University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

451

Pages:

2
Author:

Mariam A. A.

Treatments for infertile couples Clomiphene Citrate • • • Estrogen antagonist properties except at low estrogen levels. Increase GnRH -> LH and FSH. Increased FSH -> follicle maturation. Insulin sensation agents • Increase target tissue response to insulin -> decrease compensatory hyperinsulinemia. Gonadotropins • Usually derived from hMG preps extracted and purified from post-menopausal women’s urine -> has active components which are FSH and LH. Aromatase inhibitors • • Inhibit estrogen conversion. Supress ovarian oestradiol secretions -> decrease negative feedback at pituitary and hypothalamus -> increase FSH -> multiple ovarian follicle growth. Intrauterine Insemination (IUI) • • Processes semen and separates motile, morphologically normal spermatozoa from dead sperm, leukocytes and seminal plasma. Obtained highly motile fractions inserted transcervical by flexible catheter near time of ovulation. Invitro Fertilisation • • • • • • Mature oocyte from stimulated ovaries retrieved transvaginal with sonographic guidance. Sperm and ova combine in Virto to promote fertilisation. - Freshly ejaculated sperm cannot fertilise egg and much be capacitated. Embryo transferred transcervical into the endometrial cavity using sonographic guidance. Benefits of using COH prior to egg retrieval: - Because many ova are functionally abnormal -> exposure to several ova to sperm -> increase the chance of healthy embryo. GnRH analogues used in conjunction with gonadotropins (FSH and hMG) to prevent possibility of spontaneous LH surge and ovulation prior to egg retrieval. 10 -20 ova are harvested, but ideally only 1 healthy embryo transferred. Egg donation • Used in infertility associated with ovarian failure or decrease ovarian reserve. • Also used in fertile women when offspring at risk of maternally transmitted genetic diseases. Gestational Carrier Surrogacy • • Variations of IVF -> places fertilised egg into uterus of surrogate. Indications: - Women with uncorrectable uterine factors. - Women of whom pregnancy poses significant health risks. - In those with repetitive unexplained miscarriage. Intracytoplasmic sperm injection • • • • • Variations of IVF -> most applicable to male causes of infertility. Cumulus cells surrounding ova enzymatically digested. Single sperm injected through zona pellucida and oocyte cell membrane. Pregnancy rate comparable with those achieve with IVF for other causes of infertility. This technique makes pregnancy possible for azoospermia men. - i.e., sperm mechanically extracted from testicles or epididymis. Gamete intrafallopian transfer • • • • • egg retrieval performed after COH. Eggs and sperm placed via catheter through fimbria -> deposited into oviduct. - Performed at laparoscopy. Used in unexplained infertility and should not be used for tubal factors that cause infertility. Largely replaced by IVF. Requires transfer of more than two eggs for optimal pregnancy chances -> increases the risk of multi foetal gestation. Zygote intrafallopian transfer. • Embryo transfer into oviduct at laparoscopy.