1b Infertility Treatments Flashcards
What are the symptoms of low testosterone?
loss of early morning erections, libido, decreased energy, shaving
What are the different options for testosterone replacement?
Daily gel
3 weekly intramuscular injection
3 monthly intramuscular injection
lmplants
What are the two safety monitoring techniques when on testosterone replacement therapy?
Check for increased haematocrit (risk of hypersensitivity and stroke)
Prostate - monitor the Prostate Specific Antigen levels
Is testosterone useful to give to a patient who is looking to conceive?
No - Testosterone reduces sperm count and therefore decreases fertility
What us secondary hypogonadism?
deficiency of gonadotrophins (LH and FSH) ie hypogonadotrophic hypogonadism
Why is LH needed for male fertility?
Stimulates leydig cells to increase intratesticular testosterone levels
Why is FSH needed for male fertility?
Stimulates seminiferous tubule development and spermatogenesis
what are the treatment options for people wanting sperm induction?
hCG injections (Act on LH receptors and help to stimulate sperm production
if no response in 6 months - then add FSH injections
What are the three things which can worsen hypothalamic amenorrhoea?
Low Body weight
Excessive Exercise
Stress
Genetic Susceptibility
What are the symptoms of Polycystic Ovary Syndrome?
Hyperandrogenism
Polycystic Ovaries on an Ultrasound
Irregular periods - olioamenorrhoea (no periods for 8-9 months)
What is the aim during ovulation induction?
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
What treatments are used to restore ovulation in PCOS?
- Change lifestyle
- metformin - to treat the increased insulin resistance
- Letrozole - Aromatase inhibitor to prevent increases in testosterone which leads to hursuitism
- Clomiphene
- FSH Stimulation
What treatments are used to treat hypothalamic amenorrhoea?
- Lifestyle - weight gain and reduce exercise
- Pulsatile GnRH Pump
- FSH Stimulation
- Letrozole
- Clomiphene
Describe the steps of IVF?
- Oocyte retrieval
- Fertilisation in vitro
- Embryo Incubation
- Embryo Transfer
What are the most common methods of contraception?
Barrier - Male / Female Contraception
Combined oral Contraceptive
Progesterone Only Pill
Long Acting Reversible Contraception
Emergency
What are the positives and negatives of condoms?
Pros:
- protect against STI’s
- Easy to obtain
- No contra-indications
Cons:
- Skill to use
- Interruptions to sex, sensation and erections
How does the combined oral contraceptive pill work?
Contains Oestrogen and Progesterone
- Acts on the hypothalamus and pituitary (- ve feedback) t reduce LH and FSH
- Acts on the ovaries - Anovulation
What are the effects of the COP?
- Anovulation
- Thickening of cervical mucus
- Thinning of Endometrial Lining to reduce the chances of implantation
What are the pros and cons of taking the oral contraceptive pill?
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
What are the non contraceptive uses of the combined pill?
Makes periods lighter
help in the symptomatic treatment of PCOS = reduce LH, hyperandrogenism (acne and hirsutism)
What is the Mini Pill?
Progesterone only pill
What is the main pros and cons of the mini pill compared to the main pill?
pros: suitable if oestrogen cannot be taken
cons: shorter acting - needs to be taken at the same time each day
What are the side effects of the POP?
irregular bleeds
Headaches
Sore Breastes
Changes to mood
Changes in sex drive
Why might some patients not be able to take an oestrogen containing pill?
They have a high risk of CVD / stroke
