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Reproduction > Exam 3 Lecture 2 > Flashcards

Exam 3 Lecture 2 Flashcards

1
Q

infertility

A
  • inability to conceive after 1 year of frequent contraception-free intercourse
  • includes inability to carry prego to live birth
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2
Q

infertility if OCs were previously used

A

inability to conceive after 15 months of frequent contraception-free intercourse

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3
Q

primary infertility

A

when a couple has NEVER conceived a child

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4
Q

secondary infertility

A

when a couple has PREVIOUSLY conceived and is unable to achieve a NEW pregnancy

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5
Q

normal conception rates

A

20-24%/month

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6
Q

most fertile age

A

20-24 years.

gradual decline into 30s and sharp decline after 35

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7
Q

how much do male partners contribute to cases of couple infertility

A

40-50%

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8
Q

dysfunction of __ can lead to infertility

A
  • estrogen in follicular phase (endometrial lining & cervical mucus)
  • progesterone in luteal phase (oviducts & uterus)
  • FSH and LH
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9
Q

hyperprolactemia

A

down regulates the production of FSH/LH which can lead to infertility
- can be caused by hypothyroidism

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10
Q

the most common cause of anovulation & menstrual problems in women with normal prolactin and androgen levels

A

chronic hypothalmic dysfunction

  • weight loss/eating disorder
  • intense exercise
  • stress
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11
Q

hyperandrogeniciy

A
  • often diagnosed as PCOS

- chronically incr. LH levels that stimulate follicular production of androgens which leads to anovulation

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12
Q

historical factors that may warrant earlier evaluation of infertility than 12 months

A
  • known or suspected uterine/tubal disease or endometriosis
  • female is >35
  • history of oligomenorrhea/amenorrhea or PID
  • partner is known to be subfertile
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13
Q

female evaluation includes

A
  • medical, surgical, FH, SH (endocrine disorders)
  • physical exam
  • screen for chlamydia & gonorrhea
  • confirm ovulation
  • hysterosalpingogram
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14
Q

Basal body temperature (BBT)

A
  • take first measurement on first day of menstrual cycle & each morning before any activity
  • temp is lower before ovulation
  • rise of 0.4-0.6*F indicates ovulation has occurred
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15
Q

what causes increase in temp AFTER ovulation?

A

progesterone production by corpus luteum during luteal phase

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16
Q

ovulation testing kit counseling

A
  • begin testing 3-4 days before expected day of ovulation

- have sex w/in 24 hours of first positive test and the following day

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17
Q

clear blue fertility monitor

A

daily monitoring

tests for LH

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18
Q

fertility scope

A

saliva testing

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19
Q

first response fertility test

A

measures FSH on day 3

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20
Q

ovWatch

A

measures chloride levels in sweat

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21
Q

spermCheck

A

sperm count test for males

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22
Q

male fertility evaluation

A
  • semen analysis; abstain from ejaculation for 2-3 days; checks volume, viscosity, density, morphology, motility
  • abnormal results should be confirmed on 2-3 evaluations
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23
Q

normal semen volue

A

1.5-5mL

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24
Q

normal semen viscosity

A

<3 scale 0-4

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25
Q

normal sperm density

A

> 20million/mL or >40million/ejaculate

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26
Q

normal sperm morphology

A

> 15% normal

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27
Q

normal sperm motility

A

> 50%

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28
Q

nonpharmacologic treatments

A
  • reduce BMI<30
  • females avoid NSAIDs & ASA before ovulation
  • avoid meds that can cause hyperprolactemia or impair spermatogenesis
  • avoid vaginal lubricants bc they can impair sperm motility
  • intrauterine insemination
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29
Q

intrauterine insemination (IUI)

A
  • sperm are separated from semen & injected trans-cervically into uterus
  • performed AFTER ovulation
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30
Q

assisted reproductive therapy (ART)

A
  • direct retrieval of oocytes and manipulation of sperm to achieve prego.
31
Q

types of ART

A
  • invitro fertilization & embryo transfer (IVF-ET)
  • gamete intrafallopian transfer (GIFT)
  • Zygote intrafallopian transfer (ZIFT)
32
Q

most common ART

A

IVF

33
Q

GIFT/ZIFT

A

placement of human ova and sperm or zygote into the distal end of the oviduct (fertilization occurs in fallopian tube)

34
Q

IVF-ET

A

fertilization of the egg occurs in a lab

- fertilized egg is placed back into uterus

35
Q

clomiphene citrate

A
  • anti-estrogen drug
  • nonsteroidal estrogen receptor modulator. Blocks feedback inhibition of hypothalamus. Raises FSH & LH levels and HPO function
  • enlarged ovaries & drug induced ovulation
  • CYP2D6
  • long half life & Vd
36
Q

gonadotropin therapy

A

menotropin (human menopausal gonadotropin) and urofollitropin

37
Q

ADE of clomiphene

A
  • common: hot flashes, abdominal discomfort, visual blurring, reversible ovarian enlargement, cyst formation .
  • can lead to multiple ovulations
  • endometiral thinning and thick cervical mucus may decr. prego
38
Q

clomiphene dosing

A

50 mg po qd for 5 days starting on cycle day 2-5.
if no ovulation occurs, incr. dose by 50mg each cycle.
- max of 150mg/day

