Infertility, spermatogenesis and ACT Flashcards
(144 cards)
1
Q
what is ACT
A
any treatment that involves gametes outside the body
2
Q
how many couples in the UK require assessment of fertility
A
1/6
3
Q
of those getting fertility assessments how many will require ACT
A
half
4
Q
before treatment begins: limit alcohol to _____
A
4 units per week
5
Q
before treatment begins: aim to have BMI between what
A
19-29
6
Q
before treatment begins: stop
A
smoking
7
Q
what supplements are women given before ACT
A
folic acid
8
Q
what is the dose of folic acid given
A
0.4mg/day pre-conception to 12 weeks gestation
or 5mg if high risk of NTD
9
Q
what vaccine should women get if they dont alreddy have it
A
rubella
10
Q
what can rubella cause to a fetus
A
congenital blindness
heart defects
miscarriage/still birth
11
Q
before treatment begins women should have a ___
A
cervical smear
12
Q
before treatment begins women should be screened for what BBVs
A
Hep B and C
HIV
13
Q
how is ovarian reserve assessed
A
antral follicle count or AMH (anti-mullerian hormone)
14
Q
what is the biggest risk factor for determining IVF success
A
maternal age
15
Q
what are the 6 types of ACT
A
donor insemination ICSI IUI IVF freezing surrogacy
16
Q
how is IUI carried out
A
natural or stimulated cycle (latter improves success), prepared semen inserted into uterine cavity around ovulation
17
Q
what is the criteria for getting IVF on NHS
A
infertility
one partner doesnt have a child
up to 3 rounds per couple
18
Q
what is primary infertility
A
never conceived
19
Q
what is secondary infertility
A
have conceived before, regardless of outcome
20
Q
age over what is a RF for infertility
A
35
21
Q
BMI of what is a RF for infertility
A
< 20 or > 30
22
Q
when is IVF indicated (4)
A
- pelvic disease (endometritis, tubal disease, fibroids)
- unexplained infertility > 2 years
- anovulatory infertility (after failed ovulation induction)
- failed IUS (after 6 cycles)
23
Q
how long does a cycle of IVF last
A
6 weeks
24
Q
when is ICSI indicated
A
- severe male factor infertility (below 1x10^6 motile sperm)
- previous failed IVF
- preimplantation genetic diagnosis
25
if azoospermia what is required for ICSI
surgical sperm aspiration
26
where is sperm aspirated from in obstructive azoospermia
epididymus
27
where is sperm aspirated from in non-obstructive azoospermia
testicular tissue
28
outline ICSI
each egg is stripped, sperm immobilisation, single sperm injected, incubated at 37 degrees overnight
29
how long does ovarian folliculogenesis last
85 days
30
what are the 2 phases of ovarian folliculogenesis
tonic phase and growth phase
31
how long is the tonic phase
65 days
32
how long is the growth phase
20 days
33
what happens in the tonic phase
antral follicles formed
34
what happens in the growth phase
antral follicles --> pre ovulatory follicle (graafian)
35
the growth phase is dependent on ____
gonadotrophin
36
in a stimulated cycle, what does giving gonadotrophins during early follicular phase result in
synchronised growth of all follicles
37
what are the 5 stages to IVF
```
down regulation
ovarian stimulation
oocyte collection
fertilisation
embryo transfer
```
38
what is the purpose of down regulation in IVF
puts woman into menopause so the IVF can be precisely timed with no spontaneous ovulation
39
how is down regulation achieved
synthetic gonadotrophin releasing hormone analogue
40
give an example of a synthetic gonadotrophin releasing hormone analogue
Buserelin
41
how is buserelin administered
nasal spray or injection
42
what are some side effects of the down regulation stage
hot flushes
mood swings
nasal irritation
head aches
43
what is involved in the ovarian stimulation phase
synthetic/urinary gonadotrophins (FSH +/- LH) given as a SC injection
44
what is given after gonadotrophins and why
HCG injection - mimics spontaneous LH surge
45
what are some SEs to ovarian stimulation
mild allergic reactions
| ovarian hyperstimulation syndrome
46
when is oocyte collection done and where
36 hours after ovarian stimulation in theatre
47
what are some risks of oocyte collection
bleeding
infection
failure to obtain oocytes
