Infertility and contraception Flashcards
What is assisted contraception treatment (ACT)?
Any treatment which involves gametes outside the body
Causes of infertility/ Indications for ACT
- Male factor infertility (most common, ICSI)
- Unexplained
- Endometriosis
- Ovulatory disorders
- Tubal disease
Other indications for ACT
cancer, transgender patients and social reasons
Treatment to avoid transmission of blood borne viruses between patients
Pre implantation diagnosis of inherited disorders
Single parents or same sex couples
Surrogacy in the case of abnormal or absent uterus
Management before treatment
Alcohol: females limit to 4 units per week
Weight: between 19-29 optimal both male and female
Smoking: advise to stop smoking due to risk of miscarriage
Folic acid: 0.4mg/day preconception-12 weeks gestation (5mg increase risk NTD/obese)
Rubella: check if female immune to rubella, if not immunise
Cervical smears: check up to date according to national screening programme
Occupational factors: avoid exposure to hazards
Drugs: prescribed, over-the-counter and recreational
Screen for blood born viruses: hep B/C and HIV
Assess ovarian reserve: antral follicle count or AMH
Counselling: offer supportive counselling
Types of ACT available
Donor insemination Intra-Uterine Insemination (IUI) In Vitro Fertilisation (IVF) Intra-Cytoplasmic Sperm Injection (ICSI) Fertility Preservation Surrogacy
Indications for Intra Uterine Inseination
- Same sex relationship
- Psycho-sexual problems
- Discordant BBV or abandoned IVF
Method of intrauterine insemination
Can be in natural or stimulated cycle
Prepared semen inserted into cavity around time of ovulation
Indications for In-vitro Fertilisation
Unexplained infertility >2 years
Pelvic disease - endometriosis, tubal disease, fibroids
Anovulatory infertility (after failed induction of ovulation)
Failed IUI (after 6 cycles)
What is down regulation?
GnRH analogue or agonist
Reduces cancellation of ovulation - improves success rates
Allows precise timing of oocyte recover by using HcG trigger
Scan performed - TVUSS
Side effect of down regulation
Hot flushes and mood swings
nasal irritation
Headaches
What is ovarian stimulation?
Gonadotrophin hormone containing either synthetic or urinary gonadotrophins (FSH+/-LH)
Can be self administered (sc injection)
Causes follicular development
What occurs during the semen stage of ACT treatment?
Abstinence for 72 hours beforehand
Produced in ‘Men’s room’ in the ward or at home (within 1 hour)
Assessment for: Volume Density - numbers of sperm Motility - what proportion are moving Progression - how well they move Prepared to remove seminal plasma and concentrate
What are the risks of oocyte collection?
Bleeding
Pelvic infection
Failure to obtain oocytes
Risk of injury to bowel and bladder
