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Ob / Gyn 2 > Fertility Managment > Flashcards

Fertility Managment Flashcards

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1
Q

ART

A

Assisted Reproductive Technology

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2
Q

Define infertility

A

Inability to conceive after 12 months of unproducted intercourse

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3
Q

What is the #1 reason for infertility

A

Postponement of pregnancy until the later years

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4
Q

What is the primary cause relating to ovaries for the infertility in women

A

Ovulatory dysfunction

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5
Q

What is the secondary cause of infertility in women relating to ovaries

A

Inability to transport ova/embryo

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6
Q

The inability to transport ova/embryo is typically due to what

A

Blocked Fallopian tube

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7
Q

What are the uterine causes related to infertility in women

A

Congenital abnormalities (uterine anomalies)
Fibroids
Asherman’s

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8
Q

What are % of infertility is linked to women

A

40

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9
Q

What are the different causes of infertility in women

A

Ovarian
Uterine
Cervical
Immunologic

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10
Q

What % of infertility is linked to men

A

40

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11
Q

What are the causes of infertility in men

A

Varicocele
Testicular failure
Tubular obstruction

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12
Q

What are the different forms of testicular failure

A 
Mumps
Torsion
Orchitis
Testicular Ca
Frequent marijuana use
Undescended testes
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13
Q

What is another term for undescened testes

A

Cryptoorchidism

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14
Q

What is orchitis

A

Inflammation of the teste

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15
Q

What causes a tubular obstruction

A

Vas deferens not connecting to sperm

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16
Q

What makes up the other 20% of infertility

A

Unknown causes, which is when all the test of the male and female come back normal but the doctors do not know the cause

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17
Q

IUI

A

Intrauterine insemination

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18
Q

IVF

A

In vitro fertilization

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19
Q

ICSI

A

Intracytoplasmic sperm insertion

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20
Q

What are the services in ART

A

Ovulation induction
IUI
IVF
ICSI

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21
Q

What must a women have for ovulation induction ART

A

Patent Fallopian tubes

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22
Q

What causes the need for ovulation induction

A

Ovulation impairment, when no Graafian follicle is produced

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23
Q

What is US role in ART ovulation induction and why

A

Monitoring the cycle, as they are trying to achieve only one Graafian follicle

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24
Q

When assessing follicles on US, how are the assessed for ART

A

Measuring the 3 dimensions of the 3 largest follicles on each ovary
Checking the pouch of Douglas for ff

