3.5.3 Assisted Reproductive Treatments

Question 1

Describe the assisted reproductive technique of IVF and the indications of it.

Answer 1

IVF – in vitro fertilization, stimulate ovulation with hCG → US guided oocyte retrieval → IVF

Indications – tubal or pelvic factor, severe male infertility

Question 2

What are the characteristics of egg cryopresentation?

Answer 2

Question 3

What are the characteristics of rFSH stimulation?

Answer 3

Question 4

What are the characteristics of Clomiphene citrate?

Answer 4

Question 5

What are the main causes of infertility?

Answer 5

Male factor - 35%

Female - 50% - Tubal/pelvic path - 35%

Anovulation/oligoovulation -15%

Question 6

What are some possible uterine anomalies?

Answer 6

Bicornuate

Didelphys

Unicornuate

Septate

T-shaped

Question 7

What are the characteristics of IVF?

Answer 7

Requires careful monitoring

Risk of OHSS

Embryo transfer 5 days after retrieval

Can control number of embryos transferred

Question 8

What is the risk for multiple gestation with Clomid and rFSH?

Answer 8

Clomid - 7% twins, 0.5% triplets

rFSH - 20% twins and 5% triplets

Question 9

What are some possible causes of occluded fallopian tubes?

Answer 9

PID - particularily chlamydia

Endometriosis

Question 10

If patient doesn’t want kiddos and has PCOS what are some treatment options?

Answer 10

OCPs, spironolactone, mirena IUD, provera,

Question 11

What happens to the rate of fetal aneuploidy by maternal age?

Answer 11

Question 12

What are teh important characteristics of oligospermia?

Answer 12

Question 13

How does paternal age relate to fertility?

Answer 13

INcrease in spermatic DNA fragmentation but no increase in aneuploidy

Greater the 40 have greater risk of autism

Question 14

What is the treatment of endometriosis?

Answer 14

If not wanting kids

Surgical fulguration/excision of endo

Menstrual suppression

If wanting kids - IVF if tubes are blocked, consider suppression prior to cycle w/ GnRH agonist

Question 15

What is recurrent pregnancy loss?

Answer 15

2 or more sAB (clinical losses)

Question 16

What is ICSI?

Answer 16

Intracytoplasmic sperm injection

Question 17

Describe the hormonal evaluation for a female with reproductive issues?

Answer 17

Question 18

What does HSG give information about?

Answer 18

Uterine cavity, anomalies, tubal patency and presence of hydrosalpinges

Question 19

What is the most common cause of teratospermia?

Answer 19

Varicocele

Question 20

What are the characteristics of endometriosis?

Answer 20

Question 21

What are some of the psychological impacts of infertility?

Answer 21

Question 22

What are the characteristics of a male semen analysis?

Answer 22

Question 23

What is the use of Hysteroscopy with laparoscopy?

Answer 23

Gives same information and can be therapeutic.

Can treat endometriosis, fibroids etc

Consider in patients with severe dysmenorrhea

Question 24

What is the definition of infertility and what is the dependence on age?

Answer 24

Def - inability to conceive after one year

Age dependence - After age of 35 and treatment warrented after 6mo. After 40 many recommend referral to specialist after 3mo.

Question 25

What are some possible treament options for tubal disease?

Answer 25

IVF Tuboplasty Tubal reanastamosis - if history of BTL

Question 26

What are the characteristics of PCOS?

Answer 26

Complex ovulatory dysfunction involving the hypothalamus, pituitary, ovaries, and other tissues all contributing to an endocrine imbalance associated with hirsutism and infertility

Question 27

Describe the epidemiology of infertility.

Answer 27

Question 28

What are some possible causes of azoospermia?

Answer 28

Question 29

What are the semen analysis parameters?

Answer 29

Question 30

What are possible causes of motility dysfunction in male sperm?

Answer 30

Question 31

What is fecundity?

Answer 31

Probability a single cycle will result in live birth

Question 32

What are some possible causes for low volume of semen?

Answer 32

Obstruction Absence of vas deferens Retrograde ejaculation Androgen deficiency

Question 33

When would it be a good idea as a physician to refer a couple to a specialist for fertility issues?

Answer 33

Question 34

What all goes into a female infertility evaluation?

Answer 34

Question 35

How does age relate to fertility?

Answer 35

Women's fertility decreases with age After 34 - 11% infertility At 40 - 33% infertility At 45 - 87% infertility

Question 36

Describe the assisted reproductive technique of controlled ovarian stimulation.

Answer 36

clomiphene and letrozole, monitor follicle growth with US and estradiol level

Question 37

What are some ways to preserve fertility?

Answer 37

Safe sex practices Stop smoking EtOH in moderation Decrease caffeine intake Maintain healthy weight