Assisted Reproductive Techniques (ART) Quiz
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Assisted Reproductive Techniques (ART) Quiz

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Questions and Answers

What is the primary purpose of intrauterine insemination (IUI)?

IUI aims to introduce prepared sperm directly into the uterine cavity to enhance the chances of fertilization.

List two conditions in which IUI is not recommended.

IUI is not recommended for women with severe fallopian tube disease or a history of pelvic infections.

What is the success rate of IUI per treatment cycle?

The success rate of IUI ranges between 10% and 20% per treatment cycle.

What role does human chorionic gonadotrophin (hCG) play in stimulated IUI?

<p>hCG is used to trigger ovulation and determine the timing for insemination in stimulated IUI.</p> Signup and view all the answers

What are the primary uses of in-vitro fertilization (IVF) today?

<p>IVF is used for various infertility issues, including tubal disease, endometriosis, and cases requiring donor eggs.</p> Signup and view all the answers

What is the function of pituitary down-regulation in IVF?

<p>Pituitary down-regulation prevents endogenous LH surges and premature ovulation during the IVF process.</p> Signup and view all the answers

What factors contribute to the emotional and financial stress of assisted reproductive techniques (ART)?

<p>Various factors include the uncertainty of success rates, physical demands of treatments, and financial costs associated with multiple cycles.</p> Signup and view all the answers

How does the Human Fertilisation and Embryo Authority (HFEA) relate to ART in the UK?

<p>The HFEA regulates ART practices in the UK to ensure the safety and ethical standards of fertility treatments.</p> Signup and view all the answers

What is the primary role of GnRH agonists in ovarian stimulation?

<p>GnRH agonists block the release of FSH and LH from the pituitary, aiding in controlled ovarian stimulation.</p> Signup and view all the answers

How do GnRH antagonists provide advantages over GnRH agonists?

<p>GnRH antagonists can shorten treatment time and reduce the incidence of ovarian hyperstimulation syndrome.</p> Signup and view all the answers

What is the ideal number of follicles that should be recruited during controlled ovarian stimulation?

<p>Ideally, around 15 follicles should be recruited during controlled ovarian stimulation.</p> Signup and view all the answers

What role does hCG play in the IVF process?

<p>hCG acts as a surrogate for the LH surge, triggering final egg maturation and scheduling the egg collection.</p> Signup and view all the answers

Why is it important to monitor oestradiol levels during ovarian stimulation?

<p>Monitoring oestradiol levels helps assess ovarian response to stimulation and the development of follicles.</p> Signup and view all the answers

What are the two methods of fertilization mentioned in the process?

<p>The two methods of fertilization are conventional IVF and intra cytoplasmic sperm injection (ICSI).</p> Signup and view all the answers

What is the main purpose of measuring endometrial thickness during IVF preparation?

<p>Measuring endometrial thickness helps assess the uterine environment for embryo implantation.</p> Signup and view all the answers

What is the typical fertilization success rate for conventional IVF and ICSI?

<p>The fertilization rate is usually around 60% for IVF and 70% for ICSI.</p> Signup and view all the answers

What is the significance of the polar body position during ovum rotation in ICSI?

<p>The polar body should be at 12 or 6 o'clock to allow the needle insertion at 3 o'clock for optimal positioning.</p> Signup and view all the answers

How many days after embryo development is optimal for transferring embryos back into the uterus?

<p>Embryos can be transferred back into the uterus after 2, 3, or 5 days of development, with day 5 being optimal.</p> Signup and view all the answers

What role does transabdominal ultrasound play in embryo transfer?

<p>Transabdominal ultrasound is used to ensure correct placement of the embryos during the transfer.</p> Signup and view all the answers

What is the risk associated with multiple embryo transfers?

<p>Multiple embryo transfers increase the risk of multiple pregnancies and their associated complications.</p> Signup and view all the answers

Why is progesterone supplementation necessary after egg collection?

