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
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2
Q

What are some treatments for female anatomic causes of infertility?

A
  • Uterus - surgery or gestational carrier
  • Fallopian tubes - surgery (rare) or IVF
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3
Q

What are the treatments for anovulation?

A
  • Treat any underlying endocrinopathy
  • Ovulation induction with clomiphene citrate or injectable gonadotropins
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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
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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
  • Cons
    • very costly
    • associated with risk of multiple pregnancy and ovarian hyperstimulation syndrome
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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
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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
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8
Q

What is the treatment for endometriosis?

A
  • Laparoscopic assessment and treatment
  • Adjunctive medical therapies
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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
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