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==Week 4 Assessment==
==Week 4 Assessment==
=Fertilisation Quiz=
===Fertilisation Quiz===


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<quiz display=simple>

Revision as of 13:19, 4 September 2015

Lab Attendance

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Please do not use your real name on this website, use only your student number.

2015 Course: Week 2 Lecture 1 Lecture 2 Lab 1 | Week 3 Lecture 3 Lecture 4 Lab 2 | Week 4 Lecture 5 Lecture 6 Lab 3 | Week 5 Lecture 7 Lecture 8 Lab 4 | Week 6 Lecture 9 Lecture 10 Lab 5 | Week 7 Lecture 11 Lecture 12 Lab 6 | Week 8 Lecture 13 Lecture 14 Lab 7 | Week 9 Lecture 15 Lecture 16 Lab 8 | Week 10 Lecture 17 Lecture 18 Lab 9 | Week 11 Lecture 19 Lecture 20 Lab 10 | Week 12 Lecture 21 Lecture 22 Lab 11 | Week 13 Lecture 23 Lecture 24 Lab 12 | 2015 Projects: Three Person Embryos | Ovarian Hyper-stimulation Syndrome | Polycystic Ovarian Syndrome | Male Infertility | Oncofertility | Preimplantation Genetic Diagnosis | Students | Student Designed Quiz Questions | Moodle page

Glossary Links

Glossary: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | Numbers | Symbols | Term Link

Test student 2015

Week 1 Assessment

1) PMID 18603501

Increased Progesterone/Estradiol Ration on the Day of hCG Administration Adversely Affects Success of In Vitro Fertilisation-Embryo Transfer in Patients Stimulated with Gonadotropin-releasing Hormone Agonist and Recombinant Follicle-stimulating Hormone

This study examines the influence of premature luteinisation, with respect to ovarian response, during IVF. This was done using gonadotropin-releasing hormone agonist (GnRHa) and recombinant follicle-stimulating hormone (rFSH).The study defined premature luteinisation as a ratio between progesterone and estradiol of greater than one, the day hCG was administered. The experimental group of prematurely luteinised was then compared to the non-prematurely luteinised groups.

The study was performed on 311 infertile couples, in which a total of 339 cycles of ovarian hyperstimulation with GnRHa and rFSH. The females studied were aged from 20 to 40 years, and did not undergo cycles incorporating hMG, nor did they receive oocyte donations. The patients underwent ovarian stimulation, a long stimulation protocol of GnRHa therapy, rFSH administration as well as transvaginal oocyte retrieval, respectively. hCG was administered after adequate follicular maturation and oocytes were obtained 35-37 hours after hCG administration using transvaginal aspiration with ultrasound assistance. The follicular fluids and follicular washes were examined using a dissecting stereomicroscope that was incubated at 37 degrees with 5%CO2. Sperm insemination procedures were also performed, after which the oocytes were inseminated with spermatozoa. The oocytes were removed after 2 hour exposures to the spermatozoa and cultured in fresh IVF medium. The control group underwent ICSI procedures, while the experimental group underwent IVF procedures. The oocytes were then cultured and assessed for pronuclei presence 16-18 hours incubation in order to determine fertilisation (presence of 2 pronuclei). Embryos were then cultured and classified, as were the blastocysts.

The study found 137 out of the 339 cycles to have premature luteinisation. Poor ovarian response was more common in the experimental group. It was also found the the experimental group had a higher progesterone level and lower E2 level on the hCG administration day. However the mean luteinising hormone on day 6 of stimulation was similar in both control and study groups but higher in the control group on hCG administeration day. The experimental group demonstrated a lower number of oocytes obtained, and lower number of mature oocytes recovered. It should be noted that fertilisation rates were similar in both groups. Embryo number was lower for the experimental group compared to the control group. 130 gestational sacs were demonstrated after a transfer of 577 embryos in the control group while 76 gestational sacs were demonstrated out of 339 embryo transfers in the study group. The non-prematurely luteinised group and prematurely luteinised group had similar implantation rates. It was also found that 48.5% of the non-prematurely luteinised group achieved clinical pregnancies while 36.6% of the prematurely luteinised group achieved clinical pregnancies.

<pubmed>18603501</pubmed>

2) PMID 21793811

Impact of endometriosis on in vitro fertilization and embryo transfer cycles in young women; a stage-dependent interference

Due to the significantly higher prevalence of endometriosis in infertile women as compared to the general population, a causal relationship between endometriosis and infertility has been postulated. In vitro fertilisation and embryo transfer (IVF-ET) has been considered a suitable treatment for patients with a history of endometriosis. This study examines the effect of endometriosis on IVF-ET cycles on women younger than 35 years of age and who have had surgical treatment for endometriosis without clinical recurrence signs. The endometriosis group was compared to another group of patients also undergoing IVF-ET, but with tubal infertility without clinical signs of endometriosis. The results were analysed according to the different stages of endometriosis as classified by the American Society for Reproductive Medicine.