48
when the egg and surrounding mass of cells is collected where is it placed
in cell culture medium and incubated at 37 degrees
49
after fertilisation, how many embryos are transferred to the uterus
```
1 embryo
(maximum 3 in exceptional circumstances)
```
50
what day is an embryo transferred
blastocyst stage - day 5
51
what is given to a woman following embryo transfer
luteal support
52
what is luteal support
progesterone suppositories for 2 weeks (cyclogest)
53
what is done 16 days after oocyte recovery
pregnancy test
54
if pregnancy test is positive what is done
TVUS 5 weeks after embryo transfer
55
what are the 4 types of OHSS
mild
moderate
severe
critical
56
what are the symptoms of mild OHSS
abdominal bloating
mild abdominal pain
ovarian size usually < 8cm^3
57
what are the symptoms of moderate OHSS
moderate abdominal bloating
N+V
US evidence of ascites
ovarian size 8-12 cm^3
58
what is the management of OHSS before embryo transfer
single embryo transfer or elective freeze
59
what is the management of OHSS after embryo transfer
monitor with scans and bloods
analgesia
reduce risk thrombosis - fluids, TED stockings, fragmin
60
give 3 complications of ART
OHSS
multiple pregnancy
ectopic pregnancy
61
before semen collection for IVF how long should the main abstain
72 hours
62
what is the window between sample production and delivering it
1 hour
63
what is the sperm sample assessed for
volume
density
motility
progression
64
what is sperm density
no of sperm
65
what is sperm motility
what proportion are moving
66
what is sperm progression
how well sperm moves
67
how is the semen prepared
prepared to remove seminal plasma and concentrate
68
how is the semen prepared
prepared to remove seminal plasma and concentrate
69
what is the inheritance of androgen insensitivity syndrome (testicular feminisation)
X linked recessive
70
what is the karyotype of AIS / TF
46 XY
71
do testes develop in AIS
yes but don't descend
72
what does AIS look like phenotypically
external female genitalia
absent uterus/ovaries
short vagina
73
people with AIS are often brought up ____
female
74
what happens when people with AIS reach puberty
primary amenorrhoea and lack of pubic hair
75
what causes AIS
end organ resistance to testosterone - induction of wolffian duct doesnt occur but mullerian inhibition does occur
76
why do the testes live outside the body
lower temperature for spermatogenesis
77
where do the testes develop in utero
abdominal cavity and drop into scrotal sac before birth
78
what muscle contracts to raise and lower scrotum depending on temperature
dartos muscle
79
what is the name for undescended testes
cryptoorchidism
80
are people with cryptoorchidism infertile
reduces sperm count but usually fertile if unilateral
81
when should an orchidoplexy be performed and why
before age 14 to reduce risk of testicular germ cell cancer
82
if undescended as an adult what should be considered
orchidectomy (6 x increase risk of cancer)
83
where is the sperm made
seminiferous tubules
84
where is the sperm stored
epididymus
85
what produces testosterone
leydig cells
86
what is the function of the sertoli cells
form a blood testes barrier
provide nutrients for developing cells
phagocytosis
secretions
87
what 4 things do sertoli cells secrete
seminiferous tubule fluid
androgen binding globulin
inhibin
activin
88
what is the purpose of the blood testes barrier
protects sperm from antibody attack
| provides a suitable fluid composition which allows later stages of development of sperm - very different from blood
89
what is the nick name for sertoli cells
nurse cells - supportive role
90
what do sertoli cells phagocytose
surplus cytoplasm from packaging process and destroy defective cells
91
what is the function of the seminiferous tubule fluid
carries cells to epididymus
92
what is the function of androgen binding globulin
binds to testosterone so concentration remains high in lumen
93
what does FSH stimulate
spermatogenesis
94
FSH acts on what
sertoli cells
95
LH stimulates what
testosterone secretion
96
LH acts on what
leydig cells
97
inhibin _____ FSH
| activin ____ FSH
