infertility

Question 1

describe what key assessments should be carried out for male fertility and the normal ranges

Answer 1

semen analysis

count = 15M/ml

motility = 40% forward progression

volume = 1.5ml

total no. sperm = 39 million in ejaculate

morphology = 4%

Question 2

list 6 leading causes of female infertility

Answer 2

anovulation
PCOS
tubal disease
endometriosis
cervical problems insemination
premature menopause
no uterus

Question 3

draw a diagram of the 6 steps involved in IVF

Answer 3

1. egg production stimulated by hormone therapy
2. eggs retrieved from ovary
3. sperm sample provided
4. eggs and sperm combined to allow fertilisation (incubated)
5. fertilised eggs introduced into uterus
6. embryo freezing

Question 4

know 3 different fertility drugs and what they do

Answer 4

progesterone = luteal support

GnRH agonist = stimulate ovulation

GnRH antagonist = prevent ovulation

Question 5

appreciate the impact of age on fertility

Answer 5

success of IVF declines with age

now one of the leading causes of infertility

implantation rate decreases

aneuploidy increases with age (abnormal chromosomes)

Question 6

list at least 2 recent innovations or trends in IVF

Answer 6

time-lapse photography and single step media

• undisturbed culture (doesnt leave intubation)
• individual embryo tracking of cell division
• algorithms predict those with best potential
• provides full info
• no more snapshot selection

Question 7

tubal disease and treatment

Answer 7

cysts, tumors or adhesions that block fallopian tubes

surgery
IVF

Question 8

ovarian stimulation

Answer 8

• stimulation = FSH
• control (prevent ovulation) = GnRH antagonist
• trigger maturation = stimulate ovulation HCG or GnRH agonist
• luteal support = progesterone essenstial

Question 9

IVF tracking

Answer 9

transvaginal ultrasound to measure follicles before stimulation given

blood tests

• estrogen ~1000U/follicle
• progestrone <6pmol/L

Question 10

draw a diagram of the 6 steps involved in ICSI

Answer 10

sperm selection

1. select motile sperm with normal morphology
2. immobilise sperm
3. aspirate sperm tail first
4. position sperm in needle

Question 11

causes of male infertility

Answer 11

oligospermia

OATS (oligoasthenoteratospermia)

• low conc, slow motility and abnormal form
• triple defect

azoospermia
- no sperm

treatment

• intra-cytoplasmic sperm injection
• donor sperm

Question 12

draw a diagram of the 6 steps involved in ICSI

Answer 12

sperm selection

1. select motile sperm with normal morphology
2. immobilise sperm
3. aspirate sperm tail first
4. position sperm in needle
5. position PB at 12
6. suction pipette
7. insert needle into egg
8. rupture egg membrane by aspirating
9. expel the sperm

Question 13

another recent innovation - egg freezing

Answer 13

• vitrified in the same way as embryos but less successful
• need ~10 eggs frozen to achieve a pregnancy
• fertility preservation before chemotherapy, radiation

Question 14

another recent innovation - egg freezing

Answer 14

• vitrified in the same way as embryos but less successful
• need ~10 eggs frozen to achieve a pregnancy
• fertility preservation before chemotherapy, radiation

Question 15

another recent innovation - preimplantation genetic screening

Answer 15

day 5 biopsy

• perform genetic analysis