Assistive Reproductive Technology

Question 1

What is infertility?

Answer 1

failure to conceive after regular unprotected intercourse
-within 12 months in pts < 35 yrs old
-within 6 months in pts > 35 yrs old

Question 2

What happens to ovarian reserves with age?

Answer 2

ovarian reserves decline with age
-most important factor in female infertility is age
-as reserves decline, so do quality

Question 3

How does maternal age affect IVF success?

Answer 3

as we move up in maternal age, there is a significant decline in live birth rate

Question 4

What are the factors that may contribute to female infertility?

Answer 4

ovulatory disorders
tubal factors
endometriosis
cervical factors
unexplained

Question 5

What are the factors that may contribute to male infertility?

Answer 5

sperm production issues
genetic factors
ejaculatory dysfunction
lifestyle
environmental

Question 6

Why are we seeing an increase in infertility rates?

Answer 6

increased maternal age
starting families later
people talk about it and share

Question 7

What is ovulation induction?

Answer 7

letrozole or clomiphene
timed intercourse
with or without “trigger” short

Question 8

What is super ovulation?

Answer 8

ovaries are stimulated with hormones to produce follicles
goal: produce 2-4 eggs
often combined with IUI
medications used for SO and IVF are the same
-lower dose with SO

Question 9

What is intrauterine insemination?

Answer 9

inserting the sperm directly into the uterus
sperm are prepped prior to insertion
-separated in a centrifuge
-evaluated
-washed
may done +/- super ovulation

Question 10

What is intracytoplasmic sperm injection?

Answer 10

injecting the sperm directly into the egg
may be used for:
-low sperm count
-impaired sperm penetration
-anti-sperm antibodies
-previous IVF failure

Question 11

What are the steps in IVF?

Answer 11

tests & diagnosis
ovarian stimulation & control
egg retrieval
sperm collection/retrieval
fertilization
transfer
pregnancy test

Question 12

Describe the ovarian stimulation stage of IVF.

Answer 12

stimulation of ovaries with hormones to produce follicles
typical IVF stimulation lasts 8-14 days
intense monitoring:
-estrogen, progesterone, follicle development and size

Question 13

What are some FSH agents?

Answer 13

follitropin alpha
follitropin beta
follitropin delta

Question 14

What is an LH agent?

Answer 14

lutropin alfa

Question 15

What is the purpose of the control stage of IVF?

Answer 15

control to prevent premature ovulation using GnRH agonists or antagonists
-so that we get egg collection at the right time (tighter control over ovulation)

Question 16

What are examples of GnRH agonists?

Answer 16

leuprolide
nafarelin
buserelin

Question 17

What are examples of GnRH antagonists?

Answer 17

ganirelix
cetrorelix

Question 18

How do GnRH agonists work?

Answer 18

binding to pituitary receptors
induce release of large amounts of FSH and LH (flare-up)
increase GnRH receptors (upregulation)
prolonged use (7-10 days) = decrease in GnRH receptors and hence a decrease in gonadtropins

Question 19

How do GnRH antagonists work?

Answer 19

competitively binding GnRH receptors to prevent endogenous pulses on the pituitary
work relatively quickly (within hours of admin) and no “flare-ups” occur
d/c rapidly results in recovery of the pituitary-gonadal axis
highly dose dependent

Question 20

Which protocol is most common for ovarian stimulation?

Answer 20

GnRH antagonist protocol

Question 21

What is a good practice tip for IVF?

Answer 21

patients will be given a timetable
-ask if they have one and then put a copy on file

Question 22

What is a risk of ovarian stimulation?

Answer 22

ovarian hyperstimulation syndrome
-ovaries are over stimulated
-intensely monitored by clinic, modifications can be made
-very painful
-possibly detrimental

Question 23

What is the trigger shot used for oocyte retrieval?

Answer 23

HCG
choriogondatrophin alpha

Question 24

What is the role of the trigger shot?

Answer 24

matures egg and prepares for ovulation

Question 25

When does oocyte retrieval occur?

Answer 25

34-36 hours after trigger shot -timing is of the utmost importance -ideally retrieve 10-12 well developed oocytes

Question 26

What is luteal phase support?

Answer 26

progesterone to support the pregnancy -changes endometrium from follicular to luteal phase -helps create a ready wall for when embryo comes back

Question 27

When is sperm collection ideally done?

Answer 27

ideally obtained day of oocyte retrieval -collection of fresh sperm

Question 28

When should fertilization occur?

Answer 28

18-24 hours after exposing oocyte to sperm

Question 29

What happens once fertilization has occured?

Answer 29

embryos are transferred to a growth medium, assessed & incubated for 24 hours

Question 30

When does transfer occur?

Answer 30

day 2 or 3 (embryo transfer) day 5 (blastocyst transfer)

Question 31

How many embryos/blastocysts are transferred?

Answer 31

usually 1 or 2 -3 to 4 may be transferred

Question 32

What are the side effects of the medications used in IVF?

Answer 32

headache mood changes injection site discomfort, bruising hot flashes breast tenderness wheal response bloating constipation nausea, cramping fatigue and exhaustion

Question 33

What are the success rates of IVF?

Answer 33

60-70% of couples treated for infertility end up with a healthy child

Question 34

Why use cryopreservation?

Answer 34

donor and carrier synchronization/timing issues suboptimal uterine environment during start of ART issues discovered during process preservation of reproductive material decreases future costs if lots of embryos to freeze freeze to decrease damage of repeated procedures if retrieval required