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25
In ovulation induction what are used to ensure ovulation occurs
Fertility drugs
26
Why is IUI done
Usually due to male infertility factors Unexplained infertility Donor insemination Same sex couples
27
What is US role in IUI ART
Gynaecology US not typically indicated | May be asked to assess uterus for congenital abnormalities
28
What is the definition of IVF
Fertilization in a glass or lab | Egg and sperm are fertilized outside the body
29
What are the reasons for IVF
Blocked Fallopian tubes Impaired eggs Impaired sperm Unexplained infertility
30
How many steps are there in IVF
6
31
What are the 6 steps of IVF
``` Initial lab and US investigations Ovarian suppression Ovarian stimulation Egg to oocyte retrieval Insemination Embryo transfer ```
32
What does step 1 of IVF involve
Lab- bloodwork, ovarian reserve testing US-assessing uterus, adnexa and ovaries Hysterosalpingogram Sonohysterogram
33
what is ovarian reserve testing
Insignt into number of eggs left or ovarian age | FSH
34
In ovarian reserve testing FSH should be what for indicating eggs are present
<10
35
In IVF US is assessing the uterus for
Fibroids | Congenital abnormalities
36
In US for IVF what is the adenxa being assessed for
HYDROSALPINX
37
US role in IVF for the ovaries is to assess for
Cysts- PCOS Ovarian cysts BAFC
38
BAFC
Baseline natural follicle count
39
What is the BAFC
The number of small natural follicles observed at the beginning of the menstral cycle
40
What BAFC indicated poor ovarian response
<10
41
HSG
Hysterosalpingogram
42
What is a HSG
X-ray, where dye or contrast is injected into the uterus
43
What is a HSG assessing for
Uterine cavity for congenital abnormalities | Patience of the Fallopian tubes
44
Why is HSG good for assessing the patency of the Fallopian tubes
Contrast spilling into the posterior cul de sac indicates that at least one fallopian is patent
45
SHG
Sonohysterogram
46
What is a SHG
Saline is injected into the uterus; US guided
47
What is a SHG assessment of
Uterine cavity | Patency of the Fallopian tubes
48
What is more reliable for assessing Fallopian tube patency, HSG or a SHG
HSG
49
What are the complications associated with HSG and SHG
Infection Fainting Spotting HSG- radiation and iodine allergy
50
What does step 2 of IVF involve
Downregulation | Ovarian suppression checks
51
What does downregualtion involve
GnRH agonist is given to stop natural ovulation Temporary state of menopause Prevents premature ovulation CONTROLS THE TIMING OF THE IVF CYCLE
52
What does an ovarian suppression check involve
Ultrasound to ensure no new finding such as an ovarian cyst has not occurred
53
What is step 3 of ovarian stimulation involve
Controlled ovarian stimulation
54
What is involved with controlled ovarian stimulation
Medication injected for 9-14 days US is preformed on days 4,7, 9, 11, 13 (9/11/13 only while on FSH) To monitor the size and number of follicles on each ovary Trying to achieve superovulation- with gonadotropins
55
What is step 4 of IVF
Egg retrieval
56
What is involved with IVF egg retrieval
Oocyte retrieval done under endovaginal guidance Patient is sedated Needle is inserted through vaginal wall Follicular fluid, cells and egg are aspirated into a tets tube Eggs are examined under a microscope for quality
57
What is step 5 of IVF
Insemination
58
What does IVF insemination involve
Semen is collected 1-3 hrs after egg retrieval | The embryologist assess the zygotes
59
ICSI
Intracytoplasmic sperm injection
60
What is conventional insemination in IVF
Done in a Petri dish
61
What does the embryologist assess the zygotes for in IVF
``` Cell division Timing of the division Cell size Cellular components Any fragmentation ```
62
What is step 6 of IVF
Embryo transfer
63
What days are embryos transferred in IVF after retrieval
3 or 5
64
What are day 5 embryos classified
Blastocyst
65
Why are day 5 embryos more preferable for IVF
Better assessment of implantation abilities | Usually only ONE embryo is transferred
66
What are the factors involved with determining the number of embryos transferred in an IVF cycle
Maternal age Quality of the embryos Previous fertility history
67
What is the sonographic contributions in ART
Confirmation of pregnancy and number | Around 6-8 weeks gestation
68
What is the sonographic protocol for ART
``` Ovulation induction -follicular monitoring Routine pelvic US Tracking the growth of follicles Checking the pouch of Douglas for FF ```
69
Why is a non lubricate/ non latex condom or probe cover used on a EV transducer
May contain spermicid and latex allergy
70
Is gel or lube used on the outside of the condom
No, only water is used
71
What are the different types of hormonal drugs used in ART
``` Clomiphene citrate Clomid Pergonal GnRH agonist hCG hMG ```
72
What is clomid
Increase FSH Acts like a normal cycle Produces one Graafian follicle
73
hMG
Human menopausal gonadotropin
74
What is pergonal
Stimulates FSH and LH | More than one follicle matures per cycle
75
What does a GnRH agonist do
Shuts off pituitary
76
What does hCG do in ART
Induces ovulation | Encourages implantation
77
If hCG is used in ART what can the patient not do
Take a pregnancy test right away to determine if they are pregnant because it will produce a positive test
78
ovarian hyper stimulation syndrome may occur with ___ and is caused by
drugs used in fertility management Higher incident rate when PERGONAL and hCG are used together -over production of theca luteal cysts
79
Ovarian hyper stimulation syndrome math result in
``` Ascites Pleural effusion Possible thromboembolic states -DVT’s Even shock and death ```
80
What is given after transfer
hCG is given on the day of transfer -than every other day for 3 doses Progesterone is continued until 10weeks gestation
81
Why is progesterone continued until 10 week gestation
Physicians want to maintain the placenta until the placenta hormones take over and can keep the pregnancy viable
82
Why is hCG given after embryo transfer and maintained for 3 doses
Encourages implantation
83
Unsuccessful IVF occurs when
Ovaries lack response to hormones No eggs in the follicular fluid Ova fail to fertilize or grow Failure to implant
84
What is the most common problem in an unsuccessful IVF
Failure to implant
85
Why are we more aware of pregnancy failure in IVF than the general public
Because IVF is so closely monitored
86
Cryopreservation
Good quality zygotes are cryopreserved in liquid nitrogen for later attempts at pregnancy
87
GIFT
Gamete intrafallopian transfer
88
GIFT is
Oocyte and sperm are injected into the ampulla of the Fallopian tube Usually done laparoscopically Sometimes done using transvaginal US Usually used when couples have unexplained infertility or endometriosis Considered more natural than IVF
89
ZIFT
Zygote intrafallopian transfer
90
ZIFT is
Modification to IVF | 1 day old zygotes are placed into the Fallopian tubes
91
What is the theoretical advantages of ZIFT
The embryo develops in the Fallopian tube

Ob / Gyn 2 (8 decks)

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