49: infertility Flashcards
Infertility
-inability to become preg after 12 months
Evaluate infertility earlier in patients:
-women over 35
-h/o oligo/amenorrhea
-uterine/tubal disease or endometriosis
-partner known to be subfertile
Rates of infertility increasing
-later marriage
-delayed child bearing age
-more contraception
-inc abortion
-concern of environment/economics
Causes of infertility
-1/3 male factors
-1/3 female
1/3 both
Male infertility causes
-lifestyle factors
-ejactulation probs
-abnormal semen
-infection
-structural abnormalities
-immunologic factors
Female infertility causes
-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
Ovulatory factors that can cause infertility
-hypothalmic pituitary failure
-dysfunction of hypothalmic/pituitary/ovarian axis (PCOS)
-ovarian failure
Nonpharmacologic treatment of infertility
-weight adjustment
-avoid smoking, alcohol, caffeine, illicit drugs
-reduce stress
-expectant management
Expectant management
-if regular periods are present confirm evidence of ovulation
-kits, mucus, temp, etc
Uterine ovulation predictor kits
-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
Oova fertility translator
-detect surge in LH and progesterone
-15 strips for $136
Expectant management: timed intercourse
-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
FDA approved fertility tracker apps
-Natural Cycle
-Clue Birth Control
Cervical mucus
-allows sperm to pass through cervix during fertility
-fertile is clear and stretchy
-2 day method
Vaginal monitoring (expectant management)
-OvuSense Device
-measure temp during sleep
-provide exact date of ovulation
When to evaluate women UNDER 35 y/o for infertility
-12 months of not getting preg
when to evaluate women 35-40 for infertility
-after 6 months no preg
when to evaluate women over 40 for infertility
-after less than 6 months
Pharmacologic treatment of infertility
-aromatase inhibitor
-gonadotropins
-assissted reproductive techniques
Controlled ovarian hyperstimulation by what drug
-aromatase inhibitor (letrozole)
-with or without IUI
Letrozole (Femara)
-aromatase inhibitor
-use to induce ovulation
-avoid use with CYP2A6
-monitor use with tamoxifene and methadon
Letrozole (Femara) dosing
-2.5-10mg orally x 5 days starting day 3 of menses
Gonadotropin treatment of infertility
-develop multiple follicles by inc FSH
-combo FSH and or LH
-IM or SC
-low dose careful monitoring
Gonadotropin dosing
-specialized to each clinic
Human Chorionic Gonadotropin treatment of infertility
-trigger ovulation
-use aromatase inhibitors after
-similar to LH
hCG dosing
-injection at end of ovulation
-IM or SC
-timing is very important
Assissted Reproductive Techniques
-IUI
-IVF
-INVOCell
-ICSI
Intrauterine insemination
-deliver washed sperm into uterine cavity via catheter
-less invasive/expensive
-75% success after 12
In Vitro Fertilization
-surgical retrieval of eggs from ovaries and fertilized in vitro
-embryos transfered back 3-5 days after
-very expensive
-20-30% success/cycle
INVOCell
-egg and sperm in chamber
-chamber put in cooch
-fertilization in uterus
-chamber removed after 3 days and best embryos are transfered to uterus
Intracytoplasmic sperm injection (ICSI)
-single sperm injected into egg to achieve fertilization
-overcome male factor infertility
-combo w IVF
-50-80%
Complications of Infertility treatment
-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)
Fertility Preservation
-freezing techniques
-preservation of ovarian or testicular tissue for prepubertal children
