Week 19 Flashcards
Timeline of pregnancy?
40 weeks, 240 days, 10 months. Full term is accepted as being approx. 38 weeks +
Counted from Last Menstrual Period (LMP)
Development of pregnancy is counted from?
Counted from fertilisation
Some developmental changes occur at birth (perinatal) and continue postnatally such as the nervous system, lungs, reproductive system, kidney, etc.
What are the critical timings of pregnancy: fertilisation/conception?
Fertilisation/conception- approx. 14 days LMP
What are the critical timings of pregnancy: preorganogenesis?
Preorganogenesis: 2-4 weeks LMP. Pre and perimplantation period
What are the critical timings of pregnancy: embryonic period?
Embryonic period: 3-10 weeks LMP: placental growth and organogenesis
What are the critical timings of pregnancy: fetal period?
Fetal period: 11 weeks: functionality and shaping, final structure formation
What are the critical periods for development of the organ systems?
Organs: embryonic period
However, nervous system and others continue well into the fetal period (final tweeks) and further postnatally
What are the external risks in the first trimester: teratogen exposure?
Drugs (recreational and medical) smoking
alcohol
workplace and environmental conditions
What are the external risks in the first trimester: diet?
- excess vitamin A
- low folic acid
external risks in the first trimester: Teratogen exposure, diet and drugs can cause what?
Miscarriage
Fetal alcohol disorder
Small for Gestational Age (SGA)
spina bifida – failure of neural tube closure
Limb and cardiac syndromes (thalidomide)
Systemic syndomes: eg Rubella virus syndrome
What is Spina Bifida? What causes this?
Failure to close neural tube. Most likely at spinal closure points at top and bottom of spine.
Exposure to amniotic fluid causes degeneration of neural tissue in extreme cases.
What is Rubella Virus Syndrome in neonates? What is it caused by?
Rubella is mild in adults (mild rash and itching)
MMR prevents maternal contraction
Postnatal health problems:
Cataract, glaucoma, bilateral deafness, congenital heart problems, mental and physical disabilities
Early maternal changes: week 0-4 (LMP)?
Ovulation at d14. Insemination can occur several days pre or post ovulation.
Early pregnancy factor detected in maternal blood at 2-3d post fertilisation (week 3 LMP)
Human Chorionic Gonadotrophin (hCG) is detectable early in week 4 (8d post-fertilisation)
Week 4: embryo’s hormones start supporting the corpus luteum
hCG insufficiency may lead to loss of pregnancy (58% attrition)
What hormone holds importance for labour?
Glucocorticoids and oxytocin
maternal change and consequences:
- organ squashing
- respiratory function increase
- digestive problems
- weight gain
- increased heart rate and stroke volume
- increased urination (micturition) and incontinence
- breast enlargement
- Uterine expansion and fetal growth
- Tidal volume increase
- GI motility decreases (hormonal effects)
- Fetus, placenta, uterus, ↑Blood Volume (BV)↑ breast size, ↑ storage of protein and fat,
- HR ↑ by 10-15%, BV increase
- Squashing of bladder, ↑ filtration rate, stress incontinence
- Increase in Oestrogen promotes tissue development
Problems with implantation and placenta: Gestational trophoblastic tumours - rare?
“Hydatiform mole” Overgrowth of trophoblast. Lack of genetic material to form embryo. Pregnancy growth look “bigger than stage”
Benign. Very rare cases can lead to choriocarcinoma
Problems with implantation and placenta: Ectopic pregnancy - 1:90?
Implantation in uterine tubes : “normal” pregnancy signs.
Unilateral pain, displaced pain in shoulder, vaginal bleeding or discharge.
Detected in ultrasound. Pregnancy has to be terminated. Tube rupture can be fatal
Problems with implantation and placenta: Pre-eclampsia - 1-5:100 (mild), 1:200 severe?
From 20 weeks or post-birth
High blood pressure and proteinuria: headache, vision problems, vomiting and swelling. May cause pain below ribs.
Pregnancy monitored. May induce early.
