Infertility and assisted conception Flashcards Preview

Repro > Infertility and assisted conception > Flashcards

Flashcards in Infertility and assisted conception Deck (24):
1

list indictions for assisted conception treatment

fertility preservation in cancer patients
treatment to avoid transmission of blood borne viruses between patients
pre implantation diagnosis of inherited disorders
treatment of single parents or same sex couples

2

before treatment begins
alcohol
weight
smoking
folic acid
rubella
smear
occupation factors
drugs
screen for what
assess what

females limit to 4 units/wk
19-29 both male and female
stop smoking
0.4g/day pre conception
check if immune
cervical smear
exposure to hazards
OTC, prescribed, recreational
blood borne viruses - hepB/C, HIV
assess ovarian reserve - antral follicle count or AMH

3

what treatments are available

donor insemination
intra uterine isemination
in vitro fertilisation
intra cytoplasmic sperm injection
fertility preservation
surrogacy

4

indications for IUI and method

unexplained infertility, mild or mod endometriosis, mild male factor infertility
natural/stimulated cycle
prepared semen inserted into uterine cavity around time of ovulation

5

IVF indications

unexplained >2 years
pelvic disease (endometriosis, tubal disease, fibroids)
anovolulatory infertility
male factor infertility if >1x106 motile sperm

6

down regulation in IVF is what

artificial menopause

7

how is down regulation done

synthetic gonadotrophin releasing hormone analogue or agonist which is administered as a spray or injection

8

what does down regulation do

reduces cancellation from ovulation and improves success rate
allows precise timing of oocyte recover by using HCG trigger

9

SE of down regulation

hot flushes and mood swings
nasal irritation
headaches

10

what is the next step for IVF and how
what does it do
S/E

ovarian stimulation - gonadotrophin hormone containing synthetic or urinary gonadotrophins (FSH/LH)
can be self administered s/c injection
causes follicular development
mild allergic reaction and ovarian hyper stimulation syndrome

11

what happens if there is a slow response

repeat scan 72 hours later

12

what happens if there is a poor response

increase dose of FSH
assess for hyper stimulation
plan date/timing of HCG injection

13

how is a sperm sample taken

abstinence for 72 hours beforehand
mens room in the ward or at home

14

assessment of the sperm sample

volume
density - number
motility - how many are moving
progression - how well they move

15

oocyte collection risks

bleeding
pelvic infection
failure to obtain oocytes

16

what does the embryologist then do

search through follicular fluid and identify eggs and surrounding mass of cells
collect them into cell culture medium
incubate at 37oC

17

what happens during the embryo transfer

normally transfer 1 (max is 3)
progesterone suppositories for 2 weeks

18

indications for a intra cytoplasmic sperm injection

severe male factor infertility
previous failed fertilisation with IVF
preimplantation genetic diagnosis

19

if azoospermia - surgical sperm aspiration where form

epididymis if obstructive
testicular tissue if non-obstructive

20

what happens to the aspiration then

each egg is stripped
sperm immobilised
single sperm injected
incubate at 37oC overnight

21

hyperstimulation is what
symptoms

enlarged ovaries- enlarged follicles
abd pain/bloating
N/diarrhoea
breathless

22

treatment for hyperstimulatio before embryo transfer

coasting - stop the GDT
elective freeze
single embryo transfer

23

treatment after embryo transfer

monster with scans and blood
antithrombotic - fluids, TED stockings, fragmin
analgesia
hospital admission if required IV fluids/more intensive monitoring/paracentesis

24

other risks of artificial conception

multiple pregnancies
no edges retrieved
surgical risks of oocyte retrieval
surgical risks of sperm aspiration
failed fertilisation
ectopic pregnancy
non continuing pregnancy
increase risk in on going preg
psychological issues