ASSISTED CONCEPTION Flashcards by Iseoluwa Ojo

ASSISTED CONCEPTION
• Assisted Conception as known as ____________________________ or
_____________________________–( newer term)

assisted reproductive technology (ART)

MEDICALLY ASSISTED REPRODUCTION (MAR)

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ART is any procedure where the _________ is ______________ or ___________ from the _________ and
__________ either as ____________ or as an __________

gamete ;manipulated

removed ; body; returned

an oocyte ; embryo

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__________________________ (returning the gamete as sperm) is not assisted conception.

Intrauterine insemination

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TYPES OF ASSITED CONCEPTION
• _____________ and _____________ : ≈ 99% of ART cycles
•_____________________ (GIFT)
•____________________(ZIFT)
• ____________________ (TET)
•___________________ techniques

In vitro fertilization and embryo transfer (IVF+ET)

Gamete intrafallopian transfer

Zygote intrafallopian transfer

Tubal embryo transfer

Micromanipulation

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IVF ??

ET??

In vitro fertilization

embryo transfer

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Micromanipulation techniques:
——————————————, ________________ techniques, assisted hatching, ____________________________, _____________ transfer, oocyte _________

Intracytoplasmice sperm injection (ICSI)

sperm aspiration

pre- implantation genetic diagnosis

frozen embryo; donation

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Assisted hatching

• The ___________ (outer shell) of the embryo is _________ or __________ using _________ or ___________ .
• Aims to help the embryo hatch and ___________ better.
• used in older women or previous IVF failures.

zona pellucida

thinned ; breached

laser ; acid

implant

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Pre-implantation Genetic Diagnosis (PGD)
• A few _______ from the ———— are __________ to test for _________________ before transfer.
• Useful for couples at risk of transmitting genetic conditions (e.g. cystic fibrosis, sickle cell).

cells; embryo; biopsied

genetic diseases

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Frozen Embryo Transfer (FET)
• Embryos not _________________________ are ____________ .
• Later thawed and transferred into the uterus.
• Allows multiple attempts from a single cycle of egg retrieval.

used in a fresh IVF cycle

cryopreserved

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Oocyte Donation

• Eggs are retrieved from a ________ , then __________ with __________ (partner’s or donor), and _________ is transferred to the recipient’s uterus.
• Indicated in ___________________ , older women , Or poor

donor

fertilized ; sperm

embryo

premature ovarian failure

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Differences between IVF+ET and ICSI

Fertilization
Sperm needed
Used for
Cost

Natural (sperm added to egg); Manual (sperm injected into egg)

Thousands per egg; Only 1 sperm per egg

Tubal/mild infertility; Severe male infertility

Lower; higher

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____________ assisted conception is now obsolete; one of the earliest forms and is rarely practiced these days.

Egg and sperm transferred through the fimbriae. It is for historic purpose.

GIFT

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GIFT (Can or Cannot?) be done in tubal blockage.

Cannot

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• Zygote(ZIFT) = level of _________ – ____ cell embryo
• TET = at level of ________ or ____-cell - developing embryo
(2-8 cell stage)

pro-nuclei; 1

blastocyst; 2

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______,________,________ are now old techniques of assisted conception

ZIFT, GIFT, TET

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INDICATIONS FOR ART
• Treatment of ______________ (main indication)
• Fertile couples for _________ reasons (pre-implantation genetic diagnosis)
• Couples ____________ for certain communicable disease such as _______

infertility; genetic

discordant; HIV

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ART in serodiscordant couples

– ___________________ : Semen is processed to separate sperm
cells from HIV-carrying fluid and infected cells.
–_______ or _________ : Washed sperm is then used to fertilize the egg
in vitro, and the embryo is transferred to the woman’s
uterus.

Sperm washing

ICSI or IVF

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First IVF in Nigeria was performed by Prof. O.F. _____________ and Prof. O.A. ___________ in 1989

The science of IVF has advanced and many centres now performIVF

Giwa-Osagie

Ashiru

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GOAL OF IVF
• To put ____________________ of selected spermatozoa __________________ to the oocyte
which could lead to fertilization

adequate number

as close as possible

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TYPES OF IVF

• Natural-cycle IVF – collects _________ at a time

• Conventional IVF – give something, cause _____________ development; collect the eggs and then fertilise them. ___________ sperm around 1 egg.

one egg

multi- follicular; 200,000

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Types of IVF

• ICSI – holds the ________, picks ____________ , use a special needle to inject the sperm into the egg.