Problems with later pregnancy: Gestational Diabetes - 4-5:100?
Thirst, hunger, tiredness. Increased sugar in the urine.
Elevated blood glucose (insulin resistance)
Problems with later pregnancy: Gestational hypothyroidism - 2.5:100?
Decreased TSH levels. Symptoms similar to normal pregnancy: tiredness, mood changes so difficult to detect
Problems with later pregnancy: Obstetric cholestasis - 1:140?
Pruritis (itching), leakage of bile salts into the blood stream. More common with multiple pregnancies.
Problems with later pregnancy: Gestational transient thyrotoxicosis - 2-11:100?
Persistent vomiting, weight loss, tremors. Increased T4(TH) levels as hCG stimulates T4 production. May resolve at 20 weeks. Associated with Hyperemesis Gravidarum
What is the route to implantation?
1.Fertilisation results in a zygote
2.Presence of protective layer (Zona Pellucida) until the uterus is reached
- Cell division increases the number of cells in the ball, not the size of the ball
- Ball of dividing cells is a Morula
5.Blastocyst (a hollow ball) hatches from zona pellucida for implantation
- Implantation between the secretory glands
- Implantation is more likely in the upper quadrants
Implantation:
how does embedding of pre-embryo and extra-embryonic membranes into the uterine wall occur (step 1)?
Process begins with the attachment of the blastocyst to the uterine wall (approximately d6 post-fertilisation). Hyaluronic acid from blastocyst aids process
Implantation:
how does embedding of pre-embryo and extra-embryonic membranes into the uterine wall occur (step 2)?
Site of attachment: anterior or posterior uterine wall. Anywhere! Implantation is most likely to occur in the upper quadrants of the uterus
Implantation:
how does embedding of pre-embryo and extra-embryonic membranes into the uterine wall occur (step 3)?
Generally between secretory glands (uterus is in secretory phase)
Fully embedded (implanted) by day 14 (day 28 LMP)
Day 5-9 implantation: different cell types?
As the blastocyst starts to implant, the structure is continuing to grow in complexity
The outer cells (trophoblast) start to differentiate ad set up two layers: the cytotrophoblast and the syncytiotrophoblast
What is a cytotrophoblast?
More densely packed cells with more obvious cell structure. Will create the villi of the placenta
(d5-9 implantation)
What is a syncytiotrophoblast?
Outer, invasive cells. Cells are not dense but “loose”, so form gaps/holes. Lacunae
Creates the layer separating the fetus from the maternal blood.
(d5-9 implantation)
Day 9 implantation: developing the placenta?
Vacuoles begin to form in the syncytiotrophoblast (Lacunae)
Development of the extraembryonic membranes:
- Amniotic cavity expands
- Formation of a yolk sac
Day 13 (d27 LMP) implantation: developing placental function?
Extraembryonic cavity grows and expands
Mesoderm: crosses at umbilical stalk to line the extraembryonic cavity to create the chorion
Syncytiotrophoblast produces human ChorionicGonadotrophin (hCG)
Cytotrophoblast forms villi, invading the syncytiotrophoblast
Maturation of the placenta?
Villi increase at the fetus to form the Chorion frondosum and create the placenta for exchange.
Amnion and chorion fuse (amniochorionic membrane)
Chorion laeve opposite the fetus is smooth and fuses with the uterine wall
Placental circulation?
Maternal blood flows into intervillous lakes (not lacunae)
chorionic villi (Villous trees) grow into lakes
Blood flows into these capillaries from the embryonic heart, via the umbilical arteries.
Fetal blood picks up oxygen and nutrients from the maternal blood. Returns to fetus
Fetal blood (Hb)has a higher affinity for Oxygen
Fetal blood supply relatively deoxygenated
Maternal and Fetal blood supplies ALWAYS separated by syncitiotrophoblast
Placental function: protection?
Support growth of the fetus:
Gas exchange (respiration)
Nutrition
waste exchange (excretion)
Placental function: hormone production?
hCG (till ~20 weeks)
Progesterone
Oestrogen
Placental prolactin
Placental lactogen (glucose availability)
Relaxin (pregnancy accommodation and labour)
Placental growth?
