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Flashcards in Infertility and Assisted Conceptions Deck (22)
1

What is assisted conception treatment?

Any treatment which involves gametes outside the body

2

How many couples require assessment of infertility in the UK and how many of these will require ACT

1 in 6
half will require ACT

3

What percentage of live births in the UK are a result of ACT

2 percent

4

Why is the demand for ACT rising

increasing parental age
increasing chlamydia and male factor infertility
improved ACT range of treatments and success rates

5

What are the most common indications for ACT

Male factor infertility
Multiple factors infertility
Unexplained infertility
Tubal disease

6

What are the other indications for ART

Uterine factors
endometrioses
fertility preservation in cancer patients
treatment to avoid transmission of BBV between pts
Pre implantation diagnosis of inherited disorders
Single parents/same sex couples

7

What things do the patients need to do before treatment can begin?

Alcohol- female limits to 4 units per week
Weight- BMI 19-29 for both male and female
Smoking- advised to stop
Folic acid- 0.4mg/day preconception until 12 weeks gestation (5mg if increased risk of NTD)
Rubella immunity
Cervical smears up to date
Occupational factors
Medication and recreational drug review
BBV screen- hep B/C and HIV

8

What treatments are avaiblable?

Donor insemination
Intra-uterine insemination
In-vitro fertilisation (IVF)
Intra-cytoplasmic sperm injection (ICSI)
Surrogacy

9

What are the indications for IUI

unexplained infertility
mild to moderate endometriosis
mild male factor infertility

10

What is the methid of IUI

Prepared semen is inserted into uterine cavity around time of ovulation (which may be either natural or stimulated cycle)

11

What are the indications for IVF

Unexplained (more than 2 yrs duration)
Pelvic disease (eg endometriosis)
Anovulatory infertility
Male factor infertility (if more than 1x10 to the 6 motile sperm)
Others - pre implantation genetic diagnosis

12

What is the method for IVF?

See notes.

13

What is the name of the synthetic gonadotrophin releasing hormone given in IVF

Buserelin

14

How is a sperm sample taken for IVF?

Abstinence for 72 hours
Ejaculates samples - important.

15

What is the sperm sample assessed for

Volume
Density - number of sperm
Motility- how many are moving
Progression- how well they move

16

What are the indication for ICSI

Severe male factor infertility
Previous failed IVF

17

What is the method of ICSI?

For female it is the same preparation as IVF
Male - sperm surgically aspirated in azoospermia

Each egg is stripped. Sperm are immobilised and a single sperm in injected into the egg. Incubate overnight at 37 degress.

The rest of the process is the same as IVF.

18

What are the complications of ART?

Ovarian hyperstimulation syndrome
Multiple pregnancy

Others:
No eggs retrieved - uncommon
Surgical risks
Failed fertilisation (four percent)
Ectopic pregnancy
Non continuing pregnancy
Increased risk in pregnancy
Psychological

19

What are the symptoms of OHSS

Enlarged ovaries due to excess follicles.
Abdo pain
bloating
nausea
diarrhoea
breathless

Can be mild, moderate, severe (1 in 1000)

20

What is the treatment of OHSS

Before embryo transfer:
- coasting = with hold gonadotrophins
- elective freeze
-sinlge embryo transfer

After embryo transfer
- monitor
-fluids
-pain killers

21

What are the success rates for IVF?

In women under 37 the success rate is just over a third (37 percent)

Success rates decrease after age 37 and success if very low in women older than 40.

ICSI success rates are comparable to IVF, maybe slightly higher in younger patients (less than 40)

22

What are the risks or increasing parental age?

Increased risk of :
miscarriage
ectopic pregnancy
chromosomal abnormalities
low birth weight/ prem baby
still birth

Increased incidence of chronic disease eg diabetes