DNAP 2027 > Fall_25_IVF/ART > Flashcards

Fall_25_IVF/ART Flashcards

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1
Q

Year and significance of the first IVF live birth?

A

1978; first infant conceived via IVF with single oocyte retrieval, in vitro fertilization, and embryo transfer. 【66†3】

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2
Q

Core role of the anesthetist in ART procedures?

A

Provide short-duration anesthesia for comfort while minimizing exposure and preserving outcomes. 【66†2}

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3
Q

Why must ART anesthesia be as brief as possible?

A

To limit potential drug effects on oocytes/embryos and avoid delayed recovery. 【66†2】

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4
Q

Two key determinants when choosing anesthesia for ART?

A

Procedure purpose and patient consultation/consent regarding anesthetic modality. 【66†2】

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5
Q

Primary goal of ovarian stimulation regimens?

A

Retrieve ~10–15 oocytes to increase probability of live birth. 【66†4】

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6
Q

Timing of transvaginal oocyte retrieval after hCG?

A

Performed ~34–36 hours post‑hCG to avoid spontaneous ovulation. 【66†4】

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7
Q

Most common ART procedure in the U.S.?

A

IVF with embryo transfer (IVF‑ET) accounts for ~99% of ART. 【66†4】

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8
Q

Two routes for embryo transfer and key advantage of the common one?

A

Transcervical to uterine cavity (simple, lower cost, no patent tubes needed) vs fallopian tube. 【66†5】

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9
Q

Main disadvantage of transcervical embryo transfer vs ZIFT?

A

Lower probability of successful pregnancy compared with tubal transfers historically. 【66†5】

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10
Q

GIFT: where does fertilization occur?

A

In vivo within the fallopian tube after transabdominal/transvaginal oocyte and sperm placement. 【66†6】

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11
Q

ZIFT: sequence of steps?

A

Oocyte retrieval → IVF in vitro → confirm fertilization → laparoscopic transfer of embryos to tube. 【66†6】

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12
Q

Dominant predictor of ART success?

A

Maternal age. 【66†7】

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13
Q

Historical vs contemporary pregnancy rates: tubal vs uterine transfers?

A

Historically higher with GIFT/ZIFT; parity in outcomes has increased over time. 【66†7】

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14
Q

What registry role exists in ART?

A

CDC and registries analyze ART outcomes annually. 【66†7】

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15
Q

Most common complication of ovarian stimulation?

A

Ovarian Hyperstimulation Syndrome (OHSS). 【66†8】

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16
Q

Typical features of mild OHSS?

A

Abdominal discomfort, bilateral ovarian enlargement, ascites. 【66†8】

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17
Q

Severe OHSS manifestations?

A

Follicular rupture/hemorrhage, pleural effusion, hemoconcentration, oliguria, thromboembolism. 【66†8】

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18
Q

Anesthetic implications of OHSS on pharmacology?

A

Higher free drug concentrations due to hemoconcentration/low protein; adjust dosing carefully. 【66†8】

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19
Q

Airway/respiratory implications in massive ascites or effusion?

A

Consider pre‑induction paracentesis/thoracentesis if respiratory compromise is present. 【66†8】

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20
Q

Why do programs limit number of embryos transferred?

A

To reduce multifetal gestations and associated morbidity. 【66†9】

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21
Q

Relative risk of ectopic pregnancy in ART vs natural?

A

Up to 5× higher with ART. 【66†9】

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22
Q

Neonatal outcomes in ART singletons vs natural?

A

Higher rates of preterm birth, low birth weight, and SGA in ART singletons. 【66†9】

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23
Q

Key caveat when interpreting anesthetic effects on ART outcomes?

A

Animal/cell data may not translate; outcomes depend on route, dose, timing, combinations, and exposure duration. 【66†10】

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24
Q

Clinical selection principle balancing benefits and risks?

A

Choose techniques that offer hemodynamic stability and low PONV while minimizing theoretical reproductive risks. 【66†10】