Maternal resources primarily support PLACENTAL growth in the first trimester. Resources to embryo are minimal.
Placental function and growth is determined in first trimester.
Increased weight gain and support of growth in last 2 trimesters comes from fetal growth. In the 1st trimester embryonic growth is relatively small: even though this the most vulnerable period of development.
When do placental development problems become apparent?
after the first trimester when fetal demand on the placenta and maternal resources becomes significant.
Placenta creates a semi-permeable barrier. What may this mean for the immune response?
Immune response occasionally initiated: resulting in an attack on fetal blood cells causing:
Haemolytic disease of the fetus. When mother is Rh - and father is Rh +, resulting in Rh + baby. Rarely occurs now due to testing and treatment.
Severe anaemia → oedema → hydrops
What maternal events occur week 0-4 (LMP)?
- Ovulation = d14. Insemination can occur several days pre/post ovulation
- Early pregnancy factor detected in maternal blood at 2-3d post fertilisation (= week 3 LMP)
- Human Chorionic Gonadotrophin (hCG) is detectable early in week 4 LMP (8d post-fertilisation)
- Week 4: placental hormones start supporting corpus luteum
- hCG insufficiency may lead to loss of pregnancy (58% attrition)
What Pre-organogenesis events occur week 0-4 (LMP)?
Fertilisation
Week 3 (d5-9) blastocyst starts to implant
End of week 4 (d12-14), three embryonic layers begin to form: Gastrulation. (HFEA defines this as start of life as an embryo.)
End of week 4 (d12), implantation is complete. May get maternal “spotting”; small amount of blood lost.
Early feto-maternal circulation
What does HFEA define as the start of life as an embryo?
Once Gastrulation occurs: three embryonic layers begin to form (basic body plan)
Problems that may occur in the first 4 weeks of pregnancy resulting in embryo loss?
Placental hormones are not produced at sufficient levels to maintain placenta.
Genetic problems mean that cells don’t replicate or survive
Cell adhesion issues:
- In some cases the embryonic tissue splits, or two eggs are ovulated and released, resulting in twinning
Gastrulation related conditions that may arise from early events: Caudal dysgenesis?
lack of caudal mesoderm (causing fusion of lower half in some cases - mermaid babies). Association with maternal diabetes: 1:350 vs 1:1000.
Severe case known as Sirenomelia
Gastrulation related conditions that may arise from early events: Situs inversus?
1:10000
Reversal of internal organs (eg heart on right side, intestinal twisting, etc).
May be underdiagnosed worldwide
Gastrulation related conditions that may arise from early events: Situs ambiguous?
partial malrotation. Contributes to 3% of congenital heart disease
Gastrulation related conditions that may arise from early events: Sacrococcygeal teratoma?
origins in primitive streak causing a mass tumour? 1:40000
What embryogenesis events occur week 4-6 (LMP)?
Neurulation initiated in week 2-3
Somites develop (will become part of the torso MSK system)
Formation of blood vessels and cells in the yolk sac
Heart tube starts to beat in week 5
Neural tube closure
Heart valves form in week 6
Limb buds appear
5mm and 20mg by week 6
Outline Cardiac development of the embryo?
The heart starts off as a cardiac tube, which swells and loops to form a more complex, compact structure.
Growth in specific areas leads to separation of the tube into 4 chambers.
- Vitelline veins come up and form the atrium chambers, sinus venosus and truncus twist to form ventricles, and finally the valves form and split the chambers as well as the arteries.
What embryogenesis events occur weeks 6-8 LMP?
Brain development progressing; brain and spine separate into distinct regions
Gut tube formed in gastrulation splits into Oesophagus and trachea, with lungs budding from the trachea.
Ureteric bud, and Metanephric tissue begins to form the kidney
Limbs have distinct regions.
Craniofacial development from neurocrest cells.
What causes Neurological and craniofacial problems that may arise from weeks 4-8 pregnancy: alcohol?
