Fertility - ART, Infertility investigations, OHSS

Question 1

Ovulation induction
-what is normal
-what is not normal

Answer 1

Follicular phase
-FSH - multiple follicles develop
-O - released by follicles => inhibit FSH release
Luteal phase
-LH - release stimulated by O, triggers ovulation

Hypothalamic issue - hypothalamic amenorrhea
Hormones released but not balanced - PCOS
Ovarian issue - POI

Question 2

Management of ovulation induction
-conservative
-medication

Answer 2

Exercise, weight loss
-1st line for PCOS

Medication
-letrozole - reduce negative feedback of O => increased FSH
-clomiphene - reduce negative feedback of O => increased FSH
-gonadotrophin therapy - has increased risk of OHSS and multiple pregnancy

Question 3

Ovarian hyperstimulation syndrome
-what is it
-presentation
-investigations
-management

Answer 3

Ovaries are overstimulated, release chemicals that make the blood vessels more permeable => fluid shifts
OFTEN CAUSED BY GnRH t TREATMENT

Mild - Abdo pain, bloating
Moderate - N/V, ascities on US
Severe - clinically ascitic, oliguria
Critical - thromboembolism, ARDS, anuric, tense ascities

Mild/moderate - NSAIDs, paracetamol, fluids
Severe/critical - NSAIDs, paracetamol, strict monitoring of fluids, paracentesis, AC

Question 4

Semenalysis
-what do patients need to know
-what is assessed

Answer 4

Min2-max7 days abstinence

Volume
pH
Sperm conc
Morphology
Motility
Vitality

Repeat test in 3 months - takes around 64 days for cycle of sperm production to complete

Question 5

Infertility
-causes
-investigations
-management

Answer 5

Male factor - 30%
Unexplained - 20%
Ovulation failure - 20%
Tubal - 15%
Other - 15%

Semenalysis
Serum P 7 days before next period - indicates whether ovulation has occured

Folic acid
BMI - 20-25
Regular intercourse 2-3days
Smoking, drinking cessation

Question 6

Options for ART

Answer 6

Intrauterine insemination - introduce sperm directly into uterus

Intracytoplasmic sperm injection - sperm introduced directly into egg with micropipette

Preimplantation genetic diagnosis is often done in IVF
-embryos identified free from the condition of concern will be used

Surrogacy
-full - party carrying fetus is not genetically related to implanted fetus
-partial - party carrying fetus is genetically related to implanted fetus

Question 7

Vasectomy
-procedure
-management
-complications

Answer 7

LA procedure, but can be GA
-not an immediate form of sterilisation
Can be reversed

Semenalysis 2x after procedure - must be clear before they can have unprotected sex

Bruising, hematoma
Infection
Sperm granuloma
Chronic testicular pain