Term
| what are the 4 types of infertility tx? |
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Definition
| drug (fertility drugs for pts w/ovulation dysfunction), sx (anatomical abnormalities, fibroids, scarring, tubal disease), insemination (mild-moderate male subfertility or mucus problems), and ART (IVF: most common) |
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Term
| what was IVF initially developed to treat? |
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Definition
| *infertility due to tubal disease by bypassing the tubes altogether* |
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Term
| what are indications for IVF? |
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Definition
| tubal disease, male factor infertility, unexplained infertility, endometriosis, PCOS, and repeat pregnancy loss |
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Term
| what is ART defined? what are the different types? |
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Definition
| ART: any procedure which involves removal of the egg from the ovaries; IVF (most common, basically an in-office procedure), GIFT (gamete intrafallopian transfer - no real advantage), ZIFT (zygote intrafallopian transfer), ICSI (intracytoplasmic sperm injection), AH (assisted hatching), and PGD (preimplantation genetic dx) |
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Term
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Definition
| *ovarian stimulation and monitoring. a powerful ovary-stimulating drug is administered to get multiple follicles to grow. these drugs are very powerful, so blood testing/transvaginal USs are performed to ensure the pt is not over-responding. |
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Term
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Definition
| US-guided *oocyte retrieval. needle aspiration yields oocytes bilaterally which are passed on to an embryologist. |
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Term
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Definition
| *insemination/fertilization. egg and sperm are cultured together on a petri dish in hopes of fertilization occurring. |
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Term
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Definition
| the *embryo is transferred back into the uterus after the fertilized egg has been lab grown for 3-5 days. |
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Term
| what is the progression of embryo development during and after step 3 of IVF? |
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Definition
| day 1: pronuclear stage (unicellular), day 1.5: first division, day 2: 4 cells, day 3: 8 cells (usual day of IVF step 4), day 4: morula, day 5: blastocyst (another possible day of IVF step 4) |
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Term
| how is embryo transfer/IVF step 4 carried out? |
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Definition
| via a US-guided soft/thin catheter into the uterine cavity (air bubbles indicate contents of syringe/catheter have been released) |
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Term
| what characterizes ICSI? indications? |
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Definition
| this assisted fertilization technique involves injection of a single sperm into the egg w/a microneedle (bypasses penetration of the zona pellucida by sperm). indications: idiopathic fertilization failure (at least one failed IVF attempt) and known significant male factor (abnormal sperm analysis or obstructive azoospermia). |
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Term
| what characterizes assisted hatching? |
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Definition
| this assisted implantation technique is used very frequently w/ICSI+IVF. in normal conception, the egg remains inside the zona pellucida up until day 4-5. w/IVF or ICSI, it is thought that the implanted embryo may not be able to break out of the zona pellucida or"hatch" properly - so a needle or laser is used to pierce a hole in the zona pellucida *just prior to implantation* to improve implantation. |
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Term
| what are indications for assisted hatching? |
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Definition
| age > 38 (the zona pellucida in older women is harder to hatch from), diminished ovarian reserve, thick zona pellucida ( > 15 um), and prior failed implantation (despite everything else) |
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Term
| what is embryo cryopreservation (as opposed to oocyte freezing)? |
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Definition
| a good way to preserve extra embryos. advantages: enhanced overall pregnancy rater per retrieval, alternative to destruction of excess embryos, simple office procedure, and frozen embryo transfer cycles are less expensive and less invasive |
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Term
| what is preimplantation genetic dx (PGD)? |
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Definition
| this allows for a genetic dx (of a single blastomere) prior to embryo implantation/pregnancy initiation. it is performed via either: fluorescent in-situ hybridization (FISH): fluorescent DNA probes label chromosomes to r/o aneuploidy OR PCR to dx certain genetic defects such as sickle cell, tay-sachs, and CF. |
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Term
| what are the indications for PGD? |
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Definition
| dx of a single gene defect (w/a fam hx of thta defect), a prior chromosomally abnormal pregnancy, recurrent pregnancy loss (if balanced translocation - pick a better embryo to implant), family balancing (allows family m:f ratio to be chosen - controversial), multiple IVF failure, and age related infertility (becoming a more common indication for PGD) |
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Term
| what are the risks and limitations for PGD? |
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Definition
| damage to the embryo during bx procedure, probes only may exist for certain chromosome types, can't detect chromosomal additions/deletions/translocations, and mosaicism (single cell may not reflect the chromosomal make up of the entire embryo) |
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