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PSIO 469 Exam 03 > Lecture 13: Infertility and Assisted Reproductive Technology > Flashcards

Lecture 13: Infertility and Assisted Reproductive Technology Flashcards

1
Q

What is the definition of “infertility?”

A

inability to achieve pregnancy after 12 months of unprotected intercourse

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2
Q

Infertility affects how many people?

A

12%

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3
Q

What are the 4 major categories of Infertility and what is their percentage affected?

A

Female Factors: 40-50%
Male Factors: 30-40%
Combined female/male factors: 30%
Idiopathic: 20%

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4
Q 
FSH measured on Day\_\_\_\_\_ of menstrual cycle.
A) 2
B) 3
C) 5
D) 4
A

B) 3

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5
Q

If FSH is less than ______ mlU/mL, it indicates_____ prognosis

A

10; poor

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6
Q

What is “Hysterosalpingogram?” (HSG)

A

An x-ray with contrast dye to determine whether tubes are open or blocked

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7
Q

How can you tell if a tube is blocked?

A

If they dye does not highlight the area

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8
Q

How can you tell if sperm is good using a Sperm Analysis?

A 
Volume: greater than 2.0mL
Liquefaction: less than 60 mins
Viscosity: Moderate to Low
Concentration: greater than 20 x 10^6 mL
Motility: greater than 50%
WHO Morphology: greater than 15%
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9
Q

How is infertility treated?

A

Conventional medical therapies such as:

  • Dietary modifications
  • Exercise
  • Medication
  • Surgery
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10
Q

Define “Polyp?”

A

Non-cancerous growth attached to endometrium extending into uterine cavity

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11
Q

Define “Septum?”

A

Wedge-like partition within uterine cavity

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12
Q

What are the 4 steps with Intrauterine Insemination (IUI)?

A
  1. Controlled Ovarian Stimulation
  2. Transvaginal Ultrasound
  3. Trigger Ovulation at appropriate time
  4. Intrauterine Insemination
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13
Q

What is happening during step 01 in IUI (Controlled Ovarian Stimulation)?

A
  • Increase FSH and LH secretion during early to mid follicular stage
  • Stimulate follicle growth
  • Permit more than one follicle to mature
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14
Q

What 3 hormones play a factor in Step 01 of IUI?

A
  • Clomiphene Citrate (Clomid)
  • Letrozole (Femara)
  • Follicle Stimulating Hormone (FSH)
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15
Q

What is the goal of Clomiphene Citrate?

A
  • Blocks negative FB by Estradiol and stimulates FSH and LH secretion
  • May change the quality of cervical mucus and reduce endometrial proliferation
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16
Q

what is SERM?

A

Selective Estrogen Receptor Modulator

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17
Q

What is the goal of Letrozole?

A

Aromatase inhibitor

  • Prevents ovarian peripheral conversion of andeogens to estrogens
  • Lower estradiol permits more FSH and LH secretion
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18
Q

What is the goal of FSH?

A
  • Directly stimulates follicle development

- Low doses stimulate growth of 2-3 follicles

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19
Q

What is the goal amount of the follicles for IUI?

A

around 2-3 good follicles

20
Q

What does the transvaginal ultrasound accomplish?

this is step 02

A
  • Determine # and size of lead follicles

- Cancel cycle if there are too many follicles

21
Q

What id the ideal conditions for LH surge?

A
  • Lead follicle: around 15-18 mm

- Endometrium around 6-10 mm

22
Q

What is the goal of step 03 (trigger ovulation at appropriate time)?

A

1) Mimic LH surge to simulate ovulation by:
- Human Chorionic Gondaotropin (hCG)
2) Ovulation occurs approx. 36 h after hCG injection

23
Q

What is the goal if step 04 (IUI)?

A

Washed sperm are placed in the uterus by catheter just prior to expected time of ovulation

24
Q

Washing the sperm removes_______.

A

Prostaglandins

25
Q

What is the definition of “ART?”