_____________ was no longer an issue here, as long as its viable and normal. _____ is ______ to allow easy picking
up of sperm to inject it.

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egg; one sperm

Motility

Tail ; cut

BASIC STEPS IN IVF -
Conventional
• Pituitary __________
• Ovarian ___________ - exogenous FSH to give ______________
• ______________ or egg
retrieval
• Sperm preparation
• Insemination
•__________ & ___________
•________ transfer
• Luteal phase support - __________

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suppression; stimulation

10-15 eggs.

Ovulation trigger

Fertilization ; embryo Culture

Embryo; progesterone

PITUITARY SUPPRESSION
•____________________
• ___________________ analogues

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Combined oral contraceptive pills

Gonadotropin releasing hormone

Pituitary suppression

GnRH agonist (GnRHa): stimulate anterior posterior to release _______ and _______ , to empty the granules and maintain on this e.g.
1. __________,
2. Leuprolide,
3. Nafarelin
– GnRH antagonist e.g.
1.____________,
2. Ganirelix

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FSH and LH

Buserelin; Cetrorelix

AIM OF GnRH ANALOG THERAPY •_________ _________ ________ secretion • Prevent __________ ______ _________

Supress endogenous FSH premature LH surge

ADVANTAGES AND DISADVANTAGES OF GNRH ANALOG ANTAGONIST • Effect within _____ to _________ • Avoids ‘__________ ’ • Dose dependant effect so _______ dose for blocking effect •____% of receptors blocked. • gonadotrophins stores are _________

4 to 6 hours flare up; Full Majority; not depleted

ADVANTAGES AND DISADVANTAGES OF GNRH ANALOG AGONIST • Effect in _____ to _____ day • Initial flare for _____ to ___ days • Maintenance of down regulation requires _________ dose • ____ % of receptors always Remain. • Gonadotropin stores are ___________

10 to 14 3 to 4 very small ;10; depleted

ADVANTAGE OF LONG GNRH AGONIST PROTOCOL •___________ down regulation • Better ________ • Good cohort of ________ • Rare cancellation of cycle due to ___________________

Complete; control follicles premature LH surge

DISADVANTAGE OF LONG AGONIST PROTOCOL •____________ • Its sequelae – Cost – Cancellation of cycle – Physical Suffering – Immediate side effects – Future side effects

Over-suppression

OHSS - OHSS is a potentially serious complication of ___________________, particularly during _______________.

ovarian stimulation

OHSS It occurs when the ovaries respond ____________ to fertility drugs, leading to ______________________________ and increased _________________, which causes fluid to shift from the intravascular space to third spaces (like the abdomen and pleural cavity).

too strongly excessive follicular development

OVULATION STIMULATION • Medications for ovarian stimulation –______________________ (hMG) – old, now purified –_______: urinary versus recombinant – Clomiphene citrate (3-5 follicles)/Letrozole (Usually results in the maturation of 1–2 follicles, mimicking natural ovulation)

Human menopausal gonadotropin FSH

Human chorionic gonadotropin (hCG) trigger*** • Administered _____________ before ___________ - This window allows the eggs to ___________ but ensures they are not _________ prematurely, so they can be retrieved before ___________. • mimic the natural LH surge, which leads to final oocyte maturation and ovulation

34 – 36 hours egg retrieval reach maturity ovulated; rupture

PROBLEMS OF OVARIAN STIMULATION • OHSS – more than _______ follicles. It is a major dreaded complication. • Up to 6% of all FSH stimulated IVF cycles • 1.5% Severe – Compare no OHSS with unstimulated cycles • Waste of Human Resources - Excess eggs ? how to deal with - Excess embryos - even worse • Multiple pregnancies and their associated complications

EGG RETRIVAL (ER) • ER is generally performed __________ after hCG administration • Originally performed by __________ – in the past •____________________ is the standard route of ER – requires minimal anaesthesia and recovery time

34-36 hours laparoscopy Transvaginal ultrasound

Egg retrieval Oocyte ________________ is important for timing of insemination - For fertilization to occur successfully, the oocyte must be mature, meaning it must be at the _______________ stage of meiosis. Only that stage oocytes can be fertilized properly and develop into good-quality embryos.

