IVF Flashcards
(22 cards)
What is IVF?
Fertilise an egg with sperm in a lab and then inject the embryo into the uterus.
What is the success rate of IVF?
Each attempt has a roughly 25-30% at producing a live birth.
What is IUI (intrauterine insemination)?
Where sperm are injected into the uterus - avoiding intercourse.
What does one cycle of IVF include?
A single episode of ovarian stimulation & collection of oocytes - one cycle may produce several embryos which can be transferred separately within the one cycle of IVF.
What are the steps in IVF?
- Suppressing the natural menstrual cycle
- Ovarian stimulation
- Ovarian collection
- Insemination
- Embryo culture
- Embryo transfer.
What is used to suppress the natural menstrual cycle?
GnRH agonists or antagonists.
How are GnRH agonists used to suppress the menstrual cycle?
An injection (goserelin) is given in the luteal phase around 7 days before the expected onset of period. This initially stimulates the pituitary gland to secrete a large amount of FSH and LH but then after the surge, there is no negative feedback to the hypothalamus so the natural production of GnRH is stopped - suppressing the menstrual cycle.
How are GnRH antagonists used to suppress the menstrual cycle?
Daily subcutaneous injections of GnRH antagonist (cetrorelix) are given, starting from day 5-6 of ovarian stimulation → suppresses body from releasing LH so no ovulation occurs.
Why do you have to suppress the natural menstrual cycle?
Otherwise ovulation would occur and the follicles which are developing would be released before it is possible to collect them.
What is ovarian stimulation?
Where subcut injections of FSH are given to promote the development of multiple follicles in the ovaries.
What is given after FSH in ovarian stimulation?
When enough follicles have developed to an adequate size, FSH is stopped and hCG injection is given 36 hours before egg collection to stimulate the final maturation of follicles.
What is it called when hCG is given in ovarian stimulation?
Trigger injection.
How are the oocytes collected?
Needle is inserted through vaginal wall under transvaginal USS guidance into each ovary to aspirate the fluid from each follicle - the fluid contains the mature oocytes.
How are the oocytes inseminated?
The male will produce a semen sample around the time of oocyte collection and the sperm & egg are mixed in culture medium. 1000s of sperm are combined with each oocyte to produce enough enzymes for one sperm to penetrate the corona radiata and zona pellicuda and fertilise the egg.
What step can you add into insemination if there is male factor infertility?
Intracytoplasmic sperm injection where the highest quality sperm are isolated from sperm sample and injected directly into cytoplasm of egg.
How long are the embryos left after fertilisation?
Left in an incubator for over 2-5 days to see which will develop & grow and then are monitored until they reach the blastocyst stage of development.
What happens in embryo transfer?
The highest quality embryos are selected and a catheter is inserted through cervix into uterus. A single embryo is injected through the catheter.
When is a pregnancy test performed?
Day 16 after egg collection. Positive = implantation has occurred. Negative = failed and hormonal treatment is stopped and the woman will have their period.
When and why is progesterone given?
Used from the time of oocyte collection until 8-10 weeks gestation as vaginal suppositories to mimic the progesterone that would be released by the corpus luteum during a typical pregnancy.
What imaging is carried out and when?
USS in early pregnancy (around 7 weeks) to check for a fetal heartbeat and rule out miscarriage or ectopic pregnancy.
Overall complications?
Failure, Multiple pregnancy, Ectopic pregnancy, Ovarian hyperstimulation syndrome.
Complications relating to the egg collection procedure?
Pain, bleeding, pelvic infection, damage to the bladder or bowel.
