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Therapeutics > 49: infertility > Flashcards

49: infertility Flashcards

1
Q

Infertility

A

-inability to become preg after 12 months

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2
Q

Evaluate infertility earlier in patients:

A

-women over 35
-h/o oligo/amenorrhea
-uterine/tubal disease or endometriosis
-partner known to be subfertile

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3
Q

Rates of infertility increasing

A

-later marriage
-delayed child bearing age
-more contraception
-inc abortion
-concern of environment/economics

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4
Q

Causes of infertility

A

-1/3 male factors
-1/3 female
1/3 both

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5
Q

Male infertility causes

A

-lifestyle factors
-ejactulation probs
-abnormal semen
-infection
-structural abnormalities
-immunologic factors

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6
Q

Female infertility causes

A

-cervical mucus not receptive to sperm
-uterine (mass or inflammation)
-tubal and peritoneal factors (blockage, barrier) most common
-ovulatory factors most common
-unexplained
-thyroid disorders

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7
Q

Ovulatory factors that can cause infertility

A

-hypothalmic pituitary failure
-dysfunction of hypothalmic/pituitary/ovarian axis (PCOS)
-ovarian failure

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8
Q

Nonpharmacologic treatment of infertility

A

-weight adjustment
-avoid smoking, alcohol, caffeine, illicit drugs
-reduce stress
-expectant management

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9
Q

Expectant management

A

-if regular periods are present confirm evidence of ovulation
-kits, mucus, temp, etc

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10
Q

Uterine ovulation predictor kits

A

-detect surge in LH levels
-use like preg test
-test MORNING urine daily
-change from - to + indicates peak fertility in 1-2 days
-5-20 strips for $20-60

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11
Q

Oova fertility translator

A

-detect surge in LH and progesterone
-15 strips for $136

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12
Q

Expectant management: timed intercourse

A

-quality of timing is critical
-fertile window is 6 days
-sperm lives 1-2 days after ejaculation up to 5 days
-egg lifespan is 12-24 hours after ovulation

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13
Q

FDA approved fertility tracker apps

A

-Natural Cycle
-Clue Birth Control

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14
Q

Cervical mucus

A

-allows sperm to pass through cervix during fertility
-fertile is clear and stretchy
-2 day method

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15
Q

Vaginal monitoring (expectant management)

A

-OvuSense Device
-measure temp during sleep
-provide exact date of ovulation

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16
Q

When to evaluate women UNDER 35 y/o for infertility

A

-12 months of not getting preg

17
Q

when to evaluate women 35-40 for infertility

A

-after 6 months no preg

18
Q

when to evaluate women over 40 for infertility

A

-after less than 6 months

19
Q

Pharmacologic treatment of infertility

A

-aromatase inhibitor
-gonadotropins
-assissted reproductive techniques

20
Q

Controlled ovarian hyperstimulation by what drug

A

-aromatase inhibitor (letrozole)
-with or without IUI

21
Q

Letrozole (Femara)

A

-aromatase inhibitor
-use to induce ovulation
-avoid use with CYP2A6
-monitor use with tamoxifene and methadon

22
Q

Letrozole (Femara) dosing

A

-2.5-10mg orally x 5 days starting day 3 of menses

23
Q

Gonadotropin treatment of infertility

A

-develop multiple follicles by inc FSH
-combo FSH and or LH
-IM or SC
-low dose careful monitoring

24
Q

Gonadotropin dosing

A

-specialized to each clinic

25
Q

Human Chorionic Gonadotropin treatment of infertility

A

-trigger ovulation
-use aromatase inhibitors after
-similar to LH

26
Q

hCG dosing

A

-injection at end of ovulation
-IM or SC
-timing is very important

27
Q

Assissted Reproductive Techniques

A

-IUI
-IVF
-INVOCell
-ICSI

28
Q

Intrauterine insemination

A

-deliver washed sperm into uterine cavity via catheter
-less invasive/expensive
-75% success after 12

29
Q

In Vitro Fertilization

A

-surgical retrieval of eggs from ovaries and fertilized in vitro
-embryos transfered back 3-5 days after
-very expensive
-20-30% success/cycle

30
Q

INVOCell

A

-egg and sperm in chamber
-chamber put in cooch
-fertilization in uterus
-chamber removed after 3 days and best embryos are transfered to uterus

31
Q

Intracytoplasmic sperm injection (ICSI)

A

-single sperm injected into egg to achieve fertilization
-overcome male factor infertility
-combo w IVF
-50-80%

32
Q

Complications of Infertility treatment

A

-Ovarian Hyperstimulation Syndrome (OHSS)
-risk of endo cancer w clomiphene
-do NOT inc risk of breast, cooch, thyroid, colon cancers (preg at earlier age is significant protective factor)
-multiple births (little higher chance with IVF than gonads)

33
Q

Fertility Preservation

A

-freezing techniques
-preservation of ovarian or testicular tissue for prepubertal children

Therapeutics (78 decks)

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