 1 x10^6 motile sperm present)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the down regulation stage in IVF?

A

Give a synthetic GnRH analogue or agonist. This reduces cancellation from ovulation and improves success rates. Allows precise timing of oocyte recover by using a HCG trigger.
A scan is also performed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What side effects can be experienced in the down regulation stage of IVF?

A

Hot flushes and mood swings
Nasal irritation
Headaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the ovarian stimulation stage of IVF?

A

This occurs once you are happy the patient is down-regulated.
Then injections of gonadotrophins (FSH or LH) are given. Can be self-administered as a subcut injection.
This causes follicular development.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the mans semen assessed for in IVF treatment?

A

Volume
Density- numbers of sperm
Motility- what proportion of the sperm are moving
Progression- how well they move

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What risks are there with oocyte collection in theatre?

A

Bleeding
Pelvic infection
Failure to collect oocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you select an egg in IVF?

A

In the embryological lab- they go through follicular fluid and identify eggs and the surrounding mass of cells. They collect them and incubate them.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How many eggs fertilise normally in IVF?

A

Approximately 60%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the hormones, egg release and development of the normal human embryo?

A

Normal LH surge
Egg is released 36 hours later
Fertilisation occurs in the ampulla normally.
By day 4 the morula is formed. By day 5 they differentiate into a blastocyst.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

At what day does transfer and cryopreservation (cooling to low temps) occur?

A

Day 5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When does implantation of the embryo into the uteral cavity occur in IVF?

A

Day 7.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How many embryos are usually transferred in IVF?

A

Usually 1- but a maximum of 3 in exceptional circumstances.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What support do you need to give patients once the fertilised eggs have been transferred?

A

Progesterone depositories for 2 weeks.

Pregnancy test 16days after oocyte extraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the indications for intra-cytoplasmic sperm injection?

A

Severe male factor infertility
Previous failed fertilisation with IVF
Preimplantation genetic diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What do you do if the man has azoospermia in ICSI?

A

Surgical sperm aspiration- can be withdrawn from epidydimus if obstructive or testicular tissue if non-obstructive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the process of intra-cytoplasmic sperm injection

A

The egg is stripped
The sperm is demobilised
The sperm is injected into the egg.
Incubated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What complications are associated with ART?

A

Ovarian hyperstimulation syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is ovarian hyper stimulation syndrome?

A

Enlarged ovaries- due to excess follicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What symptoms are associated with ovarian hyper stimulation syndrome?

A

Abdominal pain/bloating
Nausea/diarrhoea
Breathless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What treatment can be offered if ovarian hyper stimulation syndrome occurs before embryo transfer?

A

Electric freeze- freeze the embryos and wait 2-3 months to transfer them then.
Single embryo transfer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What treatment can be offered if ovarian hyper stimulation syndrome occurs after embryo transfer?

A

Monitoring with scans and bloods
Reduce risk of thrombosis- fluids, TED stockings, fragmin
Analgesia
Hospital admission if IV fluids are required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What other issues are there with ART?

A

No eggs retrieved (however very uncommon)
Surgical risks of oocyte retrieval
Surgical risks of surgical sperm aspiration
Failed fertilisation
Problems in early pregnancy e.g. ectopic pregnancy
Increased risk in on-going pregnancy
Psychological problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What determines our gender?

A

The presence/absence of a Y chromosome.

Even if you have one X, you are still a girl.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Describe the development of the internal reproductive tract?

A

The Y chromosome has the sex-determining region, causing the development of testis from the biopotential gonad.
Fetal testes secrete testosterone and mullerian inhibiting factors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the two primitive genital tracts called?

A

Mullerian- produce female genital system

Wolffian- produce male genital system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

If you are going to be female, what primitive tracts will be suppressed and which will be left?

A

Wolffian will be supressed

Mullerian will be allowed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

If you are going to be male, what primitive tracts will be suppressed and which will be left?

A

Mullerian will be surpressed

Wolffian will be allowed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

At what stage can you determine whether a baby will be a boy or a girl?

A

16 weeks gestation.

36
Q

What is testicular feminisation?

A

Someone is born looking like a female but when they hit puberty they don’t develop breasts. They actually have a male chromosome but female genitalia.

37
Q

What causes testicular feminisation?

A

Congenital insensitivity to androgens.
X linked recessive disorder
Androgen induction of Wolffian duct does not occur however Mullarian suppression does. Causes them to be born phenotypically female with external genitalia female, absent uterus and ovaries and a short vagina.

38
Q

When does testicular feminisation commonly present?

A

At puberty with lack of pubic hair and amenorrhoea.

39
Q

Why is it important that the testes descend?

A

Lower temp outside the body to facilitate spermatogenesis.

40
Q

What muscle controls where the testis sit in the scrotal sac?

A

Dartos muscle.

41
Q

What is the medical term for undescended testis?

A

Cryptorchidism- the individual has reached adulthood but the testis are not yet descended.

42
Q

What is the implications on fertility in cryptorchidism?

A

If unilateral they are usually still fertile however it reduces the sperm count.

43
Q

Do you treat cryptorchidism?

A

Orchidoplexy should be performed if they are below 14 years to minimise the risk of testicular germ cell cancer..
If an adult- consider orchidectomy

44
Q

What are the erectile tissues in the penis?

A

Corpus cavernosum

Corpus spongiosum

45
Q

What is the function of the testes?

A

Spermatogenesis (occurs in the seminiferous tubules)

Production of testosterone.

46
Q

What cells in the testes produce testosterone?

A

Leydig cells.

47
Q

What is the role of Sertoli cells?

