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BRS ENDOCRINOLOGY > 1b Infertility Treatments > Flashcards

1b Infertility Treatments Flashcards

1
Q

What are the symptoms of low testosterone?

A

loss of early morning erections, libido, decreased energy, shaving

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2
Q

What are the different options for testosterone replacement?

A

Daily gel
3 weekly intramuscular injection
3 monthly intramuscular injection
lmplants

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3
Q

What are the two safety monitoring techniques when on testosterone replacement therapy?

A

Check for increased haematocrit (risk of hypersensitivity and stroke)
Prostate - monitor the Prostate Specific Antigen levels

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4
Q

Is testosterone useful to give to a patient who is looking to conceive?

A

No - Testosterone reduces sperm count and therefore decreases fertility

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5
Q

What is secondary hypogonadism?

A

deficiency of gonadotrophins (LH and FSH) ie hypogonadotrophic hypogonadism

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6
Q

Why is LH needed for male fertility?

A

Stimulates leydig cells to increase intratesticular testosterone levels

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7
Q

Why is FSH needed for male fertility?

A

Stimulates seminiferous tubule development and spermatogenesis

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8
Q

what are the treatment options for people wanting sperm induction?

A

hCG injections (Act on LH receptors and help to stimulate sperm production
if no response in 6 months - then add FSH injections

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9
Q

What are the three things which can worsen hypothalamic amenorrhoea?

A

Low Body weight
Excessive Exercise
Stress
Genetic Susceptibility

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10
Q

What are the symptoms of Polycystic Ovary Syndrome?

A

Hyperandrogenism
Polycystic Ovaries on an Ultrasound
Irregular periods - olioamenorrhoea (no periods for 8-9 months)

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11
Q

What is the aim during ovulation induction?

A

To cause a small increase in FSH

Develop one ovarian follicle as if more than one follicle develops the risk of multiple pregnancy increases (this has big risks for the mother and the baby

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12
Q

What treatments are used to restore ovulation in PCOS?

A
  1. Change lifestyle
  2. metformin - to treat the increased insulin resistance
  3. Letrozole - Aromatase inhibitor to prevent increases in testosterone which leads to hursuitism
  4. Clomiphene (oestradiol receptor modulator)
  5. FSH Stimulation
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13
Q

What treatments are used to treat hypothalamic amenorrhoea?

A
  1. Lifestyle - weight gain and reduce exercise
  2. Pulsatile GnRH Pump
  3. FSH Stimulation
  4. Letrozole (aromatase inhibitor)
  5. Clomiphene (oestradiol receptor modulator)
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14
Q

Describe the steps of IVF?

A
  1. Oocyte retrieval
  2. Fertilisation in vitro
  3. Embryo Incubation
  4. Embryo Transfer
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15
Q

What are the most common methods of contraception?

A

Barrier - Male / Female Contraception
Combined oral Contraceptive
Progesterone Only Pill
Long Acting Reversible Contraception
Emergency

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16
Q

What are the positives and negatives of condoms?

A

Pros:
- protect against STI’s
- Easy to obtain
- No contra-indications

Cons:
- Skill to use
- Interruptions to sex, sensation and erections

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17
Q

How does the combined oral contraceptive pill work?

A

Contains Oestrogen and Progesterone

  • Acts on the hypothalamus and pituitary (- ve feedback) to reduce LH and FSH
  • Acts on the ovaries - Anovulation
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18
Q

What are the effects of the COP?

A

Thickening of cervical mucus
Thinning of Endometrial Lining to reduce the chances of implantation

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19
Q

What are the pros and cons of taking the oral contraceptive pill?

A

Pros:
- Easy to take
- Effective
- Doesn’t interrupt sex
- Weight Neutral - doesn’t change
- Reduce risk of endometrial and ovarian cancer

Cons:
- No protection against STIs
- Difficult to remember to take
- Some side effects due to hormonal imbalance, changes to mood and libido = feeling more hungry

20
Q

What are the non contraceptive uses of the combined pill?