The experimental group consisted of 148 patients whereas the control group (tubal infertility patients) consisted of 72 patients. All groups consisted of patients that were less than 35 years of age and did not have clinical indication for any other cause of infertility. The experimental group underwent 164 IVF-ET cycles while the control group underwent 80 IVF-ET cycles. Patients received a long-acting down-regulation drug regime, a daily subcutaneous FSH dose, as well as gonadotropin doses which were decided individually according to age, basal FSH, ovarian volume and ovarian response. After two or more follicles reached maximal diameter of 17-18mm, hCG was administered and oocytes were obtained 36 hours later using vaginal ultrasonography, to then be fertilised on the same day. Embryo transfers were made two to three days after oocyte retrieval. Natural progesterone in oil was then administered. Plasma beta-hCG values were used to assess pregnancy. Clinical pregnancy was determined when at least one gestational sac was found with a fetal pole and heart activity through ultrasond.

It was found that the experimental group had significantly lower numbers of follicles on the hCG day, oocytes obtained and transferred when compared to the control group, despite receiving a higher FSH dose. However no significant differences were found regardingt cycle cancellation rate, peak E2 levels of the length of the stimulation phase. 11.6% of clinical pregnancies per started cucle were observed in the experimental group as compared to 22.5% in the control group. However, this value wa not significant when the clinical pregnancy rate was considered per oocyte retrieval or per embryo transfer. It was also found that patients at stage I-II of endomtriosis had a significantly lower rate of fertilisation when compared to the control group patients. Patients at stage III-IV of endometriosis had a large reduction in pregnancy rate than the control group, however the fertilisation rate was comparable. Patients at stage III-IV had lower peak E2 concentrations, less follicles on the hCG day, fewer oocytes at retrieval and lower implantation rates. Furthermore, poor ovarion responses in 15 out of 109 cycles resulted in discontinuation of the cycle in patients at stage III-IV of the endometriosis group, compared to 2 of 55 in the stage I-II group and 3 of 80 in the control group.

<pubmed>21793811</pubmed>

Week 2 Assessment

Epigenetic factors Influencing Human Development.jpg

PMID 26216216

Week 3 Assessment

PMID 26074966 <pubmed>26074966</pubmed>

PMID 20416867 <pubmed>20416867</pubmed>

PMID 23873146 <pubmed>23873146</pubmed>

The three key pathways by which the incidence of OHSS has been curtailed involve identifying risk factors to predict OHSS development, modifying treatment regimes on the basis of the identified risk factors and intervention to prevent progression to OHSS once the patient has undergone Controlled Ovarian Stimulation.

1) Risk factors

Primary: Preexisting factors likely to exacerbate the ovarian stimulation response. Include: young age, low body weight, history of elevated response to gonadotropins, Polycystic Ovary Syndrome (PCOS), isolated PCOS characteristic or a previous history of OHSS. Anti-Mullerian Hormone markers (AMH) are a newly developed predictive tool with a sensitivity of 90.5% and specificity of 81.3%. Ultrasonographic markers including antral follicle count PMID 26074966

Secondary:


2) Prevention

Primary: a) Gonadotropins: reduce duration, reduce dose, avoid GnRH Agonists PMID 23873146

b) Use Metformin Therapy

c) Target Unifollicular Ovulation

d) Avoid hCG

e) In Vitro Maturation

Secondary: a) Reduce hCG dose

b) Coasting

c) Cryopreservation of Embryos

d) Cancel Cycle

e) Use alternative Agents

PMID 20416867

Week 4 Assessment

Fertilisation Quiz

1 Which of the following statements is incorrect in regards to the acrosome:

The acrosome reaction allows for the exposure of the inner-acrosomal membrane
Only acrosome reacted spermatozoa fuse with the oocyte
The acrosome within the spermatozoa is derived from the golgi apparatus
Zona Pellucida Binding Protein 1 is synthesised by the oocyte
The enzymatic contents of the acrosome degrade the zona pellucida

2 Which of the following statements about the zona pellucida is incorrect:

It is an insoluble extracellular matrix
It expresses several glycoproteins
It surrounds the blastocyst
It surrounds the developing oocyte
It prevents sperm binding

3 Fertilisation does not:

result in the formation of the first polar body after the second meiotic division
often occurs in the first 1/3 of the oviduct
involve spermatozoa and oocyte fusion
require the exocytosis of cortical granules in the cortical reaction
require the exocytosis of acrosomal enzymes during the acrosome reaction


References

PMID 26244658 look at this <ref><pubmed>26244658</pubmed>

here's the list