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Flashcards in clinical overview of IVF Deck (20)
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1

why is IVF needed?

tubal disease
ovulatory disorder
endometriosis
uterine
multiple female factors
male factors
multiples female and male factors
unxplained

2

what can be wrong with sperm?

oligospermia
asthenospermia
teratospermia
azoospermia

3

what is oligospermia?

low sperm count
deficiency of sperm cells in the semen.

4

what is asthenospermia?

reduced sperm motility

5

what is teratospermia?

abnormal morphology

6

what is azoospermia?

semen contains no sperm

7

how can sperm be collected?

PESA: percutaneous epididymal sperm aspiration
TESE: testicular sperm extraction

8

how can eggs be collected?

controlled ovarian hyper stimulation

9

why is pituitary down regulation needed in IVF?

to prevent premature LH surge
premature LH surge means less successful egg collection - not as many eggs to be collected at a lot die

10

how does a GnRH antagonist act?

it acts as down regulator of the pituitary
it stops GnRH binding to pituitary so LH and FSH are not secreted.
and therefore prevents a premature LH surge

11

how is ovarian hyper stimulation controlled?

1) choice of protocol
2)dose - dependant on age, body weight, ovarian reserve, astral follicle count.
3)follicular monitoring (scan, serum oestrogen, progesterone)
4)triggering ovulation

12

criteria for hCg injection and egg collection

hCG acts like LH to stimulate ovulation

- 3 or more follicles >17mm diameter
- 10,000 iu hCG
-transvaginal oocyte recover 36 hours later
-GA or sedation
-risks 1:2000

13

what are the steps that follow ovarian stimulation?

ovarian stimulation and monitoring
then egg collection
then sperm insemination or ICSI
fertilisation check day 1
embryo culture 2-5 days
embryo transfer (USS guided max 2 +/- cryopreservation)
luteal support (2 weeks progesterone)
pregnancy test

14

facts about embryo process....

critical process
dental technique
operator experience and learning curve
variety of catheters - no difference
USS (abdominal) guided better results
1-2cm from the fundus

15

why do we develop embryos to the blastocyst stage?

improve chance of pregnancy
single embryo transfers
stem cell research

16

what is luteal support?

Luteal support is the administration of medication, generally progesterone, progestins or GnRH agonists, to increase the success rate of implantation and early embryogenesis, thereby complementing and/or supporting the function of the corpus luteum.

17

early pregnancy assessment?

beta hCG at ovulations, 14 days and 21 days
low levels repeat at 48 hours
6 week and 8 week scan and then can refer back to the GP for ante-natal care

18

what clinical and laboratory success rate are measured?

clinical:
- pregnancy rate
-clinical pregnancy rate
-take home baby rate
-per cycle started/per oocyte retrieval/per embryo transferred
laboratory:
- fertilisation rate
-cleavage rate
-blastocyst formation rate

19

complications of IVF

multiple pregnancy
ectopic pregnancy
miscarriage
dissappointment

infection - rare
OHSS - rare --> triggered by hCG, increases when pregnancy occurs, can be manages medically, can be life threatening

20

what future research needs to be done for IVF?

- embryo culture systems
- time lapse morphokinetics
- metabolic proteomics
- epigenetic
- PGD / PGS
- embryo - endometrial dialogue