Female Infertility 4 Flashcards
Describe effective therapeutic approaches to the infertile couple
1
Q
What are some treatment options for male factor infertility?
A
- Donor inesmination
- In-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI)
- Intrauterine insemination (IUI) for modest abnormalities
2
Q
What are some treatments for female anatomic causes of infertility?
A
- Uterus - surgery or gestational carrier
- Fallopian tubes - surgery (rare) or IVF
3
Q
What are the treatments for anovulation?
A
- Treat any underlying endocrinopathy
- Ovulation induction with clomiphene citrate or injectable gonadotropins
4
Q
What is the mechanism and efficacy of clomiphene citrate?
A
-
Mechanism:
- selective estrogen receptor modulator (SERM)
- competes with endogenous estrogen for estrogen receptors
- binds for extended interval of time
- depletes receptor concentrations by interfering with receptor recycling
- at hypothalamus, estrogen receptor is depleted, leading to reduced negative estrogen feedback
-
Efficacy:
- start with 50 mg for 5 days, up to 200 mg
- will successfully induce ovulation in 70-80% of properly selected women
- overall cycle fecundability is up to 22% with clomiphene (starting from ~15%)
- cumulative pregnancy rate of 70-75% expected over 6-9 cycles
5
Q
What are the pros and cons of gonadotropin treatment for infertility?
A
-
Pros
- highly effective
- ex. purified urinary FSH
- ex. recombinant FSH, LH, hCG
- highly effective
-
Cons
- very costly
- associated with risk of multiple pregnancy and ovarian hyperstimulation syndrome
6
Q
What is the treatment for decreased ovarian reserve, cervical factor, or sexual dysfunction?
A
-
Decreased ovarian reserve
- no good therapy
- consider oocyte donation
-
Cervical factor or sexual dysfunction
- intrauterine insemination
7
Q
What is the treatment approach for unexplained infertility?
A
- Initial treatment is empiric
- without treatment fecundability is 2-4%
- Common treatments:
- controlled ovarian hyperstimulation (COH) with either CC or gonadotropins
- done in conjunction with intrauterine insemination (IUI)
- cycle fecundability reaches ~10%
- IVF in 25-50% of people
8
Q
What is the treatment for endometriosis?
A
- Laparoscopic assessment and treatment
- Adjunctive medical therapies
9
Q
What are some key features of IVF?
A
- Oocytes obtained from ovarian follicles by US aspiration
- prepared and combined with sperm
- Non-stimulated cycles used to reduce costs
- Pregnancy rates are ~10%
- Most patients undergoing IVF receive gonadotropins to increase the number of oocytes available for retrieval
-
Patient selection:
- IVF-ET most successful for infertile couples when female partner has an adequate follicle pool
- Antral follicle count (2-10mm in diameter) is a good predictor of ovarian reserve
- < 10 total AF have diminished ovarian reserve
- AMH is reduced with increasing age and used as a marker