Maternal alcohol consumption affects brain development: developmental delay and behaviour implications . It also affects craniofacial development.
What causes Neurological and craniofacial problems that may arise from weeks 4-8 pregnancy: neurotube disorders eg spina bifida
Lack of maternal folate (folic acid) is the most common cause of problems with spinal and cranial closure.
Anencephaly (hole in the head) arises as a result of the failure of NT closure: amniotic fluid is corrosive to neural tissue.
What problems may arise from 4-8 weeks of pregnancy: Renal agenesis?
kidney(s) absent
What problems may arise from 4-8 weeks of pregnancy: Polyhydramnios?
Polyhydramnios (too much amniotic fluid) detectable on scan: generally unexplained but may be a sign of tracheal atresia or fistula. (Maternal oedema, breathing problems)
What problems may arise from 4-8 weeks of pregnancy: structure development?
Problems with lung bud or bronchi formation
Various cardiac problems related to looping and partitioning: atrio-ventricular problems, valve malformations
Limb malformations.
- Babies with limb problems often have cardiovascular problems as well
Week 8-12 LMP pregnancy: embryo to fetal transition? (Step 1)
Tooth buds form (visible in jaw of 1st scan)
Ossification of long bones
Pituitary forms from neural and ectodermal tissue
Separation of heart into 4 chambers
Primitive Germ Cells arrive in gonadal ridge, genital tubercle and gonads form
Kidneys produce “urine”
External genitalia is advanced but incomplete; major structures form in week 12. Prediction of sex without karyotype is unreliable at this stage.
Week 8-12 LMP pregnancy: embryo to fetal transition? (Step 2)
Physiological hernia as intestines form. And extrude into amniotic fluid. Retract by week 11-12
Thyroid and pancreas are developed. Insulin produced.
Bile produced by liver
Fetal reflexes
Key elements of the lung are present
28mm and 2.7g in week 10
31mm by week 12.
What problems may arise during pregnancy from 8-12 weeks?
Congenital endocrine disorders
Caridac Septal malformations (eg Holt Oram syndrome)
Omphalocoele (2.5:10000): Gastro Intestinal Tract fails to return to body cavity after physiological herniation. Often associated with other complications and high mortality (25%)
Gut malrotation: volvulus (nothing can pass through gut, if arteries blocked in this then death of tissues occur, surgery needed)
Differences in sexual development: lack of gonads, lack of gonad migration, differences in external genitalia.
Fetal development Week 12-16 LMP: Transition phase from first to second trimester (4th month)?
80mm
Heart beat can be heard with a stethoscope
Fetal “breathing”
Antibody production
Face nearly fully developed
Muscles and nerves in most systems are developing strength
External genitalia clearly visible
Pregnancy bump may be visible
What Problems may arise from 12-16 weeks pregnancy?
Eye problems eg intrauterine infection can cause congenital cataracts. Persistent fetal vasculature if vasculature doesn’t regress in 2nd trimester
Ear problems
Teeth problems
Immune system problems: primary immunodeficiency
Brain development: development of layers. Neural development continues throughout development so can be affected at any stage in the process, leading to behavioural problems, movement and muscular problems.
What occurs in Fetal development week 16-20 LMP?
Myelination of neurones
Circulation functional
Meconium (cells, digestive secretions and amniotic fluid) collects in the bowels
Sleep and wake periods
Brown fat laid down. Vernix forms on skin
Placental development complete
What problems may occur weeks 16-20 LMP?
The majority of problems that develop in the latter stages tend to be functional. Affecting glands, hormones, neural connections, cell development
Neurological
Endocrine
Immune
Gastrointestinal
Blood cell production (moves to bone marrow wk22)
How do hormones stimulate labour?
Placental production of Oestrogen, Relaxin, Progesterone and Corticotrophin Releasing Hormone increases
Oestrogen increases “excitability”
Oxytocin receptor number increases
Release of Prostaglandins
Pressure of fetus on cervix
What are the three stages of labour? Briefly what occurs in these stages?
