Spent the morning today in Ward 35, ACU with Dr Kay and Dr Eid, witnessing two egg retrieval procedures and embryo transfer for IVF infertility treatment. The first patient was a self funding para 1 + 1 woman with previous failed cycle of IVF. Chance of success is increased with the following criteria: parous woman, young, absence of pelvic disease. 12 follicles approximately were drained, 3/4 of which contain eggs. 8 - 12 eggs are collected and approx 50% will become fertilised. The best two embryos are selected and re-implanted. The balance has to be weighed up between the risk of multiple pregnancy and the chance of a pregnancy occurring. Risks associated with IVF egg retrieval include infection, perforation of the bowel and haemorrhage although these complications are rare.

The second patient was Hep B +ve. I knew that due to her +ve status, it would be advisable to wear protective masks during the egg collection procedure however the theatre team had not done this. Therefore I went into the preparation room and collected masks to give to each of the members of staff. This should have been avoided with everyone wearing masks before entering the room with the patient. ICSI had been used for this patient, indicated due to severe male factor infertility. The long term results of ICSI are currently unavaliable. We discussed that patients wishing to have pre-implantation genetic diagnosis carried out can be referred to the regional centre in Edinburgh. I also discussed with the doctors some of the ethical implications of sperm donation, which has suffered a serious decline in numbers since new anonymity laws recently came into place.

The afternoon involved tutorials on Antepartum Haemorrhage (focusing particularly on placenta praevia & placental abruption), and Amenorrhoea, as well as a visit to the Nairn Suite to find out about councelling for termination of pregnancy. All in all an eventful day!