<p>Progesterone supplementation is required because egg collection can reduce the corpus luteum's ability to produce progesterone.</p> Signup and view all the answers

What factors influence IVF success rates?

<p>IVF success rates are significantly influenced by female age, with younger patients having higher success rates.</p> Signup and view all the answers

What is Ovarian Hyperstimulation Syndrome (OHSS) in the context of IVF?

<p>OHSS is a significant risk of IVF treatment that occurs in 1-3% of cases.</p> Signup and view all the answers

What is embryo cryopreservation and why is it used?

<p>Embryo cryopreservation is the process of preserving spare, good-quality embryos for future use.</p> Signup and view all the answers

What are two primary scenarios where donor sperm is utilized?

<p>Donor sperm is used when the male partner is azoo spermic or in cases of single women and female same-sex couples.</p> Signup and view all the answers

In which situations would donor eggs be considered for use?

<p>Donor eggs may be considered if a female has undergone early menopause or has low ovarian reserve and poor egg quality.</p> Signup and view all the answers

What is the first step in the IVF process and what is its purpose?

<p>The first step is Controlled Ovarian Stimulation, aimed at producing multiple follicles for egg retrieval.</p> Signup and view all the answers

Describe the procedure of oocyte retrieval.

<p>Oocyte retrieval involves a minor surgery under TVUS, where a needle is guided through the vaginal wall into the ovary to aspirate follicles.</p> Signup and view all the answers

What are the two methods of fertilization in IVF?

<p>The two methods are insemination, where sperm and oocytes are mixed in a container, and ICSI, where a single sperm is injected directly into the oocyte.</p> Signup and view all the answers

What is the ideal time for embryo transfer in the IVF process?

<p>The ideal time for embryo transfer is at day 5 from fertilization when the embryo reaches the blastocyst stage.</p> Signup and view all the answers

What precautions should a male partner take prior to semen collection for IVF?

<p>The male partner should abstain from ejaculation for 5 days and use a sterile cupped container without lubricants or detergents.</p> Signup and view all the answers

What is luteal phase support and why is it important in IVF?

<p>Luteal phase support involves hormone supplementation after embryo transfer to enhance uterine lining receptivity.</p> Signup and view all the answers

What is the significance of the polar body in the context of ICSI?

<p>The polar body indicates that the ovum has completed meiosis I, which is necessary for ICSI to be performed.</p> Signup and view all the answers

How do OCPs contribute to IVF protocols?

<p>OCPs synchronize the development of multiple follicles, allowing them to grow simultaneously.</p> Signup and view all the answers

What is the role of GnRH in ovarian stimulation?

<p>GnRH down-regulates the pituitary gland to prevent spontaneous ovulation by inhibiting the LH surge.</p> Signup and view all the answers

What are gonadotropins, and how are they typically administered during IVF?

<p>Gonadotropins, such as FSH, are administered via daily injections for 8-10 days to stimulate follicle growth.</p> Signup and view all the answers

What is ovarian hyperstimulation syndrome (OHSS) and how can it be identified?

<p>OHSS is a condition caused by excessive ovarian stimulation, presenting symptoms like nausea, abdominal distension, and breathlessness.</p> Signup and view all the answers

What strategies have reduced the risk of developing OHSS?

<p>Risk reduction strategies include low-dose stimulation, using GnRH antagonists, and frequent monitoring of estradiol levels.</p> Signup and view all the answers

How does cryopreservation of embryos benefit future IVF cycles?

<p>Cryopreservation allows for the use of embryos at a later time, eliminating the need for immediate ovarian stimulation.</p> Signup and view all the answers

What is the role of progesterone in IVF protocols?

<p>Progesterone is provided for luteal phase support to ensure endometrial receptivity after embryo transfer.</p> Signup and view all the answers

Study Notes

Assisted Reproductive Techniques (ART)

  • ART includes various techniques that help couples with infertility achieve pregnancy.
  • ART requires thorough understanding of indications, treatment options, associated risks, and ethical considerations.
  • It's vital to be familiar with laboratory procedures and the emotional, physical, and financial burdens involved.
  • The Human Fertilisation and Embryo Authority (HFEA) regulates ART in the UK and establishes practice codes.

