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

list indictions for assisted conception treatment

A

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

what treatments are available

A
donor insemination 
intra uterine isemination 
in vitro fertilisation 
intra cytoplasmic sperm injection
fertility preservation 
surrogacy
4
Q

indications for IUI and method

A

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

5
Q

IVF indications

A

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

6
Q

down regulation in IVF is what

A

artificial menopause

7
Q

how is down regulation done

A

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

8
Q

what does down regulation do

A

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

9
Q

SE of down regulation

A

hot flushes and mood swings
nasal irritation
headaches

10
Q

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

A

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
Q

what happens if there is a slow response

A

repeat scan 72 hours later

12
Q

what happens if there is a poor response

A

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

13
Q

how is a sperm sample taken

A

abstinence for 72 hours beforehand

mens room in the ward or at home

14
Q

assessment of the sperm sample

A

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

15
Q

oocyte collection risks

A

bleeding
pelvic infection
failure to obtain oocytes

16
Q

what does the embryologist then do

A

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

17
Q

what happens during the embryo transfer

A

normally transfer 1 (max is 3)

progesterone suppositories for 2 weeks

18
Q

indications for a intra cytoplasmic sperm injection

A

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

19
Q

if azoospermia - surgical sperm aspiration where form

A

epididymis if obstructive

testicular tissue if non-obstructive

20
Q

what happens to the aspiration then

A

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

21
Q

hyperstimulation is what

symptoms

A

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

22
Q

treatment for hyperstimulatio before embryo transfer

A

coasting - stop the GDT
elective freeze
single embryo transfer

23
Q

treatment after embryo transfer

A

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

24
Q

other risks of artificial conception

A
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