Dilation (10 cms): contractions 2-6 per hour, 30s duration, amniochorion ruptures
Expulsion: contractions every 2-3 min, 60s duration
Placental expulsion: sustained contraction
Problems may arise at birth: Atelactasis- alveolar collapse (lung collapse) is common with preterm births and can lead to what?
- Respiratory Distress Syndrome- 20% of preterm deaths
Tachypnoea (rapid breathing)
Association with maternal diabetes mellitus
- Transient tachypnea of new-born (TTNB) – 0.5-4% of all neonates.
retention of lung fluid.
Resolves with Oxygen therapy and antibiotic treatment. Link to Caesarian births.
Define control of fertility in terms of infertility?
natural, pharmaceutical, surgical and barrier methods
Define success in terms of infertility?
Potential (fecundity) and Outcome (fertility): affected by age, general health and previous pregnancies, social factors, inequalities in care, access to care, socioeconomic factors, education
Define safety in terms of infertility?
sex and birth are dangerous things: sexually transmitted disease, infection, problems with delivery and pregnancy, miscarriage. Risks can be controlled and minimised with good healthcare and education
- What is birth control about?
- What does this enable/control?
- Reproductive control
- Increased reproductive choice links to improvements in ecology, economics, equality and social change. Unregulated fertility is a significant contributor to infertility
What is control of fertility about?
Choosing when to have a family, and what size of family to have
Allowing people to have families who would otherwise experience difficulties:
Fertility treatments may aid people to have families who otherwise would experience difficulties. What may these be?
Family history of genetic conditions
Illness (current or historical)
Infertility
Post mortem
Same sex relationships
Separation (prison, etc)
Single parents
Transgender parents
When is a couple defined as infertile?
Following 12 months of trying to conceive
When is an individual eligible for infertility treatment?
after 2 years, may be sooner if secondary infertility , with age as a possible factor
Who can be infertile? What type of problems could occur due to this/
Multifactorial: male, female, combination, unexplained
Affects 88 million couples, 186 million individuals (WHO)
Male infertility only recognised in the latter half of the C20
50-70% asymptomatic.
Causes problems for both parties: emotional, medical interventions (burden on female), guilt etc.
Why may a male be infertile?
Sperm quality
Absence or blockage of ducts
Lack of gonadal tissue (Testes)
Illness or Sexually Transmitted Diseases ie chlamydia
Sperm destruction
No sperm produced
Lack of ejaculation
Low testosterone
Medications
Why may a female be infertile?
Age (of oocyte)
Problems with oocyte maturation and/or ovulation (oocyte or hormonal) (Polycystic ovary syndrome - due to higher levels of oestrogen)
Lack of gonadal tissue (Ovaries)
Lack of uterus or differences in uterine anatomy
Stage of uterine development (hormonal) ie mismatch of ovarian and uterine cycles
Blockage of uterine tubes
Stress- physical and mental
Uterine scarring
Endometriosis and Pelvic Inflammatory Disease (PID)
Cervical mucus/environment
Medications
BMI (Low and high)
Why may both males and females be infertile? (Combined)
Incompatibility ie uterine pH
Antibodies to sperm (♀ or ♂)
Medications
Knowledge and opportunity
Genetics: embryonic lethality
Are fertility rates the same worldwide?
No.
Irregulated fertility → infertility
Infection, damage, insufficient recovery
Population density affects fecundity negatively: multifactorial and multigenerational
- Richer/high infrastructure countries = 15%
- Tropical Africa (less infrastructure) = 30-40%
What is secondary infertility?
Majority of people experiencing infertility have already had a child: 1.9% females 20-44 experience primary infertility versus 10.5% for secondary.
Physical factors of secondary infertility?
Age
Underlying health conditions may have worsened: medications may be interfering as well
Weight may have increased
Scarring from previous pregnancies
Fibroids
Damage from infections: Pelvic Inflammatory Disease (PID)
Psychological / Social Factors of secondary infertility?
