"Medical Physiology Clinical Correlation: In Vitro Fertilization" 4/6 Flashcards Preview

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Flashcards in "Medical Physiology Clinical Correlation: In Vitro Fertilization" 4/6 Deck (14):
1

What are the common causes of male infertility?

1. Low sperm count
2. Abnormal sperm - teratospermia
3. Slow sperm - asthenozoospermia
4. Genetic issues

2

Besides unexplained etiology, what is the most common cause of male infertility?

Varicocele, like a varicose vein of the testes

3

Who should consider IVF?

Tubal factor infertility (blocked/absent fallopian tubes)

Male factor infertility (low sperm count/motility, abnormal morphology)

Other causes of infertility, after failing treatment with other therapies (ovulation disorders, endometriosis, cervical factor infertility, immunological infertility, unexplained infertility, )

Advanced reproductive age

Ovarian failure (donor eggs required)

4

Why do you overstimulate the ovaries?

To gather as many eggs as possible, b/c
IVF has low success rate
Usually only 1 mature egg is produced per cycle
A large number of oocytes improves pregnancy rates

5

Inhibin is produced by what cell and acts on what organ?

Inhibin is produced by granulosa cells

6

What is the function of clomophine?

Clomiphene inhibits negative feedback of
estrogen on hypothalamus, resulting in
increased secretion of GnRH and FSH/LH

7

How does a GnRH agonist function?

GnRH agonists:
-- D-amino acid substitution of Gly
in position 6 enhances increase
binding affinity and decrease
degradation.

8

What is the most commonly prescribed IVF protocol?

GnRHa long protocol
reduced amounts of LH
higher clinical pregnancy rate

9

What is ovarian hyperstimulation syndrome, OHSS?

An excessive response to the medicines (especially gonadotropins) used to stimulate follicle growth due to a large number of growing follicles (>25) along with high estradiol levels (>4000 pg/ml).

Symptoms: abdominal bloating, nausea, and weight gain due to transudation of protein rich fluid

Treatments: -- decreased activity
-- drinking electrolyte-rich fluids
-- draining fluid that accumulates in the abdomen
-- medication for nausea

10

What is capacitation?

-- Capacitation: incubation of sperms in protein-supplemented media for up to four hours

11

Who is eligible for standard oocyte insemination?

Patients with good quality of sperm and egg

12

What is ISCI, intracytoplasmic sperm injection?

Under the microscope, put one sperm in one egg

13

What is the preferred day of transfer for IVF embyros?

Blastocyst stage day 5
suited to younger patients or patients with more embryos

Day 3 cleavage for older patients, or previous IVF failure, or patients with less than 6 embryos.

14

What is luteal phase support and why is it important?

Why?
-- abnormal endometrial maturation due to extremely high levels of estradiol and androgen resulting from ovarian stimulation
-- removal of a large number of granulosa cells during oocyte retrieval could lead to inadequate production of progesterone

How?
-- progesterone supplementation daily during the luteal phase (intramuscularly or vaginally)
-- hCG once or more during the luteal phase (intramuscularly)