Fertility Flashcards
What is infertility
Inability to conceive after 12 months of unprotected sex OR 6 months of unprotected sex after the age of 35
What is the Hypothalmus-Pituitary-Testes axis that causes and inhibts spermatogenesis
Pituitary hormone effects: LH and FSH stimulate spermatogenesis and testosterone by the testes
Testes hormone effects: Testosterone and inhibin inhibit the secretion of GnRH by the hypothalmus thus inhibiting LH and FSH release from the pitutary
Which drugs affect the HPT axis
Anabolic steroids, testosterone
T/F: Giving someone testosterone will make them more likely to be fertile
False: Giving more testosterone will lead to more inhibition thus no more spermatogenesis
If there is problem with spermatogenesis due to the testes (primary), Pituitary (secondary), hypothalamic (secondary), hyperprolactinemia (secondary)
None, LH or FSH replacement therapy, pulsatile GnRH, dopamine agonists
How do dopamine agonists aid in hyperprolactinemia
Since prolactin is a potent inhibitor dopamine inhibits the inhibitor allowing for normal function
T/F: A male may be on a SERM because it allows estrogen to not inhibt the release of GnRH, aromatase does a similar way method of reducing an inhibitor
True
Which mechanisms of female infertility may not be changed by medications
Fallopian tube are absent or blocked, uterine tube has fibroids or polyps, endometriosis or history of PID
What are the four types of female infertility
Hypogonadotropic (low FSH, low, LH, low estradiol). Normogonadotropic (normal FSH, HIGH LH, normal estradiol), Hypergonadotropic (HIGH FSH, normal LH and low estradiol), other
Which SERM is used to induce ovulation BUT decrease the cervical mucus aiding sperm traversing the cervix
Clomiphene citrate
What group of infertility is Polycystic Ovarian syndrome apart of
Nornoganadotropic (normal FSH, HIGH LH, normal estradiol
What is the pathophysiology of PCOS
1) Rapid pulsing of GnRH causes hypersecretion of LH,
2) Large amount of LH and only normal levels of FSH leads to follicle that are stimulated but are leading to no ovulation (no second half of the menstrual cycle)
3) LH and insulin can also be converted to androgens
What are symptoms of PCOS
Infertility,Hyperandrogenism (hirsutism, acne, alopecia, menstrual distrubances, Endometrial hyperplasia and cancer, glucose intolerance
What are the non-pharmacological treatments of PCOS
Weight loss, Diet, Exercise
What is the first line pharmacological treatment for PCOS for patients who do not want to get pregnant, what are the other options
CHCs, Medroxyprogesterone (only reduces the endometrial hyperplasia), Spironolactione (antiandrogen)
What are the options for PCOS if the patient wants to become pregnant
Metformin (ovulation induction, lowers insulin), pioglitazone (falling out of favor; edema and weight gain)
What are is the goal of ovulation induction
Monofollicular development (one egg) while minimizing the risk of ovarian hyperstimulation syndrome
Which oral medications are used to induce ovulation, how do they work
Clomiphene citrate: SERM that down regulates estrogen receptors (dose increases by 50 mg per cycle if ineffective)
Letrozole: aromatase inhibitor that reduces the amount of estrogen to cause inhibiton (anastrazole)
What injectables are used to induce ovulation
LH/FSH combination, FSH, hCG (creates the LH surge mid cycle)
When does follicular development happen in hCG
Ovulation expected within 24 hours
What are potential adverse effects of any ovulation induction medications, how is this prevented
Multiple gestations, ovarian hyperstimulation syndrome (edema, ascites, pleural effusion, hemodynamic instability)/ low doses, step up therapy, close monitoring and withholding hCG trigger dose
What happens in assisted reproductive technology (ART)
Manipulation of oocytes and sperm through stimulating multiple follicles for oocyte retrieval and optimize implantation after in vitro fertilization
What are the steps for in vitro fertilization (IVF)
1) Controlled ovarian stimulation
2) Oocyte retrieval
3) Fertilization in vitro
4) Embryo transfer
For the ovarial stimulation needed for IVF what medications are used in conjunction and why
GnRH agonists and antagonists: suppress LH to allow for follicle development,FSH OR FSH/LH: stimulate development of multiple ovarian follicles hCG: LH surge, progesterone for 8 weeks: usually medications deplete progestetone plus endometrium is maintained for embryo transfer and implantation
T/F: If a patient needs Controlled oocyte hyperstimulation and IVF they would not take oral contraceptives because this would cause them to not get pregnant
False: CHCs are used to regulate cycle and know exactly when the menses starts allowing for the start of COHS to planned
What is the order of medications used for COHS/IVF
1) CHCs
2) GnRH agonists
3) Gonadotropins
4) hCG
5) Progesterone
What are treatment options for unsuccesful pregnancy based on type
Spontaneous abortion: Mirepristone followed by misoprostol. misoprostol
Ectopic Pregnancy: Surgical intervention, Methotrexate (IM or PO)