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25
Do local anesthetics used for retrieval alter oocyte/embryo outcomes?
Human data suggest minimal alterations when used for retrieval, GIFT, or ZIFT. 【66†11】
26
Which exposure factors dictate LA effects in animal models?
Agent, timing, and dose of exposure. 【66†11】
27
Do fentanyl/alfentanil/remifentanil/meperidine impair fertilization or preimplantation development?
No convincing interference in animal and human trials. 【66†11】
28
Are benzodiazepines universally contraindicated?
Not absolutely; decisions should weigh dose/timing/duration; data do not consistently show harm at procedural sedation doses. 【66†10】【66†11】
29
Effect of propofol on fertilization/early development per most studies?
Minimal to no detrimental effects. 【66†12】
30
Are thiopental and ketamine acceptable in ART anesthesia?
They have been used; choose dose/adjuncts judiciously in brief exposures. 【66†12】
31
Biochemical pathways affected by nitrous oxide?
Reduces methionine synthetase activity, nonmethylated folates, and DNA synthesis; impairs mitotic spindles in cultures. 【66†12】
32
Clinical implication of N₂O for ART?
Potential theoretical risk to dividing cells; many clinicians avoid or minimize N₂O during retrieval/transfer. 【66†12】
33
Cellular effects of volatile anesthetics relevant to ART?
Depress DNA synthesis/mitosis; isoflurane adversely affects embryo development in vitro; may raise prolactin. 【66†13】
34
Practical implication for volatiles in ART?
Favor TIVA/sedation or very low‑dose volatiles when necessary; keep exposure brief. 【66†13】
35
Which antiemetics may acutely raise prolactin and impair follicle/luteal function?
Droperidol and metoclopramide. 【66†13】
36
Preferred antiemetic class for ART procedures?
Nondopaminergic agents (e.g., ondansetron) when possible. 【66†15】
37
Are routine labs/ECG/CXR required before ART anesthesia?
Generally not for healthy young patients. 【66†14】
38
Preop fasting guidance for ART patients?
Follow standard ambulatory fasting guidelines. 【66†14】
39
Prevention for aspiration in higher‑risk patients before ART?
Administer a nonparticulate antacid. 【66†14】
40
If fasting was not adhered to, should case be cancelled?
Consider delay/cancellation after risk–benefit analysis rather than automatic cancellation. 【66†14】
41
Common anesthetic options for oocyte retrieval?
Sedation analgesia (often TIVA with short‑acting opioids/propofol), neuraxial, or GA when needed. 【66†16】
42
Rationale for deepening sedation to GA during ART?
To prevent movement at critical procedural moments. 【66†16】
43
Strategy to minimize reproductive risk from anesthetics?
Use the lowest effective doses for the shortest time; favor agents with minimal theoretical reproductive impact. 【66†10】【66†13】【66†16】
44
Airway plan in severe OHSS/ascites patients?
Elevate head, preoxygenate thoroughly; consider RSI if aspiration risk; decompress fluid collections pre‑induction if needed. 【66†8】【66†14】
45
Analgesia target during transvaginal retrieval?
Blunt pelvic visceral pain and puncture discomfort while maintaining spontaneous ventilation. 【66†4】【66†16】
46
Most common causes for hospital admission after ART procedures?
Hemoperitoneum and syncope after retrieval; N/V and bowel injury after laparoscopic GIFT. 【66†15】
47
Typical post‑retrieval symptoms to manage?
Abdominal pain and uterine cramping. 【66†15】
48
Common post‑laparoscopy pain pattern in ART?
Incisional pain and referred shoulder pain from diaphragmatic irritation. 【66†15】
49
Antiemetic caution post‑ART?
Limit droperidol/metoclopramide; prefer nondopaminergic agents. 【66†15】
50
Discharge criteria after ART anesthesia?
Able to drink/retain liquids, ambulate, and void. 【66†15】
51
Trend in ART patient demographics and comorbidities?
Expanding to broader ages and more comorbidities. 【66†16】
52
Which anesthetic modalities have been used successfully in ART?
Sedation, neuraxial, and general anesthesia. 【66†16】
53
Key counseling point about anesthetic drug studies in ART?
Some in vitro or animal signals exist, but human outcome data are limited; keep exposure minimal. 【66†10】【66†13】
54
Target oocyte count per stimulated cycle?
Approximately 10–15 oocytes. 【66†4】
55
hCG‑to‑retrieval interval to remember?
34–36 hours. 【66†4】
56
Most prevalent ART modality?
IVF‑ET (~99%). 【66†4】
57
Which has historically shown higher pregnancy rates than transcervical ET?
Tubal transfers (GIFT/ZIFT), though parity has increased. 【66†5】【66†7】
58
Single strongest clinical predictor of ART success?
Maternal age. 【66†7】
59
Most common stimulation complication?
OHSS. 【66†8】
60
Two severe OHSS risks anesthetists must anticipate?
Thromboembolism and respiratory compromise from effusions/ascites. 【66†8】
61
Antiemetics to limit due to prolactin effects?
Droperidol, metoclopramide. 【66†13】
62
Preferred antiemetic alternative?
Ondansetron or other nondopaminergic agents. 【66†15】
63
Volatile agent class consideration in ART?
Use sparingly; consider TIVA due to in vitro concerns (DNA synthesis/mitosis). 【66†13】
64
Nitrous oxide concern in ART?
Methionine synthetase inhibition and spindle effects → often avoided. 【66†12】
65
Local anesthetic bottom line for retrieval?
Minimal oocyte/embryo alteration in human trials when appropriately dosed. 【66†11】
66
Opioid bottom line for retrieval?
Short‑acting opioids (e.g., fentanyl/remifentanil) have not shown adverse effects on fertilization/preimplantation in studies. 【66†11】
67
Primary discharge readiness markers post‑ART?
Drink/retain fluids, ambulate, void; pain/N/V controlled. 【66†15】
68
Why might deep sedation be escalated to GA mid‑procedure?
Patient movement threatens procedural success or safety. 【66†16】
69
Preop aspiration prophylaxis agent type?
Nonparticulate antacid (e.g., sodium citrate). 【66†14】
70
Analgesia balance aim during retrieval/transfer?
Adequate analgesia with rapid recovery and minimal embryotoxic theoretical risk. 【66†10】【66†16】
71
Strategy if patient has not adhered to fasting but timing is critical?
Perform individualized risk–benefit assessment; consider delay vs proceeding with full aspiration precautions. 【66†14】
72
Key intraop monitoring priorities during retrieval under sedation?
Ventilation/oxygenation, hemodynamics, responsiveness/movement to prevent procedural disruption. 【66†16】
73
Pain sources during post‑retrieval period to anticipate?
Follicle puncture sites and uterine cramping; treat with multimodal analgesia. 【66†15】
74
When to consider pre‑induction drainage in OHSS?
With significant respiratory compromise from ascites/effusions before GA. 【66†8】
75
Global anesthesia principle across ART modalities?
Use the least drug for the shortest time compatible with safety and comfort. 【66†2】【66†10】
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