Psychosocial
Attitudes from community less supportive
Pressure on parents as see it as a “bigger” failure
Fertility treatment requirements?
Donation/extraction of sperm
Donation/extraction of oocytes
Synchronisation of cycles
Surrogate parent (where there are problems with uterus or giving birth)
What considerations are taken when giving fertility treatments?
Screening for infectious disease: sexually transmitted diseases, HIV, blood-borne viruses, hepatitis B and C, human T cell lymphotropic viruses (known to cause a type of cancer).
Family history of Disease/genetic testing
Pregnancy
Hyperstimulation of ovaries
Who regulates and licenses fertility procedures in the UK?
the Human Fertility and Embryology Authority (HFEA) and the Human Fertility and Embryology Act 1990
Assisted fertility treatments: what is IUI? When/who researched this?
Artificial insemination (AI or IUI):
1790s Dr John Hunter
Inseminated with epididymal sperm
What does Artificial insemination (IUI) treat?
Treats idiopathic infertility, paraplegia, obstructed vas deferens, long separation or illness, same sex couples or single women and post-mortem
How successful is Artificial insemination (IUI)?
15-30% success in cycles: dependent on sperm quality (morphology, motility, direction, speed)
Cheaper than IVF, fewer procedures
How does artificial insemination (IUI) work?
Sperm placed high in the uterus
Bypasses “hostile” mucous
Overall, 60-70% success over 6 cycles
Success depends on sperm count, quality. Frozen sperm has no effect.
Average success per cycle for artificial insemination (IUI)?
15.8% for women under 35
11.0% for women aged 35-39
4.7% for women aged 40-42
1.2% for women aged 43-44
0% for women over 44
In Vitro Fertilisation (19702)?
Louise Joy Brown, conceived by IVF in Oldham General Hospital
Technology had been in development for 20 years+ Steptoe and Edwards
Sperm and eggs removed and fertilisation occurs outwith the body.
Healthy embryo is implanted in the uterus
When is In Vitro Fertilisation (1970s) offered?
Offered to those who have not conceived after IUI.
Eligibility (for NHS) of IVF?
2 years of unsuccessful attempts to conceive
Females must be <43
had 12 unsuccessful rounds of IUI
Where genetic testing is required
Blocked uterine tubes
Step 1 IVF?
Hormonal treatment to suppress natural (endogenous) cycle:
Gonadotrophin (Gn) RH agonists to inhibit pituitary function
GnRH antagonists to inhibit LH/FSH release
Step 2 IVF?
Exogenous hormones to stimulate/control ovulation:
- growth of oocytes. By Follicle Stimulating Hormone for 10-12 days or clomiphene citrate (not good with PCOS)
- maturation of oocytes (artificial LH surge) : hCG- human Chorionic Gonadotrophin)
Step 3 IVF?
Monitoring of oocytes by ultrasound and harvesting of oocytes (aspiration) completed transvaginally.
Step 4 IVF?
Hormones given to prepare uterus (Progesterone) by injection or vaginally. Oestrogen can also be given
Step 5 IVF?
Aspiration from the ovary is followed by incubation with sperm for 12-16 hours.
Step 6 IVF?
Evidence of a polar body is indicative of a healthy zygote. This can be collected for preimplantation genetic testing.
Step 7 IVF?
Viable zygotes cultured for several days (up to 6d), until a healthy blastocyst forms. Transfer to uterus by catheter. Transplantation number is limited by the UK HEFA
Summary of fertilised egg quality and staging in IVF - day 1-6?
Day one: Fertilised egg with 2 pronuclei
Day two: 4 cells
Day three: 6-8 cells
Day five: Blastocyst. A hollow ball of cells with good trophoblast and Inner Cell Mass (ICM). Removal of trophoblast for PGT
Day six: Blastocyst “hatches”
Summary of fertilised egg quality and staging in IVF - day 5-5.5?
Implant day 5-5.5.
The ICM must have a reasonable number of cells
The trophoblast must have a number of well-connected cells
How does Transgender IVF overview?