Intrauterine Insemination (IUI)

  • A procedure where prepared sperm is introduced into the uterine cavity using a catheter.
  • IUI is commonly used for cases like:
    • Low sperm count or motility
    • Unexplained infertility
    • Hostile cervical conditions (cervical mucus problems)
    • Ejaculatory dysfunction
  • IUI is not recommended for women with severe fallopian tube diseases or a history of pelvic infections.
  • The success rate of IUI ranges between 10% and 20% per treatment cycle.
  • Stimulated IUI involves using subcutaneous injections of exogenous FSH to stimulate the ovaries, aiming for 2-3 mature follicles.
  • Follicular tracking with ultrasound and hCG trigger are essential for successful IUI.

In-Vitro Fertilisation (IVF)

  • Originally designed for couples with tubal factor infertility, IVF is now widely used for various other reasons, such as endometriosis, failed IUI, and cases requiring donor eggs.
  • Originally performed during a natural menstrual cycle, IVF became more efficient with gonadotrophin-controlled ovarian stimulation.
  • ART in the UK is regulated by the HFEA.

IVF Treatment Cycle

  • Pituitary Down-regulation: Pre-treatment, the pituitary gland is downregulated to prevent premature ovulation. This involves administering GnRH agonists to block FSH and LH release. GnRH antagonists offer shorter treatment times and reduced risk of ovarian hyperstimulation syndrome (OHSS).
  • Controlled Ovarian Stimulation: This involves daily subcutaneous doses of gonadotrophin medications to stimulate multiple follicles. Close monitoring through transvaginal ultrasound (TVUS) predicts follicle number and timing for egg collection. The ideal number of recruited follicles is around 15.
  • Inhibition of Premature Ovulation: Rising oestradiol levels associated with follicle development should trigger an LH surge, leading to ovulation. In IVF, this surge is blocked to schedule egg collection. This is traditionally done with GnRH agonists or newer GnRH antagonist protocols.
  • hCG Trigger: hCG is used as a surrogate for the endogenous LH surge. It causes final maturation of the egg and allows scheduling of egg collection.
  • Egg Collection: Performed approximately 37 hours after hCG trigger under anesthesia. A needle is inserted into the ovaries under TVUS guidance, and follicular fluid is aspirated to collect oocytes.
  • Fertilization: Prepared sperm is used for fertilization. Conventional IVF involves insemination with around 100,000 sperm in a petri-dish. ICSI (intra-cytoplasmic sperm injection) is used for poor sperm parameters or previous fertilization failures, where a single sperm is directly injected into the oocyte's cytoplasm.
  • Embryo Culture: Embryos are incubated under specific conditions of temperature, pH, humidity, and oxygen concentration. They may be transferred back into the uterus after 2, 3, or 5 days of development. Blastocysts (day 5 development) have the best chance of implantation. Embryo selection involves morphological and morpho-kinetic assessment.
  • Embryo Transfer: Embryos are transferred into the uterus using a soft plastic catheter. The number of embryos transferred is decided by the couple based on expert medical and embryological advice. The UK and Europe recommend single embryo transfer to reduce multiple pregnancies.
  • Luteal Phase Support: Gonadotrophin agonists or antagonists used to prevent premature LH surge result in reduced progesterone production by the corpus luteum. This is compensated by supplemental progesterone after egg collection.
  • Pregnancy Test: Performed around 14 days after embryo transfer.
  • Embryo Cryopreservation: Excess high-quality embryos can be cryopreserved for future use.

IVF Success Rates

  • Highly dependent on the female age, with success rates ranging from 40-45% for patients under 35 to below 15% for women over 40.
  • IVF does not prevent the risk of normal pregnancy complications, such as miscarriage or ectopic pregnancies.
  • The most significant risk of IVF is OHSS, occurring in 1-3% of cases.

