Invitro Fertilisation

(IVF)

<Management>

<Index>

 

 

 

 

Definition

-  Assisted Reproductive Technology (ART) combining maternal oocyte & paternal sperm in a lab & implanting embryo in uterus

 

Indication

-  Used for infertility

-  Young couple success rate 40%+/-

-  Older couple (> 40) 10-11%

 

Procedure

- Downregulation of axis w GnRH agonist

-  Ie: Synarel (Nafarelin)

-  Nasal spray x2/day

-  Initial flare response followed by block of GnRH at pituitary

- Induces low FSH & LH (menopausal state)

- Superovulation of both ovaries with daily subcutaneous FSH

- Monitoring of developing follicles

-  Rising serum oestrogen levels

-  Ultrasound

- When oestrogen levels are optimum & ultrasound indicates 5-15 good sixed follicles HCG injected (acts like LH)

-  Ensures final maturation of follicles

- Wait 36 hours

-  Any later follicle ovulate & oocyte lost

- Oocyte pickup under sedation & TV ultrasound

-  Ideally 8-10 oocytes collected

- Per vaginal progesterone given to promote endometrium to secretary phase

- Fertilisation of oocytes w partners sperm (IVF)

-  Intracytoplasmic sperm injection (ICSI)

-  Used if sperm parameters poor on SFA (ie: motility, concentration, morphology) ICSI can be used Glass needle inserted into cytoplasm of oocyte

-  Sperm directly injected into oocyte

 

ICSIb

 

- Embryo transfer usually 2-3 days after fertilization

-  Catheter inserted through cervix into uterine cavity

-  Most units now transer single embryo

-  Excess embryos can be frozen & used for future cycles

- Progesterone Rx continues to support endometrium until replaced by placenta (week 10)

 

IVF - Oocyte Retrieval

 

Complications

-  PID following oocyte harvest

-  Multiple births if multiple embryos inserted

-  Ovarian Hyperstimulation Syndrome (OHSS)