39
Q

clomiphene is first line for

A
  • ovulation induction w/ timed intercouse or insemination
  • in PCOS
  • in women with normal GnRH production
  • oligospermia in males
40
Q

clomiphene failure

A

no prego with 6 cycles of clomiphene

41
Q

what drug is an aromatase inhibitor

A

letrozole (Femara)

42
Q

letrozole MOA

A
  • inhibits conversion of testosterone to estradiol

- decrease in estrogen stimulates FSH and LH

43
Q

letrozole side effects

A

hot flashes, HA, breast tenderness

44
Q

letrozole dosing

A

2.5-5mg/day for 5 days starting on day 3 of cycle

45
Q

letrozole indications

A
  • ovulation stimulation is an off-label use

- clomiphene failure, before use of gonadotropins

46
Q

clomiphene & letrozole counseling points

A
  • ovulation should occur 5-10 days after last dose
  • have sex every day for 1 week begin 4-5 days after last dose
  • report sudden abd. discomfort, bloating or pain, N/V
  • monitor with ovulation kit or ultrasound
47
Q

who are candidates for gonadotropin therapy

A

if clomiphene doesn’t work (& lotrzole)

48
Q

gonadotropins include

A

LH, FSH, and hCG

- all contain a common alpha unit & a distinct beta unit

49
Q

cons to gonadotropin therapy

A

expensive, parenteral injection daily & require extensive monitoring

50
Q

gonadotropin therapy MOA

A

males: stimulates spermatogenesis
female: FSH stimulates maturation & development of follicles, LH causes ovulation & stimulates CL. Ovaries MUST be able to respond normally to FSH/LH

51
Q

gonadotropin therapy drugs

A
  • Repronex (menotropins)
  • Menopur (menotropins)
  • Bravelle (urafollitropin)
  • Gonal-f (follitropin alpha)
  • Follistim AQ (follitropin beta)
  • Luveris (lutropin alpha)
52
Q

gonadotropin therapy indications

A

male: spermatogenesis in men w/ 1* or 2* hypogonadism
female: hypothalmic anovulation, failure w/ clomiphene, stimulation of multiple follicles in ovulatory women for ART

53
Q

hCG drugs

A

Pregnyl, Novarel, Choriogonadotropin alpha, Ovidrel

54
Q

hCG works well in women who

A

have infertility due to lack of midcycle gonadotropin surge

55
Q

hCG drug therapy activity is essentially identical to

A

LH, but longer T1/2

56
Q

hCG ADE

A

HA, irritability, restlessness, fatigue, edema, gynecomastia, & pain at injection site

57
Q

normal release of GnRH is

A

pulsatile

58
Q

gonadorelin (Lutrepulse)

A

a synthetic decapeptide with amino acid sequence identical to GnRH
- administered via portable pump w/ ~90min infuction

59
Q

ADE of GnRH

A

tachyphylaxis (cause pituitary cells to become less responsive)
- ovarian hyperstimulation syndrome & risk of multiple gestations

60
Q

ovarian hyperstimulation syndrome

A

mild
moderate
severe
- relates to enlarged ovaries with multiple developing follicles or cysts, increased VEGF which incr. permeability of blood vessels (fluid: vascular->abdominal)

61
Q

GnRH agonist drugs

A
  • Goserelin (zoladex)
  • Nafarelin (Synarel)
  • Histrelin (Vantas, Suppreline LA)
  • Buserelin (Suprefact)
  • Triptorelin (Trelstar depot, LA)
  • Leuprolide (Lupron, Eligard)
62
Q

synthetic GnRH agonists have _____ T1/2 than native GnRH

A

longer

63
Q

GnRH agonist MOA

A
  • after transient stimulation, they down-regulate the GnRH receptor & inhibit gonadotropin secretion
64
Q

GnRH agonists are useful in

A

conditions like PCOS where GnRH agonists reduce the number of oocytes released prematurely and imprve oocyte quality, reducing prego loss

65
Q

GnRH agonist ADE

A
  • excessive ovarian stimulation & estrogen synthesis(vag bleeding, breast tenderness), estrogen defiency (hot flashes, HA, vag dryness)
66
Q

GnRH antagonist drugs

A

Abarelix (Plenaxis)
Cetrorelix (Cetrotide)
Ganirelix (Antagon)

67
Q

GnRH MOA

A

prevent premature LH surge or premature ovuation

68
Q

esrogens

A

sometimes used to stimulate endometrial growth & cervical mucus production in follicular phase

69
Q

progestins

A

sometimes used to promote endometrial development and maintenance during luteal phase to improve implantation success

70
Q

metformin (Glucophage)

A

can reduce insulin resistance and hyperinsulinemia in PCOS pts. Restores mentrual cycle and ovarian function

71
Q

guanifenesin

A

can help improve cervical mucus quality

72
Q

DA agonists

A

i. e. bromocriptine & cabergoline

- can be used to treat infertility due to hyperprolactemia

73
Q

aspirin (Low dose)

A

may increase uterine and ovarian blood flow velocity to improve function

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