M4: Fertiliy Management

Question 1

define infertility

Answer 1

inability to conceive after 12 month of unprotected sex

Question 2

1 reason for infertility

Answer 2

postponement of preg until later years

Question 3

ovarian causes of infertility

Answer 3

primary: ovulatory dysfunction
secondary: inability to transport ova/embryo due to block tube

Question 4

uterine causes of infertility

Answer 4

congenital abnormalities
fibroids (impair vascular supply or blocking tubes)
ashermans

Question 5

other causes of infertility

Answer 5

cervical

immunologic

Question 6

cause of infertility in men

Answer 6

varicocele
testicular faliure
tubular obstruction (vas deferens not connected to ED)

Question 7

causes of testicular failure

Answer 7

mumps
torsion
orchitis
cancer
cryptorchidism (increased temp impairs sperm)
marijuana use

Question 8

what % of infertility is idiopathic

Answer 8

20%

Question 9

when would ovulation induction be performed?

Answer 9

if the women has patent tubes w/ an ovulation impairment (doesnt produce a graafian follicle)

Question 10

US roll in ovulation induction

Answer 10

• routine pelvic US to monitor the cycle
• track follicle growth (3 dimensions of the 3 largest follicles)

….trying to achieve 1 graafian follicle only

Question 11

are fertility drugs used w/ ovulation induction

Answer 11

yes

Question 12

if you see FF on the US, what does that typically mean in terms of the womans cycle

Answer 12

she has already ovulated

Question 13

why is intrauterine insemination (IUI) typically done

Answer 13

due to male infertility issues
unexplained infertility
donor insemination
same sex couples

Question 14

define in vitro fertilization

Answer 14

fertilization in a glass or lab, egg and sperm fertilized outside the body

Question 15

reasons for IVF

Answer 15

blocked tubes
impaired eggs or sperm
unexplained infertility

Question 16

steps for IVF

Answer 16

1. lab and US investigation
2. ovarian suppression of norm cycles
3. ovarian stimulation (gonadotropins to hyperstimulate ovaries)
4. egg retrieval
5. insemination
6. embryo transfer

Question 17

is more than 1 egg produced w/ IVF

Answer 17

yes

Question 18

what lab work is needed to IVF

Answer 18

bloodwork

Ovarian reserve testing… checks the FSH # which tells you about number of eggs left and ovarian age

Question 19

FSH of < what number indicates eggs are present

Answer 19

<10

Question 20

US use for IVF

Answer 20

assess uterus (fibroids, congenital abnorm)

adnexa (hydrosalpinx)

ovaries (PCOS, cysts, baseline antral follicle count)

Question 21

what is baseline antral follicle count

BAFC < what # indicates poor ovarian response?

Answer 21

the number of sm antral follicles seen at the start of the menstrual cycle

<10

Question 22

what is a hysterosalpingogram (HSC)

what does it assess

Answer 22

xray, where dye or contrast in injected into the uterus

assess the uterus for congenital abnorm. and patency of tubes

Question 23

how can you tell the tubes are patent on a hysterosalpingogram

Answer 23

contrast will spill into the posterior cul de sac

Question 24

what is a sonohysterogram (SHG)

what does it assess

Answer 24

ultrasound guided procedure where saline is injected into the uterus

assess uterine cavity
patency of tubes

Question 25

is a sonohysterogram as reliable as a hysterosalpingogram for determining the patency of tubes

Answer 25

no

Question 26

complications of HSC and SHG

Answer 26

infection fainting spotting radiation (HSC)

Question 27

describe ovarian suspension in IVF

Answer 27

downregulation - GnRH agonist is given to stop ovulation and creates a temp state of menopause... purpose is to prevent premature ovulation and controls timing of IVF cycle

Question 28

what is an ovarian suppression check

Answer 28

US to see that there are no new follicles developing

Question 29

how is the egg retrieved w/ IVF

Answer 29

under endovaginal guidance, needle inserted into vaginal wall and the egg is aspirated into a test tube... ... then examined for quality

Question 30

insemination w/ IVF

Answer 30

occurs in a petri dish through intracytoplasmic sperm injection

Question 31

w/ IVF, when is/are the embryo(s) transferred

Answer 31

day 3 or 5... day 5 is better to be able to assess implantation abilities

Question 32

factors that determine # of embryos implanted

Answer 32

mothers age quality of embryos previous fertility Hx

Question 33

why is ART often used?

Answer 33

due to previous ectopic that blocked a tube

Question 34

US use post IVF

Answer 34

confirmation of preg and # @ 6-8 weeks

Question 35

do you use any type of gel when doing an EV for ART

Answer 35

no, it may have spermicide | water only

Question 36

what is clomid

Answer 36

- fertility drug that increases FSH and will simulate a norm cycle - only 1 graafian follicle produced

Question 37

what is pergonal

Answer 37

- fertility drug that stimulates FSH and LH | - more than 1 graafian follicle produced

Question 38

what does a GnRH agonist do

Answer 38

shuts off pituitary

Question 39

describe ovarian hyperstimulation syndrome

Answer 39

- can occur w/ fertility drug use... especially pergonal w/ hCG and pregnancy - creates theca luteal cysts

Question 40

what can ovarian hyperstimulation syndrome cause

Answer 40

ascites pleural effusion DVTs shock or death

Question 41

what fertility drugs increases the chances of multiple gestations

Answer 41

pergonal - because multiple follicles develop pergonal and hCG together - even higher chance than pergonal alone

Question 42

which drug is given on the day of, and immediately after, the transfer of the embryos w/ IVF why

Answer 42

hCG, encourages implantation

Question 43

after embryo implantation w/ IVF, which drug is taken until 10 weeks gestation why

Answer 43

progesterone given until the placenta takes over

Question 44

why can IVF be unsuccessful

Answer 44

- ovaries dont respond to hormones, no egg is produced - egg isnt fertilized or doesnt grow - failure to implant

Question 45

what is the most common reason that IVF is unsuccessful

Answer 45

failure to implant

Question 46

can good quality eggs be cryopreserved for later preg

Answer 46

yes

Question 47

what is GIFT how does it work

Answer 47

gamete intrafallopian transfer - egg and spem are injected into the ampulla of the tube - done w/ EV or laparoscopy

Question 48

when is GIFT usually done

Answer 48

unexplained infertility or endometriosis..... considered more natural than IVF

Question 49

what is ZIFT how does it work

Answer 49

zygote intrafallopian transfer modified form of IVF -1 day old zygotes placed in tubes

Question 50

theoretical advantage of ZIFT

Answer 50

embryo develops in the tube