Lecture 20 Flashcards
(45 cards)
List the reasons that infertility is a growing problem in the US.
- Reduced morbidity
- Societal changes (delayed childbearing, marriage and first pregnancy)
- More therapies available
- Reduced expense and less taboo
List the forms of Assisted Reproductive Technologies (ART) in women.
- Sperm donation
- Egg donation
- Embryo donation/adoption
- In vitro fertilization (IVF)
- Intrauterine insemination (IUI)
- Traditional surrogacy
- Gestational surrogacy
- Sperm cryopreservation
- Egg cryopreservation
- Embryo cryopreservation
- Post-mortem gamete harvesting
- Post-death conception
List the stages and times of a typical IVF cycle.
- TVOR, Sperm Prep and Insemination (Day 0)
- Fertilization check (Day 1)
- Embryo transfer (Day 3-5)
- Embryo freeze (Day 5-6)
In IVF, when does the embryo culture occur?
Days 1 through 6
What does TVOR stand for?
Transvaginal oocyte retrieval
In IVF, what hormones are injected and when?
-FSH (-14 to -10 days till day 0) to produce eggs
- hCG (day 0) triggers egg maturation and ovulation
- Leuprolide acetate (day 0), a GnRH agonist that can control the stimulation process or be used as a trigger shot
- Progesterone supports endometrial development and early pregnancy
- Estrogen stimulates egg growth and thickens uterine lining
- Corticosteroids improves outcome of IVF with conventional insemination when sperm has autoantibodies
What stage of the menstrual cycle is progesterone associated with?
Luteal phase
What occurs during the luteal phase in terms of follicular development and in the endometrial cycle?
Corpus luteum forms and the uterine wall thickens
What hormones spike to trigger ovulation?
- LH
- Estrogen
- FSH
What is the process of IVF egg maturation?
- Ovarian stimulation/ovulation induction: adminster FSH, LH, and GnRH for 8-14 days
- Development of eggs is monitered using trans-vaginal ultrasound
- Blood is drawn frequently to assess ovarian estrogen production
- When eggs are mature hCG injection initiates ovulation process
What is the process of IVF egg retrieval?
- 34-36 hours after hCG injection, a mld sedative and painkiller is given to the patient.
- An ultrasound probe is inserted into the vagina to visualize the ovaries and follicles
- Needle is inserted through wall of vagina to ovaries to extract the eggs
What is the process of IVF fertilization?
- If sperm are healthy, placed in a dish with the egg in an incubator over use
- If they can’t fertilize the egg, a single sperm is injected into an egg using a neeedle in a process called Intracytoplasmic Sperm Injection (ICSI)
- About 60% of IVF is performed with ICSI
- Couples should consider genetic testing if sperm cannot fertilize the egg on their own
What is the process of IVF embryo transfer?
- Embryos that develop from IVF are placed into the uterus 1-6 days after retrieval
- Procedure is normally painless but patient many experience cramping
- A long thin tube is inserted through the vagina and into the uterus to inject the embryo
- Embryo should implant into the lining 6-10 days after retrieval
Third Party Assisted ARTs
- Sperm Donation
- Egg Donation
- Surrogates and gestational carriers
When is egg donation a good option for women?
- Have primary ovary insufficiency (POI)
- Have had chemotherapy or radiation therapy
- Have had surgical removal of the ovaries
- Were born without ovaries
- Carriers of known genetic diseases
- Are infertile because of poor egg quality
What is a surrogate carrier?
A woman inseminated with sperm from the male partner of the couple
What is a gestational carrier?
A woman implanted with an embryo that is not biologically related to her.
What are the risks of traditional vs gestational surrogacy?
Surrogate: poses legal issues due to being genetically related to surrogate, surrogate undergoes IUI, comes with risks during development
Gestational: Costs more money, IVF is required
What is GIFT?
Laparoscopically placing mature eggs into the healthy fallopian tube along with washed sperm (Gamete intrafallopian transfer)
What is ZIFT?
Zygotes are placed directely into the fallopian tubes via lapaosocpy or trasncervical falloopian tube caterization (Zygote intrafallopian transfer)
How can a scientist tell if fertilization was a success?
Presence of a second polar body (meaning meiosis II occured) and male and female pronuclei both present
What is PGS?
Preimplantation genetic screening screens embryos to ensure 23 pairs of chromosomes
What is PGD?
Preimplatation genetic diagnosis diagnoses embryos for known genetic disorders that both the patient and partners are carriers of
What is CCS?
Comprehensive chromosomal screening is a next generation sequencing that detects aneuploidy with a more in-depth scan of the genoe to find abnormalities
