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Reproductive & Sexual Health > Infertility and assisted conception > Flashcards

Infertility and assisted conception Flashcards

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1
Q

Define assisted conception treatment

A

Any treatment that involves gametes outside the body

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2
Q

_ in _ couples in the UK require assessment of fertility

A

1 in 6 couples in the UK require assessment of fertility

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3
Q

Why is the demand for ACT rising?

A
  • increasing parental age
  • increasing chlamydia
  • male factor infertility
  • increasing range of ACT
  • improved success rates
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4
Q

What are the indications for ACT aside from infertility

A
  • fertility preservation in cancer, transgender patients and social reasons
  • treatment to avoid transmission of blood born viruses between patient
  • pre-implantation diagnosis of inherited disorders
  • treatment of single parents or same sex couples
  • treatment with surrogacy the absent/ abnormal uterus
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5
Q

What are the lifestyle modifications that must be made before ACT treatment begins

A 
Alcohol- limit to 4 units per week
Weight- between 19-29 optimal form males and females
Smoking- stop
Occupational- avoid hazards
Stop recreational drugs
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6
Q

What must be done before ACT begins?

A

Must take folic acid 0.4mg/day preconception- 12 weeks gestation

Check if female immune to rubella

Check cervical smears up to date

Check prescribed drugs

Assess for blood borne viruses: HIV, hep B/C

Assess ovarian reserve: antral follicle count or AMH

Counselling

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7
Q

how must the dose of folic acid be altered if the patient is obese?

A

5mg increase

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8
Q

What ACT treatments are currently available?

A 
Donor insemination
IUI
IVF
ICSI
Fertility preservation
Surrogacy
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9
Q

What are the indications for IUI

A

Sexual problems, same sex relationships, discordant BBV, abandoned IVF

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10
Q

How is IUI performed?

A

Can be in natural/stimulated cycle

Prepared semen inserted into uterine cavity around time of ovulation

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11
Q

What are the indications for IVF?

A
  • Unexplained infertility >2 years duration
  • Pelvic disease (endometriosis, tubal disease, fibroids)
  • Anovulatory infertility (after failed ovulation induction)
  • Failed intra-uterine insemination (after 6 cycles)
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12
Q

describe ovarian folliculogenesis

A

85 days long

  • tonic phase (65 days)
  • growth phase (20 days)
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13
Q

Describe the tonic phase of folliculogenesis

A

Primary and secondary follicles to antral follicles

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14
Q

Describe the growth phase of folliculogenesis

A

Antral follicles 3-5mm to pre-ovulatory follicle (20mm)

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15
Q

What is the growth phase of folliculogenesis dependent on?

A

Gonadotrophin

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16
Q

In a stimulated cycle __________ during early follicular phase result in ______ growth of all follicles (___mm a day)

A

In a stimulated cycle gonadotrophins during early follicular phase result in synchronised growth of all follicles (1.5mm a day)

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17
Q

What are the stages of IVF?

A
  1. down regulation
  2. ovarian stimulation
  3. oocyte collection
  4. fertilisation
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18
Q

What happens in the down regulation phase

A

Synthetic gonadotrophin releasing hormone analogue or agonist given

Reduces cancellation from ovulation and improves success rate

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19
Q

How is the timing of oocyte recovery controlled?

A

by using HCG trigger

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20
Q

What is the side effect of down regulation

A

Hot flushes and mood swings
Nasal irritation
Headaches

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21
Q

What happens during the ovarian stimulation phase?

A

Gonadotrophin hormone containing either synthetic or urinary gonadotrophins (FSH/;H)

Can be self-administered (injection)

Causes follicular development

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22
Q

What does the HCG injection do?

Study These Flashcards
A

Mimics LH causing resumption of meiosis in oocyte, 36 hours before oocyte recovery

23
Q

What is required from men undergoing semen retrieval?

