The 4th Misurata scientific The 4th Misurata scientific meeting of infertility meeting of infertility

Benghazi – LibyaBenghazi – Libya 10/10/200810/10/2008

Dr. Omar A. ElsraitiDr. Omar A. Elsraiti Consultant of Obst. & Gyn. Consultant of Obst. & Gyn. IVF IVF

Centre - Misurata / Libya Centre - Misurata / Libya Misurata Central Hospital / Misurata Central Hospital / Head of Head of

department of Obst. & Gyn. department of Obst. & Gyn. Faculty of medicine - 7th October Faculty of medicine - 7th October

University University MisurataMisurata

General facts about General facts about infertility managementinfertility management

Questions & AnswersQuestions & Answers

Fill in blanksFill in blanks

In IVF lab. inspection of the oocyte for In IVF lab. inspection of the oocyte for the presence of ...................... the presence of ...................... confirms that fertilization has taken confirms that fertilization has taken place . place .

In IVF lab. inspection of the oocyte for In IVF lab. inspection of the oocyte for the presence of the presence of two pronucleitwo pronuclei

confirms that fertilization has taken confirms that fertilization has taken placeplace . .

In fetal reduction , in experienced hands In fetal reduction , in experienced hands the risk of losing the entire the risk of losing the entire pregnancy from selective fetal pregnancy from selective fetal reduction is less than …..%. reduction is less than …..%.

In fetal reduction , in In fetal reduction , in experienced hands the risk of experienced hands the risk of losing the entire pregnancy losing the entire pregnancy from selective fetal reduction from selective fetal reduction is less than is less than 1010 %. %.

Elevated FSH levels , indicative of Elevated FSH levels , indicative of decreased ovarian response result decreased ovarian response result from a failure of aging ovaries to from a failure of aging ovaries to produce ………………… produce …………………

Elevated FSH levels , Elevated FSH levels , indicative of decreased indicative of decreased ovarian response result from ovarian response result from a failure of aging ovaries to a failure of aging ovaries to produce produce inhibininhibin ..

Natural cycle in vitro fertilization has a Natural cycle in vitro fertilization has a delivery rate per retrieval of delivery rate per retrieval of approximately ……. %. approximately ……. %.

Natural cycle in vitro Natural cycle in vitro fertilization has a delivery fertilization has a delivery rate per retrieval of rate per retrieval of approximately approximately 6 6 %. %.

Risks of hyperstimulation can be Risks of hyperstimulation can be decreased by decreased by …………………………………… used to …………………………………… used to initiate the cycle initiate the cycle ..

Risks of hyperstimulation Risks of hyperstimulation can be decreased by can be decreased by lowering the dose of lowering the dose of gonadotrophinsgonadotrophins used to used to initiate the cycle initiate the cycle ..

Assisted hatching consists of making an Assisted hatching consists of making an opening in the …………………… to help opening in the …………………… to help the embryo emerge the embryo emerge ..

Assisted hatching consists Assisted hatching consists of making an opening in the of making an opening in the zona pellucidazona pellucida to help the to help the embryo emerge embryo emerge ..

Pregnancies resulting from different IVF Pregnancies resulting from different IVF programs programs

Can be ectopic in about ….. % of Can be ectopic in about ….. % of cases .cases .

Can be multiple in ………. % of cases Can be multiple in ………. % of cases

. ……..% twins & ……% triplets . ……..% twins & ……% triplets or more or more ..

Pregnancies resulting from Pregnancies resulting from different IVF programs different IVF programs

Can be ectopic in absent Can be ectopic in absent 55 % of % of cases .cases . Can be multiple in Can be multiple in 3030 % of % of cases. cases. 2525% twins & % twins & 55% triplets % triplets or more. or more.

………….. % of infertility is wholly or in part .. % of infertility is wholly or in part due to a male factor due to a male factor ..