maturity grading Metaphase II (MII)

INSEMINATION • A semen sample should be obtained by masturbation just before or after ______ • Sperm preparation by either _________ or ______________ method • Highly motile fraction is incubated for 30mins to 4hours to initiated capacitation • Mature oocytes are inseminated ≈ __________ after ER

ER swim-up; gradient centrifugation 4 hours

FERTILIZATION • Generally, each oocyte is incubated with between ________ to _________ motile sperm • Oocytes are evaluated for fertilization ________ post-insemination

50,000 to 200,000 18 hours

FERTILIZATION Normal fertilization: ____ pronuclei and 2 _________ in the perivitelline space • The process of fertilization takes about ___________

2; polar bodies 24 hours

Fertilization conditions • Duration: 12-18 hours at ____0C, ____% CO2, and _____ % relative humidity

37 5 98

EMBRYO TRANSFER (ET) • ET is most commonly performed after __________ hours (Day ________ ) • ___________ transfer is generally performed at 120 hours (Day _____) • Transfer done with patient in _______________ position transcervically using a soft catheter

48 or 72 ; 2 or 3 Blastocyst; 5 dorsal lithotomy

LUTEAL PHASE SUPPORT • Supplemental ______ • Supplemental __________ – Vaginal pessary – Vaginal gel – Oral preparations – PROGESTERONE SUPPORT like duphaston – Intramuscular injection

hCG progesterone

SUCCESS RATE of IVF • Success rate about 25 – 35% (30 – 40%) – Influenced by many factors •_____________ •______________ transferred –_______ ET – in europe – Double ET

Maternal age (> 35 years) Number of embryos Single

RISK OF IVF •________________________ • Risk of borderline ___________ • Risk associate with egg retrieval: bleeding, infection, damage to _______,__________, or ________ (due to the needle) • Risks and complications of _________ pregnancy and births • Possible _________ or __________ • Physical, financial and emotional commitments • Psychological stress and high expectation

Ovarian hyperstimulation syndrome (OHSS) ovarian tumour bowel, bladder or blood vessel multiple miscarriage or ectopic pregnancy

ICSI • First performed in 1992 • One of the most successful for treatment of _______ factor & unexplained infertility • Success independent of basic sperm parameter: ________,___________, and ___________

male motility morphology concentration

ICSI ??

Intracytoplasmic sperm injection

INDICATIONS OF ICSI • ______ zoospermia • ______ zoospermia • ______ zoospermia • ______ zoospermia • Surgically retrieved sperm • ___________ _______ • Low ______ count • _____________/IVM oocytes • Repeated ___________________

• Oligozoospermia • Asthenozoospermia • Teratozoospermia • Globozoospermia • Surgically retrieved sperm • Antisperm antibodies • Low oocyte count • Cryopreserved/IVM oocytes • Repeated IVF fertilization failure

CURRENT TREND IN ART • Minimize _______________ • Minimize _______________ • Minimize patients’ ________________ – Physiological – Psychological – Financial

multiple pregnancies number of embryos transfer load and stress

PRE-ART EVALUATION • General (preconception care): history, physical examination and investigation to screen for conditions that could adversely affect pregnancy • Prerequisite testing: HIV, hepatitis B & C, syphilis, sickle cell trait, cystic fibrosis, blood group • ____________ testing •__________ analysis • Uterus: USS, HSG, SIS, laparoscopy/ hysteroscopy, “mock” transfer

Ovarian reserve Semen

In Nigeria: over ______ % of gynaecological clinic consultations are infertility related

GnRH AGONIST PROTOCOL LONG PROTOCOL 1. Avoid _________________ 2.________ timing 3. Avoid _________________ 4. Higher follicular recruitment (synchronization) 5. Improvement immune attitude 6. Expensive cost High responders, PCOS

pre-menses FSH surge Follicles; premature LH surge

GnRH AGONIST PROTOCOL SHORT PROTOCOL ___________ timing Avoid ____________________ (Lower or Higher?) follicular recruitment Make procedures (easier or harder?)

Follicles premature LH surge Lower ; easier

ASSISTED CONCEPTION Flashcards

(52 cards)