Donor Gametes

  • Donor sperm is used for azoo spermic males, single women, or female same-sex couples. Both IUI and IVF treatments are possible.
  • Donor eggs are used for cases of early menopause or unsuccessful IVF treatments associated with reduced ovarian reserves and low egg quality.
  • Gamete donation requires extensive counselling and legislative regulations in most countries.

Drugs Used in IVF Protocols

  • Oral contraceptive pills (OCPs): Used to synchronize follicles for simultaneous growth.
  • GnRH agonists/antagonists: Downregulate the pituitary, preventing spontaneous ovulation and LH surges. Antagonists have shorter durations and lower OHSS risk compared to agonists.
  • Gonadotropins (FSH): Daily injections for 8-10 days:
    • Recombinant FSH (Follistim 200 IU, Gonal-F 75 IU)
    • hMG: extracted FSH from urine of menopausal women (Menopur 75 IU)
  • hCG Trigger (ovidrel, novarel 10 000 IU): For final follicle maturation and scheduling egg retrieval after 36-37 hours. GnRH agonists can be used as triggers if GnRH antagonists are used.
  • Estrogen: Used to prepare the endometrium for embryo transfer when using preserved embryos.
  • Progesterone: Used for luteal phase support, as GnRH agonists/antagonists inhibit corpus luteum function.

Ovarian Hyperstimulation Syndrome (OHSS)

  • A potentially fatal complication caused by excessive ovarian stimulation by gonadotropins in IVF or ovulation induction.
  • Leads to activation of ovarian RAAS and VEGF.
  • Symptoms: Nausea and vomiting, abdominal distension and discomfort, breathlessness, ascites, pleural and pericardial effusions, hemoconcentration, venous thromboembolism (VTE), acute respiratory distress syndrome (ARDS).
  • Risk factors: Older age, high ovarian reserve, history of OHSS, PCOS.
  • The risk has been reduced through:
    • Low-dose stimulation (FSH)
    • Utilizing GnRH antagonists instead of agonists
    • Frequent monitoring through ultrasound and estradiol levels
    • Embryo cryopreservation

Oocyte Retrieval (Ovum Pick Up)

  • A minor surgical procedure involving follicular aspiration.
  • Performed under TVUS guidance, a needle with a guide wire is inserted through the vaginal wall into the ovary.
  • Follicles are aspirated, and retrieved oocytes are observed microscopically.
  • Additional aspiration may be required if oocytes are not initially retrieved.
  • Semen preparation:
    • Sterile cupped container
    • 5 days of abstinence from ejaculation
    • No detergents or lubricants used during ejaculation

Fertilization

  • Insemination: 100,000 sperm are placed in a container with the oocyte, allowing for spontaneous fertilization.
  • ICSI (Intra-Cytoplasmic Sperm Injection): The tail of a motile sperm is cut and injected into the oocyte using a needle, preventing DNA damage from tail movement. This procedure requires a polar body, indicating completed meiosis I.
    • Injection occurs at a 90-degree angle to the polar body.

IVF Steps

  • Controlled ovarian stimulation (GnRH agonists/antagonists, FSH, hCG). Close monitoring with TVUS (number/size of follicles & endometrial thickness) and blood estradiol levels. We need at least 4, ideally 15 follicles of 18 mm.
  • Oocyte retrieval: Under TVUS.
  • Oocyte fertilization: Insemination or ICSI.
  • Embryo culture: Under strict conditions (temperature, pH, humidity, oxygen concentration), fertilization is checked on day 1.
  • Embryo transfer: On day 5 (blastocyst stage), considered the best time for implantation in the uterus. Embryos will undergo lysis on day 7 if not transferred.
  • Luteal phase support.

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Description

This quiz covers Assisted Reproductive Techniques, including Intrauterine Insemination (IUI). Participants will explore the indications, treatment options, and ethical considerations. Understanding laboratory procedures and the associated emotional and financial impacts is also essential.

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