4040 % of infertility is wholly % of infertility is wholly or in part due to a male or in part due to a male

factor factor ..

A fundamental problem in most studies A fundamental problem in most studies of the efficacy of drug therapy in male of the efficacy of drug therapy in male infertility is infertility is ……………………………………………………………………………………………………

A fundamental problem in A fundamental problem in most studies of the efficacy most studies of the efficacy of drug therapy in male of drug therapy in male infertility is infertility is the lack of a the lack of a control group for comparison. control group for comparison.

On the basis the available literature , On the basis the available literature , currently the 2 best tests for assaying currently the 2 best tests for assaying fertility potential for in vitro fertilization fertility potential for in vitro fertilization are the evaluation of sperm are the evaluation of sperm morphology by …………….. and the morphology by …………….. and the ………………. assay .………………. assay .

On the basis the available On the basis the available literature , currently the 2 literature , currently the 2 best tests for assaying best tests for assaying fertility potential for in vitro fertility potential for in vitro fertilization are the fertilization are the evaluation of sperm evaluation of sperm morphology by morphology by strict criteriastrict criteria and the and the human zona bindinghuman zona binding assay .assay .

True or falseTrue or false

Over the last 40 years there is Over the last 40 years there is evidence which points to a evidence which points to a decreasing sperm count in men .decreasing sperm count in men .

Over the last 40 years there is Over the last 40 years there is evidence which points to a evidence which points to a decreasing sperm count in decreasing sperm count in men .men .

( True )( True )

There is no age related decline in There is no age related decline in spermatogenesis that results in some spermatogenesis that results in some decline in male fertility .decline in male fertility .

There is no age related decline There is no age related decline in spermatogenesis that results in spermatogenesis that results in some decline in male fertility in some decline in male fertility ..

( False )( False )

Hormone treatment of infertile males Hormone treatment of infertile males who do not have an endocrine who do not have an endocrine disorder is some times useful .disorder is some times useful .

Hormone treatment of Hormone treatment of infertile males who do not infertile males who do not have an endocrine disorder have an endocrine disorder is some times useful .is some times useful .

(False )(False )

It is important that any infection in the It is important that any infection in the genitourinary tract be treated genitourinary tract be treated because white cells in the seminal because white cells in the seminal plasma can significantly reduce plasma can significantly reduce sperm motility and egg penetration .sperm motility and egg penetration .

It is important that any It is important that any infection in the genitourinary infection in the genitourinary tract be treated because tract be treated because white cells in the seminal white cells in the seminal plasma can significantly plasma can significantly reduce sperm motility and reduce sperm motility and egg penetration .egg penetration .

( True )( True )

IVF success rates should be reported in IVF success rates should be reported in terms of the number of live births terms of the number of live births per retrieval.per retrieval.

IVF success rates should be IVF success rates should be reported in terms of the reported in terms of the number of live births per number of live births per retrieval.retrieval. ( True )( True )

Patients with an antral follicles count Patients with an antral follicles count less than 5 usually have poor ovarian less than 5 usually have poor ovarian response to stimulation . response to stimulation .

Patients with an antral Patients with an antral follicles count less than 5 follicles count less than 5 usually have poor ovarian usually have poor ovarian response to stimulation .response to stimulation .

( True ) ( True )

Different stimulation regimes are Different stimulation regimes are useful in improving the ovarian useful in improving the ovarian stimulation in poor responders .stimulation in poor responders .

Different stimulation Different stimulation regimes are useful in regimes are useful in improving the ovarian improving the ovarian stimulation in poor stimulation in poor responders .responders .

( False )( False )

The long term childhood out comes for The long term childhood out comes for IVF pregnancies appears to be worse IVF pregnancies appears to be worse probably directly due to the IVF probably directly due to the IVF process .process .