A

Any procedure where both sperm and oocytes are handled outside body

26
Q

ART DOES include treatments in which sperm are handled or ovarian stimulation w/o egg retrieval.
T/F

A

False; It DOES NOT

27
Q

What is the basic step to IVF?

A
  • Sperm and Egg are combined in a laboratory dish

- If fertilization occurs, embryos are transferred to uterus where one or more may implant and develop

28
Q

When was the first “test tube” baby born and where?

When was the first one born in the US?

A

1978 in Great Britain (Louise Brown)

1981

29
Q

What are the 6 steps of IVF?

A

1) Controlled ovarian stimulation
2) Prevention of Premature Ovulation
3) Egg Retrieval
4) Fertilization
5) Embryo Culture
6) Fresh Embryo Transfer

30
Q

What is the goal of step 01 of IVF (controlled ovarian stimulation)?

A

To have 8-15 good follicles

31
Q

What is the goal of step 02 of IVF (prevention of premature ovulation)?

A

1) GnRH antagonist

2) GnRH agonist

32
Q

What does the GnRH antagonist do for step 02 of IVF?

A
  • Administered in late follicular stage
  • Blocks action of GnRH on gonadotrope secretion of LH (and FSH) to prevent LH surge
  • Immediately inhibits LH and FSH production and secretion
33
Q

What does the GnRH agonist do for step 02 of IVF?

A

Prevent early ovulation- but takes more time

  • Initially stimulates pituitary gland to release all stored gonadotropins (LH and FSH). Last 10 days prior to ovarian stimulation
  • GnRH agonist suppresses production of new LH and FSH
34
Q

What is the goal of step 03 of IVF (egg retrieval)?

A
  • hCG is administered approx. 34 hours prior to retrieval

- transvaginal ultrasound aspiration under anesthesia in minor outpatient surgery.

35
Q

What is the goal of step 04 of IVF (fertilization)?

Hint: there are 2 alternatives

A

1) Standard IVF

2) Intracytoplasmic sperm injection (ICSI)

36
Q

What is happening during Standard IVF?

A
  • MII oocytes are placed in culture medium

- Motile sperm introduced to oocytes and stored in incubator where fertilization occurs within 24hrs

37
Q

What is happening during ICSI?

A
  • Used in rates where fertilization are expected to be poor (e.g. oligospermia)
  • single sperm is injected into oocyte
  • Bypasses sperm capaciation process
38
Q

In step 5 of IVF (Embryo culture):
A) Retrieval shows _____ with polar body
B) after ____ hours, Day 01 shows fertilized oocyte with ____ pro nuclei.
C) ___days later, Day 03 shows ______ (or 8-cell stage).
D) _____ days later, Day 05 shows______.

A

A) Unfertilized Oocyte
B) 16; 2
C) 2; cleaved embryo
D) 2-3; Blastocyst

39
Q

What is the goal in stage 06 of IVF (Fresh Embryo Transfer)?

A

One or more embryos is suspended in culture medium and transferred to uterus with a catheter

40
Q

Embryos are usually transferred on either day__ or day___

A

3; 5

41
Q

Extra embryos may be _____ and stored for future transfer. This is called ______

A

Cyropreserved; Frozen Embryo Transfer.

42
Q

When was the first frozen embryo born?

A

1983

43
Q

Recipient canidates include women who are ____, have _____ ovarian reserve, or are carriers of_______

A

older; ovarian reserve; genetic abnormalities

44
Q

Surrogacy has 2 options, which are:

A

1) Traditional

2) Gestational

45
Q

What is “traditional” surrogate?

A
  • Surrogate is inseminated with sperm from male to infertile couple (no IVF involved)
  • Surrogate is GENERTICALLY related to child
46
Q

What is “Gestational” surrogate?

A
  • Carries embryo created by egg and sperm to two other individuals (requires IVF)
  • Intended parents require both egg and sperm
  • Gestational carrier is NOT GENETICALLY related to child

PSIO 469 Exam 03 (7 decks)

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