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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
normal sperm density
>20million/mL or >40million/ejaculate
26
normal sperm morphology
>15% normal
27
normal sperm motility
>50%
28
nonpharmacologic treatments
- 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
29
intrauterine insemination (IUI)
- sperm are separated from semen & injected trans-cervically into uterus - performed AFTER ovulation
30
assisted reproductive therapy (ART)
- direct retrieval of oocytes and manipulation of sperm to achieve prego.
31
types of ART
- invitro fertilization & embryo transfer (IVF-ET) - gamete intrafallopian transfer (GIFT) - Zygote intrafallopian transfer (ZIFT)
32
most common ART
IVF
33
GIFT/ZIFT
placement of human ova and sperm or zygote into the distal end of the oviduct (fertilization occurs in fallopian tube)
34
IVF-ET
fertilization of the egg occurs in a lab | - fertilized egg is placed back into uterus
35
clomiphene citrate
- 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
gonadotropin therapy
menotropin (human menopausal gonadotropin) and urofollitropin
37
ADE of clomiphene
- 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
clomiphene dosing
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
clomiphene is first line for
- ovulation induction w/ timed intercouse or insemination - in PCOS - in women with normal GnRH production - oligospermia in males
40
clomiphene failure
no prego with 6 cycles of clomiphene
41
what drug is an aromatase inhibitor
letrozole (Femara)
42
letrozole MOA
- inhibits conversion of testosterone to estradiol | - decrease in estrogen stimulates FSH and LH
43
letrozole side effects
hot flashes, HA, breast tenderness
44
letrozole dosing
2.5-5mg/day for 5 days starting on day 3 of cycle
45
letrozole indications
- ovulation stimulation is an off-label use | - clomiphene failure, before use of gonadotropins
46
clomiphene & letrozole counseling points
- 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
who are candidates for gonadotropin therapy
if clomiphene doesn't work (& lotrzole)
48
gonadotropins include
LH, FSH, and hCG | - all contain a common alpha unit & a distinct beta unit
49
cons to gonadotropin therapy
expensive, parenteral injection daily & require extensive monitoring
50
gonadotropin therapy MOA
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
gonadotropin therapy drugs
- Repronex (menotropins) - Menopur (menotropins) - Bravelle (urafollitropin) - Gonal-f (follitropin alpha) - Follistim AQ (follitropin beta) - Luveris (lutropin alpha)
52
gonadotropin therapy indications
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
hCG drugs
Pregnyl, Novarel, Choriogonadotropin alpha, Ovidrel
54
hCG works well in women who
have infertility due to lack of midcycle gonadotropin surge
55
hCG drug therapy activity is essentially identical to
LH, but longer T1/2
56
hCG ADE
HA, irritability, restlessness, fatigue, edema, gynecomastia, & pain at injection site
57
normal release of GnRH is
pulsatile
58
gonadorelin (Lutrepulse)
a synthetic decapeptide with amino acid sequence identical to GnRH - administered via portable pump w/ ~90min infuction
59
ADE of GnRH
tachyphylaxis (cause pituitary cells to become less responsive) - ovarian hyperstimulation syndrome & risk of multiple gestations
60
ovarian hyperstimulation syndrome
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
GnRH agonist drugs
- Goserelin (zoladex) - Nafarelin (Synarel) - Histrelin (Vantas, Suppreline LA) - Buserelin (Suprefact) - Triptorelin (Trelstar depot, LA) - Leuprolide (Lupron, Eligard)
62
synthetic GnRH agonists have _____ T1/2 than native GnRH
longer
63
GnRH agonist MOA
- after transient stimulation, they down-regulate the GnRH receptor & inhibit gonadotropin secretion
64
GnRH agonists are useful in
conditions like PCOS where GnRH agonists reduce the number of oocytes released prematurely and imprve oocyte quality, reducing prego loss
65
GnRH agonist ADE
- excessive ovarian stimulation & estrogen synthesis(vag bleeding, breast tenderness), estrogen defiency (hot flashes, HA, vag dryness)
66
GnRH antagonist drugs
Abarelix (Plenaxis) Cetrorelix (Cetrotide) Ganirelix (Antagon)
67
GnRH MOA
prevent premature LH surge or premature ovuation
68
esrogens
sometimes used to stimulate endometrial growth & cervical mucus production in follicular phase
69
progestins
sometimes used to promote endometrial development and maintenance during luteal phase to improve implantation success
70
metformin (Glucophage)
can reduce insulin resistance and hyperinsulinemia in PCOS pts. Restores mentrual cycle and ovarian function
71
guanifenesin
can help improve cervical mucus quality
72
DA agonists
i. e. bromocriptine & cabergoline | - can be used to treat infertility due to hyperprolactemia
73
aspirin (Low dose)
may increase uterine and ovarian blood flow velocity to improve function

Reproduction (12 decks)

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