The long term childhood out The long term childhood out comes for IVF pregnancies comes for IVF pregnancies appears to be worse appears to be worse probably directly due to the probably directly due to the IVF process.IVF process. ( False )( False )

According to randomized studies According to randomized studies , advanced maternal age , advanced maternal age women do not benefit from PGD women do not benefit from PGD if the number of embryos to be if the number of embryos to be transferred is not limited .transferred is not limited .

According to randomized According to randomized studies , advanced maternal studies , advanced maternal age women do not benefit age women do not benefit from PGD if the number of from PGD if the number of embryos to be transferred is embryos to be transferred is not limited . not limited .

( True ) ( True )

Fertility is reduced with increasing age of women because of a decreasing number of oocytes. The following statement(s) concerning oocyte biology this is/are true:

(a) There is no loss of oocytes before birth. (b) The total number of oocytes both declines bi-exponentially with

age and the loss accelerates around the age of 37 years . (c) Genetic factors are more important than environmental factors in

determining the decline in the number of oocytes . (d) Alterations in the neuroendocrine control with advancing age

suggest a central contribution to the decline in the oocyte number.

(e) Recent evidence suggests that ovarian stem cells are present in

humans and are able to replenish the pool of primordial follicles .

Fertility is reduced with increasing age of women because of a decreasing number of oocytes. The following statement(s) concerning oocyte biology this is/are true:

(a) There is no loss of oocytes before birth. ( F )

(b) The total number of oocytes both declines bi-exponentially with age and the loss accelerates around the age of 37 years . ( T ) (c) Genetic factors are more important than environmental factors in

determining the decline in the number of oocytes. ( T )

(d) Alterations in the neuroendocrine control with advancing age suggest a central contribution to the decline in the oocyte number. ( T )

(e) Recent evidence suggests that ovarian stem cells are present in humans and are able to replenish the pool of primordial follicles . ( F )

Regarding the ovarian response to stimulation prior to ART:

(a) Women with better ovarian response have higher pregnancy rate .

(b) Serum FSH concentration in the early follicular phase is

a good predictor of pregnancy . (c) Antral follicle count is best correlated with the age of

women. (d) Patients with an antral follicle count less than 5 usually

have poor ovarian response to stimulation. (e) The role of ovarian stromal blood flow in the prediction

of ovarian response is well proven.

Regarding the ovarian response to stimulation prior to ART:

(a) Women with better ovarian response have higher pregnancy rate . ( T ) (b) Serum FSH concentration in the early follicular phase is a good predictor of pregnancy . ( F )

(c) Antral follicle count is best correlated with the age of women. ( T )

(d) Patients with an antral follicle count less than 5 usually have poor ovarian response to stimulation. ( T )

(e) The role of ovarian stromal blood flow in the prediction of ovarian

response is well proven. ( F )

Male factor infertility:

a. Can be associated with genetic disorders. b. Is not important in most infertile couples. c. Is best diagnosed by examining the male for

a varicocoele. d. Requires intracytoplasmic sperm injection

(ICSI) for treatment. e. Increases with age.

Male factor infertility:

a. Can be associated with genetic disorders. ( T ) b. Is not important in most infertile couples. ( F )

c. Is best diagnosed by examining the male for a varicocoele. ( F )

d. Requires intracytoplasmic sperm injection (ICSI) for treatment. ( F )

e. Increases with age. ) T )

Which of the following pathogenesis can be associated with severe oligozoospermia and azoospermia:

a. Bilateral congenital absence of the vas deference .

b. Microdeletion of the Y chromosome. c. Cystic Fibrosis . d. Erectile dysfunction . e. Klinefelter’s syndrome (47, XXY).

Which of the following pathogenesis can be associated with severe oligozoospermia and azoospermia:

a. Bilateral congenital absence of the vas deference ( T )

b. Microdeletion of the Y chromosome ( T )

c. Cystic Fibrosis ( T )

d. Erectile dysfunction ( F )

e. Klinefelter’s syndrome (47, XXY) ( T )

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