Infertility and Assisted Conception

Question 1

1 in _ couples require assessment of infertility in the UK

Answer 1

6

Question 2

why is demand of ACT rising?

Answer 2

increased parental age
increasing chlamydia
male factor infertility
improved success rates

Question 3

by your 3rd chalmydia infection there is a __% chance youre infertile

Answer 3

50%

Question 4

who is eligible for IVF? how many cycles?

Answer 4

reasonable expectation of a live birth
appropriate age
one partner has no biological children
3

Question 5

what is ICSI?

Answer 5

intracytoplasmic sperm injection; sperm is injected directly into the egg

Question 6

what is fertility preservation?

Answer 6

process of saving or protecting eggs, sperm, or reproductive tissue so that a person can use them to have biological children in the future

Question 7

what lifestyle changes should be considered before IVF treatment?

Answer 7

alcohol
weight
smoking
folic acid supplements

Question 8

females should be limited to _ alcohol units pw

Answer 8

4

Question 9

recommended BMI range for pregnancy?

Answer 9

19-29

Question 10

how much folic acid should be taken and at what point in pregnancy?

Answer 10

0.4mg per day from preconception to 12 weeks

Question 11

what immunisations should you get before IVF?

Answer 11

rubella

Question 12

why should you make sure cervical smears are up to date before IVF?

Answer 12

colposcopy is very dangerous and invasive and can be avoided if smears are up to date

Question 13

what blood screens are done before IVF

Answer 13

hep b/c

HIV

Question 14

how can you assess ovarian reserve in women?

Answer 14

anti-mullerian hormone blood test

antral follicle count

Question 15

describe intrauterine insemination

Answer 15

time a woman’s cycle (eg by using ovulation inducing drugs) and then insert good sperm when theyre about to ovulate

Question 16

indications for intrauterine insemination?

Answer 16

sexual problems
same sex relationships
discordant blood borne virus

Question 17

how long must infertility be for in order to get IVF?

Answer 17

2yrs

Question 18

indications for IVF?

Answer 18

unexplained infertility
pelvic disease
anovulatory infertility
failed Intrauterine insemination

Question 19

how long does it take for a follicle to form?

Answer 19

85

Question 20

what hormones are used in down regulation?

Answer 20

synthetic GnRH (causes pituitary LH and FSH to go low -> induce false menopause)

Question 21

side effects of down regulation?

Answer 21

menopausal symptoms eg hot flushes, mood swings

Question 22

womb lining should be in what form in down regulation?

Answer 22

thin

Question 23

what is done in the ovarian stimulation phase in IVF?

Answer 23

given a hormone containing LH and FSH which can be self-administered SC

Question 24

mature eggs are usually _mm

Answer 24

18mm

Question 25

how long should men be abstinent before giving their sperm donation?

Answer 25

72hrs

Question 26

sperm is assessed for what 4 factors?

Answer 26

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

Question 27

risks of oocyte collection?

Answer 27

bleeding pelvic infection failure to obtain oocytes

Question 28

what does the embryologist do?

Answer 28

identifies eggs in the follicular fluid and collects them into cell culure medium

Question 29

what does the sperm have to get through in the egg during fertilisation?

Answer 29

sperm breaks through zona pellucida | fuse with nucleus membrane

Question 30

how do you know fertilisaton has been successful?

Answer 30

1st cleavage

Question 31

how many embryos are normal transferred to the female?

Answer 31

1 (3 in exceptional circumstances)

Question 32

what hormone is given once the embryo has been transferred and why?

Answer 32

progesterone (to support the pregnancy)

Question 33

indications for intracytoplasmia sperm injection?

Answer 33

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

Question 34

sperm tends to be extracted from what area if theres azoospermia

Answer 34

epididymis

Question 35

what is azoospermia?

Answer 35

condition where semen contains no sperm

Question 36

symptoms of ovarian hyperstimulation syndrome?

Answer 36

abdominal pain nausea and vomiting large ovarian size USS evidence of ascites

Question 37

what is OHSS? who gets it?

Answer 37

too many eggs produced at once | can happen in young women

Question 38

what symptoms indicate severe/critical OHSS

Answer 38

``` intense ascites hydrothorax thromboembolism ARDS renal failure hyponatraemia hyperkalaemia ```

Question 39

Tx of OHSS

Answer 39

``` elective freeze single embryo transfer monitoring with scans and bloods reduce thrombosis risk: fluids etc analgesia supportive treatment ```

Question 40

how are multiple pregnancies prevented?

Answer 40

blastocyst transfer (terminates embryos at high risk of complications) improved cryopreservation increase in single embryo transfer

Question 41

what pregnancy complication is increased in ART?

Answer 41

ectopic pregnancy

Question 42

what is a heterotrophic pregnancy? why is it a problem?

Answer 42

one egg implants in the uterus and the other in the fallopian tube; can be mistaken for a healthy pregnancy as you discount ectopic by seeing an egg in the uterus

Question 43

surgical risks of oocyte retrieval?

Answer 43

bleeding | infection

Question 44

success rate is about _%

Answer 44

35

Question 45

best predictor of success rate?

Answer 45

female age (<34)