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MRCOG Subfertility > An overview of assisted reproductive technology procedures 2018 TOG > Flashcards

An overview of assisted reproductive technology procedures 2018 TOG Flashcards

1
Q

In 2015, what was the birth rate per embryo transferred?

A

21.5%

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2
Q

In 2015, what proportion of babies were as a result of IVF?

A

2.1%

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3
Q

In ovary, what is the impact of LH and FSH?

A

LH - theca cells - androgens (from cholesterol)

FSH - granulose cells - converts androgen to oestrogen - growth & proliferation of endometrium

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4
Q

In testes, effect of LH and FSH?

A

LH - Leydig cells - testosterone

FSH - Sertoli cells - increase spermatogonial number/matuatino into spermatocytes

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5
Q

In female where is progesterone produced? What is its function?

A

From corpus luteum
Endometrial decidualisation

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6
Q

Steps in assisted reproduction cycle>

A
  1. Pretreatment adjuvant strategies (W)
  2. Pituitary downregulation (W)
  3. Controlled ovarian hyperstimulation (W)
  4. Final follicular maturation trigger (W)
  5. Oocyte (W) and sperm retrieval (M)
  6. Embryology process (IVF/ICSI)
  7. Monitoring of embryos
  8. Intrauterine embryo transfer (W)
  9. Luteal phase support (W)
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7
Q

For which patients does NICE recommended hormonal pre-treatment?

A

Those undergoing GnRH antagonist down regulation to secedule ART treatment

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8
Q

For which patient does pretreatment with GnRH agonist for 3-6 months increase odd of clinical pregnancy? By how much?

A

Endometriosis associated infertility
4 fold increase

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9
Q

Which conditions need pretreatment with surgery?

A

Hydrosalpinx - salpingectomy

Uterine septum - hysteroscopic septoplasty

Intramural fibroid - distorting cavity or >50mm - myomectomy

Submucous fibroid - myomecotmy

Polyp - polypectomy

Intrauterine adhesion - adhesionlysis

Superficial Endometritis - Lap

Deep infilitrating - Sx relief only

Endometrioma - only if >50mm

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10
Q

2 main class of drug used for pituitary down regulation?

A

GnRH agonist (-relin) - inital flare then down regulation

GnRH antagonist

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11
Q

Graph showing different pituitary down regulation protocols

A
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12
Q

Its there a difference in birth rate with women wit stomal ovarian reserve between GnRH agonist/antagonsit. Difference in rate of OHSS

A

No difference in birth rate
Higher is of OHSS with agonist (do not use if predicted over-responder)

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13
Q

Which gonadotrophins can be used for controlled ovarian stimulation?

A

Human menopausal gonadotrophin
Recombinant gonadotrophin

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14
Q

Which markers can be used to produced ovarian response to controlled ovarian stimulation

A

AMH
AFC
Early follicular stage FSH

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15
Q

If expected over response?

A

Minimise OHSS risk
GnRH antagonist + minimal FSH stimulation

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16
Q

If expected normal response?

A

Maximise succes rate
GnRH agonist + standard Tx

17
Q

If expected under responder?

A

Minimise Tx burden
GnRH anttagnoist + Max FSH stimulation

18
Q

How is controlled ovarian stimulation monitored?

A

TVUS - unclear how often to perform. Most pre treatment, 1 week after stimulation and after maturation trigger

19
Q

How is final follicular maturation trigger achiecbed?

A

Pituitary downregualtioned stopped.
Drug given to mimic LH surgery - urinary hCG/ recombinant hCG or LH

20
Q

If high risk of OHSS what can be given as trigger

A

GnRH agonist

21
Q

How is oocyte retrival performed

A

TVUS with conscious sedations

22
Q

To obtain sperm from masturbation, how long should abstain from sexual activity before?

A

2-5 days

23
Q

What surgical procedures can be performed to obtain sperm are 1st line if obstructive azoospermia?

A

Percutaneous epididymal sperm aspiration

Microsurgical epididymal sperm aspiration

24
Q

What surgical procedures can be performed to obtain sperm are 1st line if non-obstructive azoospermia?

A

Testicular sperm extraction

Microsurgical testicular sperm extraction

25
Q

Which procedures can be performed by local anaesthetic

A

Percutaneous epididymal sperm aspiration

Testicular sperm extraction

All other GA

26
Q

How long after oocyte retrieval are sperm mixed with oocyte, how many sperm?

A

4-6 hours
25000-50000 soerm

27
Q

Indications for ICSI

A

Severe male factor infertility
Surgically retrieved sperm for azoospermia
Previous failed or poor fertilisation
Fertilisation of cryopreserved oocytes

28
Q

How are embryos evaluated

A

blastomere number, evenness and fragmentation using light microscopy

29
Q

When can the embryo be transferred?

A

Day 2-3 (2-8 cells)
Day 5-7 (64 cell/blastocyst state)

30
Q

Most common luteal phase support?

A

Progesterone (vaginal)

31
Q

When should pregnancy test be perfromed

A

2 weeks after oocyte retrival

32
Q

When is 1st scan performed?

A

Undertaken at 7 weeks from +ve hCG (unless previous ectopic and should be offered earlier)

MRCOG Subfertility (19 decks)

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