Options vary depending on medical transitioning ie may need to freeze eggs or sperm before surgery
Not always supported by local trusts
How does Transgender IVF overview: transgender women?
Transwomen may need clomiphene citrate or hCG injections to stimulate sperm production. Long-term hormone treatment may adversely affect sperm production
How does Transgender IVF overview: transgender men?
need to come off testosterone (3-6 months withdrawal) as it is damaging to the development of the fetus. Some transmen will start to cycle, some will need hormonal treatment for egg retrieval and to get IVF and implantation into someone’s uterus (surrogacy).
Effect of removal of testosterone will have an effect on mood, mental health and body shape that people find upsetting and difficult; alongwith the usual risks of Ovarian Hyperstimulation Syndrome (OHSS)
What problems may occur with IVF?
Emotional
Expensive
Uncomfortable and invasive
Superovulation can lead to multiple pregnancies without contraception
Multiple birth (>1 blastocyst transplanted)
Ectopic Pregnancy risk increases
Problems with IVF: Ovarian Hyperstimulation syndrome (OHSS)
Increased permeability of capillaries
Oedema: tissue and pulmonary
Renal failure
- 8% mild
- < 1% severe
About how many sperm from ejaculate make it to the isthmus?
100
Why may no sperm in semen occur?
Vasectomy
STD such as chlamydia
Chemotherapy treatment
Unable to ejaculate
Antibodies to sperm
What may occur if there is an absence of ejaculate or no semen in ejaculate?
Sperm retrieval is required; Surgical sperm extraction or aspiration
Involves aspirating semen from the testicle or epididymis. Sometimes a section of tubule is removed from several sites and sperm removed under the microscope
What is the sperm retrieval technique based on acronym:
PESA
MESA
TESA
TESE
Micro-TESE
Percutaneous Epididymal Sperm Extraction
Microsurgical Epididymal Sperm Aspiration
Testicular Sperm Aspiration
Testicular Sperm Extraction
Microscope-assisted Testicular Sperm Extraction
Procedure of collection of sperm based on the technique: Percutaneous Epididymal Sperm Extraction
PESA
Sperm aspirated from the epidydymis
Procedure of collection based on the technique: Microsurgical Epididymal Sperm Aspiration
MESA
Collection of sperm with use of a microscope directly from epidydymal tubule
Procedure of collection of sperm based on the technique: Testicular Sperm Aspiration
TESA
Sperm aspirated from testes directly through the scrotum (Non-obstructive)
Procedure of collection of sperm based on the technique: Testicular Sperm Extraction
TESE
Biopsy of testes, removal of sperm from biopsy (Non-obstructive)
Procedure of collection of sperm based on the technique: Microscope-assisted Testicular Sperm Extraction
Micro-TESE
As above, but use of a microscope to identify areas more likely to contain mature sperm (enlarged)
How do antibodies to sperm arise: males?
Vasectomy
Damage to the sperm-blood barrier
Dysfunction of Sertoli cells (SB barrier)
How do antibodies to sperm arise: females?
Damage to mucosal membranes
Exposure to sperm in the digestive tract
Infection
Consequences of antibodies to sperm resulting in infertility?
destruction of sperm
clumping of sperm; disrupting travel to oocyte
IVF modifications, what is Intracytoplasmic Sperm Injection (ICSI)?
When sperm quality is low
Sperm injected straight into harvested egg
All other parts of IVF are as normal, although the oocyte may be harvested before maturation, and matured in the lab to reduce female treatments (In vitro Maturation; IVM)
Why would there be a Low sperm quality during IVF, causing Intracytoplasmic sperm injection to be used?
Poor motility
Low number
Abnormal morphology
Frozen rather than fresh sperm used
IVF modifications, what is Frozen Embryo Transfer (FET)?
Problems with implantation. Gives time for body to recover
If Preimplantation Genetic Testing is being carried out on Trophectoderm cells
If a number of high quality embryos were collected but further full treatment is not an option
For future years to increase family
May have increased success rate, decrease premature birth and maternal bleeding (Bhattacharya 2012, 2016)