A

Form a blood-testis barrier- this protects the sperm from antibody attack. Provides a suitable fluid composition which allows later development of sperm
Provide nutrients
Phagocytosis- destroy defective cells and removes surplus cytoplasm
Secrete seminiferous tubule fluid
Secrete androgen binding globulin
Secrete inhibin and activin hormones

48
Q

What is the function of androgen binding globulin?

A

Keeps the concentration of testosterone high (by binding to it) in the lumen

49
Q

What is the role of inhibin and activin hormones?

A

Regulates FSH secretion and controls spermatogenesis.

50
Q

What is the role of seminiferous tubule fluid?

A

Carries the sperm to the epididymis.

51
Q

What hormone stimulates the production of testosterone?

A

LH.

52
Q

What does gonadotrophin releasing hormone do?

Which hormone controls this by negative feedback?

A

Stimulates the anterior pituitary to release FSH and LH.

Testosterone causes less GnRH to be released by negative feedback.

53
Q

What does lutinising hormone do on the male reproductive tract?

A

Stimulates the leydig cells to produce testosterone.

54
Q

What does follicle stimulating hormone do to the male reproductive tract?
Which hormone regulates FSH?

A

Acts on Sertoli cells to enhance spermatogenesis.

Regulates by negative feedback from inhibin

55
Q

Where is testosterone secreted into?

A

The blood and seminiferous tubules.

56
Q

What are the effects of testosterone before birth?

A

Masculinises the male reproductive tract and promotes descent of testis.

57
Q

What are the effects of testosterone at puberty?

A

Promotes puberty and male characteristics

58
Q

What are the effects of testosterone in an adult?

A

Controls spermatogenesis

Secondary male characteristics (male body shape, deepens voice, thickens skin, libido)

59
Q

What cell secretes inhibin and activin? What is their function?

A

Sertoli cells

Inhibin inhibits FSH. Activin stimulates FSH.

60
Q

What occurs to spermatozoa after ejaculation?

A

They become liquified (by enzymes in the prostate gland)
Capacitation- a series of biochemical and electrical events occurring before fertilisation
Chemoattraction to oocyte and bind to zona pellucida of oocyte.
Acrosome reaction
Hyperactive motility
Penetration and fusion with oocyte membrane
Zonal reaction.

61
Q

Which area of the Fallopian tube does fertilisation occur?

A

Ampulla

62
Q

What is the function of the epididymis and vas deferens?

A

Exit route from testes to urethra, concentrate and store sperm, site for sperm maturation.

63
Q

What is the function of the seminal vesicles?

A 
Produce semen into ejaculatory duct. 
Supply fructose
Secrete prostaglandins (stimulates motility)
Secrete fibrinogen (clot precursor)
64
Q

What is the function of the prostate gland?

A

Produces alkaline fluid (neutralises vaginal acidity)

Produces clotting enzymes to clot semen inside female.

65
Q

What is the function of the bulbourethral gland?

A

Secrete mucus to act as a lubricant

66
Q

What is the definition of male infertility?

A

Failure of the sperm to normally fertilise the egg.

67
Q

What can cause of male infertility?

A

Idiopathic
Obstructive
Non-obstructive

68
Q

What is the most common cause of male infertility?

A

Idiopathic

69
Q

Name some examples of obstructive pathologies causing male infertility?

A

Cystic fibrosis
Vasectomy
Infection

70
Q

Name some examples of non-obstructive pathologies causing male infertility?

A 
Congenital- crytorchidism 
Infection- mumps, 
Iatrogenic- chemotherapy/radiotherapy
Pathological- testicular tumour 
Genetic- chromosonal e.g. Kleinfelters syndrome
Specific semen abnormality- azoospermia, 
Systemic disorder 
Endocrine disorder
71
Q

What are the common endocrine causes of male infertility?

A

Pituitary tumours- hyperprolactinaemia (decreases LH, FSH and testosterone), acromegaly, cushings
Hypothalmic cause-
Thyroid disorders
Diabetes
Steroid abuse (decrease LH, FSH and testosterone)
Androgen insensitivity (normal or raised LH and testosterone)

72
Q

What examinations would you do in male infertility?

A

General examination- including secondary male characteristics
Genital examination- testicular volume, presence of vas deferens and epididymus, penis (urethral orifice), presence of variceal or swelling.

73
Q

What is the normal testicular volume for adults?

In prepubertal boys?

A

12-25mls.

1-3mls

74
Q

What testicular volume are you likely to be infertile if you are below?

A

5mls.

75
Q

What do they analyse the semen for?

A 
Volume
Density- number of sperm
Motility- what proportion are moving
Progression- how well they move?
Morphology
76
Q

What does an obstructive male infertility show like on examination?

A

Normal testicular volume
Normal secondary sexual characteristics
Vas deferens may be absent

Endocrine- normal LH, FSH, testosterone

77
Q

What does a non-obstructive male infertility show like on examination?

A

Low testicular volume
Reduced secondary sexual characteristics
Present vas deferens

Endocrine- High FSH and LH, low testosterone

78
Q

What life style factors can be changed to help maximise fertility in the male?

A 
Frequent sexual intercourse
Less than 4 units a day of alcohol
Stop smoking
BMI less than 30
Avoid tight fitting underwear and long hot baths
Certain occupations
79
Q

When is intra-uterine insemination indicated?

A

Mildly reduced sperm count

80
Q

When is intra-cytoplasmic sperm injection indicated?

A

Very low sperm count

81
Q

When is surgical sperm aspiration indicated?

A

Azoospermia

82
Q

When is donor sperm insemination indicated?

A

Azoospermia or very low sperm count
Genetic conditions
Infectious

83
Q

What does oligoasthenospermia mean?

A

Low sperm count and motility

84
Q

What does teratoasthenospermia mean?

A

Low motility and abnormal forms

85
Q

Which drug is an ovulatory inducer?

A

Clomefene citrate.

Reproduction (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions