HR (Human Reproduction) Lecture Notes: Pregnancy
IVF, Immunology, Loss and Diagnosis
In Vitro Fertilisation
Anything that affects normal metabolism can affect fertility
Normal fertility: success of ‘actively trying’ couple in 1 or 2 years
Different laws in different countries so there’s reproductive tourism
Gametes
● Counselling essential for donor gametes
● Screen for viruses
IVF
● Transfer max of 2 embryos
● Can still get monozygotic twins from 1 embryo
Manipulating cycle
● Synchronise cycle (turn it off and restart it)
○ Oral contraceptive pill withdrawal bleed to set day 1
○ Artificial menopause
◆ GnRH agonist, long-term downregulation
◆ GnRH antagonist, short-term downregulation
● Ovarian stimulation
○ rFSH
○ Collect (aspirate) 8-10 follicles
○ Can freeze eggs (even cancer patients, for use after cancer
treatment)
○ Risk of OHSS (Ovarian HyperStimulation Syndrome)
● Trigger ovulation
○ rhCG, clomiphene
IUI (IntraUterine Insemination)
● Needs at least 1 patent tube
● Minimal ovarian stimulation (<3 follicles) to prevent multiple gestation
● Induce ovulation with rhCG mimicking LH surge
Male infertility
● Types
○ Athenospermia: sperm with poor motility
○ Teratospermia: sperm with abnormal morphology
○ OATS: combination of oligo, atheno and terato
● Recover sperm
○ Aspirate sperm from epididymis
○ Electroejaculation via rectal probe for spinal cord injury
● Inject sperm into egg
○ Crush flagella for activation
IVF, Immunology, Loss and Diagnosis
In Vitro Fertilisation
Anything that affects normal metabolism can affect fertility
Normal fertility: success of ‘actively trying’ couple in 1 or 2 years
Different laws in different countries so there’s reproductive tourism
Gametes
● Counselling essential for donor gametes
● Screen for viruses
IVF
● Transfer max of 2 embryos
● Can still get monozygotic twins from 1 embryo
Manipulating cycle
● Synchronise cycle (turn it off and restart it)
○ Oral contraceptive pill withdrawal bleed to set day 1
○ Artificial menopause
◆ GnRH agonist, long-term downregulation
◆ GnRH antagonist, short-term downregulation
● Ovarian stimulation
○ rFSH
○ Collect (aspirate) 8-10 follicles
○ Can freeze eggs (even cancer patients, for use after cancer
treatment)
○ Risk of OHSS (Ovarian HyperStimulation Syndrome)
● Trigger ovulation
○ rhCG, clomiphene
IUI (IntraUterine Insemination)
● Needs at least 1 patent tube
● Minimal ovarian stimulation (<3 follicles) to prevent multiple gestation
● Induce ovulation with rhCG mimicking LH surge
Male infertility
● Types
○ Athenospermia: sperm with poor motility
○ Teratospermia: sperm with abnormal morphology
○ OATS: combination of oligo, atheno and terato
● Recover sperm
○ Aspirate sperm from epididymis
○ Electroejaculation via rectal probe for spinal cord injury
● Inject sperm into egg
○ Crush flagella for activation