A

Makes periods lighter
help in the symptomatic treatment of PCOS = reduce LH, hyperandrogenism (acne and hirsutism)

21
Q

What is the Mini Pill?

A

Progesterone only pill

22
Q

What is the main pros and cons of the mini pill compared to the main pill?

A

pros: suitable if oestrogen cannot be taken
cons: shorter acting - needs to be taken at the same time each day

23
Q

What are the side effects of the POP?

A

irregular bleeds
Headaches
Sore Breasts
Changes to mood
Changes in sex drive

24
Q

Why might some patients not be able to take an oestrogen containing pill?

A

They have a high risk of CVD / stroke

25
Q

Which contraceptive pill can be used when breastfeeding?

A

POP

26
Q

What are coils?

A

Contraception which is suitable for most women - prevents the implantation of conceptus

27
Q

What is an IUD?

A

Copper coil - Mechanically prevents implantation, decreases sperm / egg survival and can cause heavy periods

28
Q

What is an IUS?

A

Intra-uterine System - secretes progesterone to thin the lining of the womb and thicken cervical mucus

29
Q

What is the most effective form of emergency contraception?

A

Copper intrauterine device -

30
Q

How does the ulipristal pill work?

A

Morning After Pill - stops progesterone from working and prevents ovulation

31
Q

How does Levonelle work?

A

Synthetic progesterone which prevents ovulation

32
Q

What are the side effects of the morning after pill?

A

Headache, Abdominal Pain and nausea

33
Q

What are the contraindications for OCP?

A

Migraine with aura
Smoking
Stroke
Current Breast Cancer

34
Q

What type of drugs affect the efficacy of OCP?

A

P450 Liver enzyme-inducing drugs

35
Q

What are the benefits of HRT?

A

symptom relief due to low oestrogen eg flushing, sweats, disturbed sleep, decreased libido, low mood
reduction in osteoporosis related fractures

36
Q

What are the risks of HRT?

A

Venous Thrombo-embolism - DVT or PE
Stroke
Cardiovascular Disease
Endometrial cancer
breast cancer
Ovarian cancer

37
Q

What do oral oestrogens undergo?

A

The first pass in the liver - therefore transdermal oestrogens are safer for VTE risk than oral - avoid if BMI is greater than 30

38
Q

Which two cancers are hormone sensitive cancers?

A

Breast, Ovarian and Endometrial

39
Q

What happens to the risk of Breast cancer for women on combined HRT?

A

Slight increase - risk is related to the duration of treatment and reduces after stopping

40
Q

What must be prescribed to patients with endometrial cancer?

A

Progestogens - synthetic progestins and the natural hormone progesterone

41
Q

What might indicate endometrial cancer?

A

Post menopausal bleeding

42
Q

Which form of HRT results in an increased risk of Stroke?

A

oral HRT
(Combined E2 and progesterone) has more risk than oestrogen only

43
Q

What is cisgender?

A

cis means same ie Birth Sex & Gender Identity are aligned

44
Q

What is a transgender man?

A

Transgender men- Female Sex at birth, but Male Gender (FtM is no longer used).

45
Q

What is meant by non-binary?

A

Gender does not match to traditional binary gender understanding,
includes agender, bigender, pangender, gender fluid.

46
Q

How to treat a transgender man? - transitioning to male?

A

Treat with Masculinising Hormones :
Testosterone (injections, gels)
Progesterone to suppress menstrual bleeding if needed (endometrial hyperplasia 15%).

47
Q

How to treat a transgender women?

A

Treat with Feminising Hormones :
1. Reduce Testosterone
GnRH agonists (induce desensitisation of HPG axis)
Anti-Androgen medications
2. Estrogen (transdermal, oral, intramuscular)
High dose oestrogen eg 4-5mg per day (side-effects: higher risk of VTE 2.6%)

BRS ENDOCRINOLOGY (20 decks)

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