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Flashcards in Infertility and assisted coneption Deck (33):
1

What is assisted conception treatment? (ACT)

Any treatment that involves gametes outside of the body

2

How many couples require assessment of infertility?

1 in 6 (everywhere else says 1 in 8)
-approximately half of these will require assisted conception treatment

3

Indications for assisted conception treatment

Fertility preservation in cancer patients
Treatment to avoid transmission of blood born viruses between patients
Pre-implantation diagnosis of inherited disorders
Treatment of single parents or same sex couples
Others: cryopreservation of gametes for social reason

4

How much alcohol can you drink before treatment?

Max 4 units per week

5

Optimal BMI before treatment?

19-29

6

How much folic acid should you give pre-conception and how long should you continue?

0.4mg/day and continue for 12 weeks
(give 5mg a day if increased risk of NTD)

7

Indications for intra uterine insemination

Unexplained infertility
Mild or moderate endometriosis
Mild male factor infertility

8

How do you carry out intrauterine insemination?

-can be part of natural or stimulated cycle
-prepared semen inserted into uterine cavity around time of ovulation

9

Indications for IVF?

-unexplained infertility for more than 2 years
-pelvic disease (endometriosis, tubal disease, fibroids)
-anovulatory infertility
-male factor infertility (if more than 1x10^6 motile sperm)
-others (pre-implantation genetic diagnosis)

10

What is down regulation and how do you achieve it?

it is "shutting down" pituitary - ovarian hormones
-do it with synthetic gonadotropin releasing hormone (Buserelin)

-adminstered as a spray or injection

11

Side effects of down regulation/buserelin

Hot flushes and mood swings
Nasal irritation (bc administered as a spray)
Headaches

12

What medication do you give in ovarian stimulation?

Gonadotrophin hormone (Gonal-F, menopur)

13

Side effects of ovarian stimulation

-mild allergic reactions
-ovarian hyperstimulation syndrome (OHSS)

14

When do you give the hCG (ovitrelle) injection and why?

Single injection given 36 hours prior to egg collection - mimics LH surge

15

Rule for sperm sample

Abstinence for 72 hours beforehand

16

Day 0

Egg collection

17

Day 1

Pronuclear stage

18

Day 2

Average 4 cell stage

19

Day 3

Average 6-8 cell stage

20

How many embryos can you transfer in a patient under 40?

No more than 2 embryos to be transferred

21

How many embryos can you transfer in patients aged 40 and over

3 may be transferred in exceptional circumstances only

22

What should you do during the luteal phase in IVF?

Give cyclogest (progesterone) pessaries (probably because progesterone is the main pregnancy hormone)
and then do a pregnancy test 2 weeks after embryo transfer

23

If you have a positive pregnancy test after IVF what should you do?

Transvaginal scan (5 weeks after embryo transfer)

24

Indications for intracytoplasmic sperm injection?

Severe male factor infertility (e.g. if your sperm are super messed up/azoospermia)

Previous failed fertilisation with IVF

25

How do you carry out ICSI?

Egg is stripped
Sperm immobilised
Single sperm injected
Incubate at 37degreesC overnight

26

Symptoms of ovarian hyperstimulation syndrome?

Abdominal pain
Bloating
Nausea/diarrhoea
Breathless!!

27

Chances of ovarian hyperstimulation syndrome?

1 in 1000

28

All assisted conception stuff has to be licensed by who?

The HFEA (human fetal and embryo authority)

29

Steps of IVF

Down regulation
Ovarian stimlation
Oocyte retrieval
Embryo transfer
Luteal support

30

Complications of IVF

Multiple pregnancy
Ovarian hyperstimulation
Ectopic pregnancies

31

IVF success rate

35%

32

By age 35, how much of her ovarian reserve has a woman lost?

95%

33

When are embryos usually transferred to womb in IVF?

Usually allowed to develop until day 5/6 (which is when they reach blastocyst stage) and then they can be transferred