Chapter 29 Management of Infertile Couple Flashcards
___ is the best serum marker of OVARIAN RESERVE (#of follicles/oocytes available in a given month)
anti-mullerian hormone (AMH)
___ is first line treatment for ovulation induction in anovulatory pts with polycystic ovary syndrome
clomiphene citrate
women with PCOS, and all obese pts, should be encouraged to
lose weight prior to attempting fertility.
evaluation of infertility:
chlmydia antibody (CAT) and hysterosalpingogram (HSG). should be integrated into the diagnostic evaluation.
anti mullerian hormone has been shown to be superior to other hormonal markers of ovarian reserve. there is evidence that AMH levels are significantly more associated with ___ retrieved following stimulation from IVF than other serum markers.
AMN levels are associated with egg numbers retrieved following stimulation from IVF. AMH is highly is correlated with the antral follicles count.
Polycystic Ovarian Syndrome is characterized by 2 of the following:
- oligomenorrhea
- hyperandrogenism/hyperandrogenemia
- polycystic ovaries.
for conception, the most critical of the factors is
irregular cycles with anovulation.
__ is first line fertility treatment for PCOS.
Clomiphene citrate.
addition of metformin to clomiphene citrate conferred no additional benefit with respect to conception, pregnancy or live birth rate in pcos population.
true
clomiphene citrate has ___ effect on endometrium and cervical mucus
antiestrogenic effects.
2nd type of ovulation induction medication is __
letrozole (aromatase inhibitor).
letrozole acts by
inhibiting conversion of androgens into estrogens; thus estrogen feedback to the pituitary is decreased and endogenous gonadotropin release is increased.
Letrozole is as effective as clomiphene citrate in ovulation induction, without the associated negative effects on the endometrium.
true
as opposed to obesity or insulin resistance, extent of clinical and biochemical hyperandrogenism appears to be the STRONGEST negative predictor of successful ovulation induction
true.
weight reduction as little as 5% of total body weight has been associated with increase in __ and decrease in __
SHBG sex hormone binding globulin; testosterone
improvement in hirsutism has also been shown with weight reduction
true
miscarriage rates appear to increase with marked obesity, BMI of
> = 35
fewer lifetime ovulatory evens associated with __ risk of breast cancer
decreased risk of breast CA
ovulation induction could be linked to increased breast cancer risk by increasing the # of lifetime ovulatory events
true
there is no strong evidence to support relationship between the use of fertility drugs and either breast or ovarian cancer.
true
submucosal leiomyomata; several studies demonstrated association btwn submucosal leiomyomata and __ , __, and )
- decreased implantation
- decreased ongoing pregnancy rates
- increased miscarriage rates
this led to recommendation for resection of submucosal myomata prior to embarking on IVF.
Intramural leiomyomata. insufficient evidence to offer routine resection of intramural myomata for reproductive optimization. studies showed significant decrease in both clinical pregnancy rates and live birth rate following IVF in pts with noncavity distorting intramural leiomyomata
true. decrease in pregnancy rates, and decrease in live birth rate?
data regarding impact of intramural leiomyomata are conflicting.
true.
Tubal Factor: dx
testing for chlamydia antibody CAT) is most cost-effective test.
Male subfertility. circulating hormone levels of__ and __ are reflective of Sertoli cell function and spermatogenesis
follicle stimulating hormone (FSH)
and Inhibin B.
reflective of sertoli cell function and spermatogenesis.
clomiphene citrate has both estrogenic and antiestrogenic effects, depending on tissue type.
true
CC acts as a competitive INHIBITOR OF estrogen feedback at the level of HYPOTHALAMUS, increasing release of gonadotropin releasing hormone (GnRH) and as a result, endogenous gonadotropins.
inhibits estrogen feedback at the level of hypothalamus, thus increase release of GNRH => increase of endogenous gonadotropins.
CC+IUI, <41, 90% or more of all pregnancies were initiated in the first 3 cycles of CC-IUI. in the 41,42 age group, 83.3% of all pregnancies occured in the first 4 cycles.
true.
Letrozole - IUI.
pregnancy outcomes after ovulation induction similar to pregnancies achieved via CC or gonadotropins.
letrozole has significantly lower rate of multiple gestations when comared to CC, exogenous gonadotropins.
true.
Letrozole appears to be as effective as clomiphene citrate in ovulation induction, without associated negative effects on the endometrium .
letrozole can be considered an alternative to clomiphene citrate for ovulation induction.