Study These Flashcards
A

Abstinence for 72 hours beforehand

Sample prepared at home within 1 hour and kept warm, or in ward

24
Q

What is semen assessed for?

Study These Flashcards
A

Volume
Density- numbers of sperm
Motility- what proportion are moving
Progression- how well they move

25
How is a semen sample prepared?
Prepared to remove plasma and concentrate
26
What are the risks of oocyte collection
Bleeding Pelvic infection Failure to obtain oocytes
27
What happens to the follicular fluid in the embryology lab?
Embryologist searches through the follicular fluid to identify eggs and surrounding mass of cells Collects them into culture medium Incubated at 37 degrees Celcius
28
Approximately __% of eggs fertilise normally in IVF
Approximately 60% of eggs fertilise normally in IVF
29
What day does transfer or cryopreservation normally take place?
Day 5
30
How many embryos are transferred
Normally transfer 1 embryo (maximum 3 in exceptional circumstances
31
What supports embryo transfer?
Luteal support: Progesterone suppositories for 2 weeks
32
When does the patient take a pregnancy test after IVF?
16 days after oocyte recovery
33
What are the indications for ICSI?
- Severe male factor infertility - Previous failed fertilisation with IVF - Preimplantation genetic diagnosis
34
What is required if the male has azoospermia?
Surgical sperm aspiration | Can be extracted from epididymis (if obstructive) or testicular tissue (non-obstructive)
35
Describe the process of ICSI
- Each egg is stripped - Sperm immobilised - Single sperm injected - Incubate at 37 degrees overnight
36
What is the presentation of mild OHSS
Abdominal bloating Mild abdominal pain Ovarian size usually <8 cm
37
What is the presentation of moderate OHSS
Moderate abdominal pain Nausea +/- vomiting US evidence of ascites Ovarian size usually 8-12cm
38
What is the presentation of severe OHSS
``` Clinical ascites (+/- hydrothorax) Oliguria (<300ml/day or <30ml/hr) Haematocrit >0.45 Hyponatraemia Hypo-osmolality Hyperkalaemia Hypoproteinaemia Ovarian size usually >12cm ```
39
What is the presentation of critical OHSS
Tense ascites/large hydrothorax Haematocrit >0.55 White cell count >25000/ml
40
Approximately __% of patients develop OHSS
1%
41
How can OHSS be prevented?
Low dose protocols | Use of antagonist for suppression
42
What is the treatment for OHSS before embryo transfer?
Elective freeze | Single embryo transfer
43
What is the treatment for OHSS after embryo transfer?
- monitoring with scans and bloods - reduce risk of thrombosis: fluids, TED stockings and fragmin - analgesia - hospital admission if required IV fluids/more intensive monitoring/paracentesis
44
What measures have been taken in ACT to decrease multiple pregnancy?
Move to blastocyst transfer Improved cryopreservation Increase in single embryo transfer
45
The incidence of ectopic pregnancy is increased _-_ fold in IVF?
2-3
46
What is a heterotopic pregnancy and what is the risk in IVF?
Approximately 1% | When a intrauterine and ectopic pregnancy occur simultaneously
47
List some of the problems with IVF and ICSI
- No eggs retrieved - Surgical risks of oocyte retrieval - Surgical risks of surgical sperm aspiration - failed fertilisation - psychological problems - failed treatement
48
What are the risks of oocyte retrieval?
Bleeding | Infection
49
What are the risks of sperm aspiration
Haematoma | Infection
50
What are the problems in early pregnancy common in ACT?
Increase miscarriage and ectopic pregnancy
51
What are the problems in on-going pregnancy common in ACT?
Possible increase in prematurity and intra-uterine growth retardation, congenital abnormalities
52
What is the overall success rate for IVF?
35%
53
What is the role of HFEA?
Regulate all treatment & research Consider welfare of child Rights of people seeking treatment to appropriate care Respect for human life at all stages of development

Reproductive & Sexual Health (54 decks)

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