inhibin decreases FSH
| activin stimulates FSH
98
what effect does testosterone have on release of GnRH and LH
negative feedback
99
what enlarges male sex organs and is responsible for secondary male characteristics
DHT
100
DHT is anabolic/catabolic
anabolic
101
FSH and LH release is cyclical/constant in males
constant
| cyclical in females
102
the release of GnRH from hypothalamus is
pulsatile - every 2-3 hour bursts
103
when does release of GnRH begin
age 8-12
104
testosterone is a steroid hormone derived from
cholesterol
105
what does testosterone do before birth
masculinises reproductive tract and promotes descent of testes
106
what does testosterone do at puberty
promotes puberty and male characteristics
107
what does testosterone do in adulthood
controls spermatogenesis, secondary sexual characteristics, libido, erection, aggression
108
inhibin and activin are secreted by what
sertoli cell
109
sperm are liquified by enzymes from ____
prostate
110
what is capacitation
series of biochemical and electrical events before fertilisation - hyperactive mobility, ability to bind zona pellucida and acrosome reaction
111
after ejaculation how do sperm reach the egg and what do they do when there
chemo attraction to oocyte
bind to and digest ZP
penetration and fusion with oocyte membrane
112
what is an acrosome reaction
sperm uses acrosome enzymes to digest ZP of egg
113
what is the purpose of zonal reaction
prevents multiple fertilisations of egg
114
exit route from testes to urethra, concentrate and store sperm, site for sperm maturation
epididymus and Vas deferens
115
what is the function of the seminal vesicles
produce semen into ejaculatory duct, supply fructose for energy, secrete prostaglandins and fibrinogen
116
what is the purpose of prostaglandins in semen
stimulate motility
117
what is the purpose of fibrinogen in semen
clot precursor
118
what is the function of the prostate gland
produces alkaline fluid and enzymes
119
why does the prostate gland produce alkaline fluid
neutralise vaginal acidity
120
why does the prostate gland produce enzymes
to clot semen within female
121
what is the function of the bulbourethral glands
secrete mucus to act as lubricant
122
what happens in an erection
parasympathetic control
| blood fills corpus cavernosa
123
what happens in emission
contraction of accessory sex glands and vas deferens so semen expelled to urethra
124
what happens in ejaculation
contraction of smooth muscle of urethra and erectile muscles
sympathetic control
125
male infertility is _____
increasing
126
what is the most common cause of male infertility
idiopathic
127
what are 3 causes of obstructive infertility
cystic fibrosis
vasectomy
infection
128
mutations in the CFTR gene can cause
absent vas deferens
129
what is a congenital cause of non-obstructive infertility
cryptorchidism
130
what is an infectious cause of non-obstructive infertility
mumps orchitis
131
what is an iatrogenic cause of non-obstructive infertility
chemo/radio therapy
132
what are 3 genetic causes of cause of non-obstructive infertility
klinefelters
microdeletions of Y chromosome
robertsonian translocation
133
what is the karyotype of klinefelters
47 XXY
134
what are 2 environmental factors that might influence fertility
excessive heat on testes
| pesticides
135
how is testicular volume measured
orchidometer
136
what is normal testicular volume
12-25 mls in adult
137
what is normal testicular volume pre-pubertal
1-3mls
138
sperm reflects health of the man _ months earlier
3
139
what are the clinical features of obstructive infertility
normal testicular volume
normal secondary sexual characteristics
VD may be absent
LH, FSH and T all normal
140
what are the clinical features of non-obstructive infertility
```
low testicular volume
reduced secondary sexual characteristics
vas deferens present
high LH, FSH
low/normal testosterone
```
141
what is the treatment for hyperprolactinaemia
cabergoline
142
surgical sperm aspiration is required if what
azoospermia
143
____ decreases semen quality and health
smoking
144
men should avoid
tight fitting underwear and prolonged hot bath/sauna
