Fertility II Flashcards
What are the therapeutic uses of gonadtropins in fertility?
They can be used to treat infertility in anovulatory women or women with hypogonadism.Women who have not been able to become pregnant with clomiphene (Clomid, Serophene) may be encouraged to try gonadotropins as a next step.
What is Menotropin?
Menotropin preparations are mixed solutions of FSH and LH isolated from urine that are designed for use in selected women where they stimulate the ovaries to mature follicles, thus making them more fertile. They can also be used inhypogonadalmen to stimulate sperm production.
How are menotropins given?
They are administered by typically daily injection, intramuscularly or subcutaneously, for about ten days under close supervision to adjust dose and duration of therapy.
Are Menotropins 1:1 in FSH:LH ratios?
While earlier menotropin medications contained FSH and LH at a 1:1 ratio, the recognition that it is FSH that is critical for follicle stimulation has led to development of newer preparations that contain a much higher FSH/LH ratio, Fertinex being an example.[4]
T or F. Progesterone inhibits uterine contraction
T.
What are the pharmacokinetic advantages of synthetic estrogens like ethinyl estradiol and mestranol?
These have ethinyl groups (triple bonds) which greatly decrease hepatic metabolism compared to native estrogens which have very poor bioavailability
Why would clomiphene and fulvestrant be useful for infertility in anovulatory women?
These are pure antiestrogens, aka they inhibit estrogen action in all tissue so they prevent feedback inhibition of natural estrogens and stimulate release of GnRH which stimulates LH/FSH release leading to ovulation
The risk for CV events in women taking estrogen is especially high in what population?
smokers
What are the most effective contraceptives?
IUDs, progestin implants, and sterilization
What are the most popular contraceptives?
hormonal contraceptives
What are the least effective contraceptives?
Barrier and fertility-based methods (calendar)
Why would combo estrogen/progestin be a good contraceptive?
feedback inhibition on the pituitary inhibits gonadotropin release. While there are many different formulations, the estrogen in these pills is typically ethinyl estradiol or mestranol and the progesterone is typically noerthindrone, norgestrel, or levonorgestrel
How are most oral contraceptives packaged?
21/7 cycle (21 active/7 placebo). Some have less placebo days- these preps may decrease menstrual symptoms (HA, bloating, menstrual pain)
What are some contraindications to combo oral contraceptives?
TE diseasecerbral vascular diseaseMI or CADcongenital hyperlipidemiaKnown or suspected breast cancerEndometrial cancer
What is a ‘minipill’?
Low dose of only progestin. Blocks ovulation in only 60-80% of cycles and the presence of progestin impairs pserm transport by thickening the cervical mucus, decreases motility of ova in the fallopian tubes, and impairs the endometrium
T or F. Minipills have a slightly higher failure rate than combo pills
T.
What are some non-contraceptive benefits of birth control?
-reduced dysfunctional uterine bleeding and dysmenorrhea-Menstrual regularity-increased hemoglobincombo pills raise SHBG and thus decrease free androgens, resultsing in less hirsutism and acne-Tx of PCOS
How are minipills taken?
Taken daily and continuous, no placebos. Pills should be taken at the same time each day.
Minipills are best for women who are _____
breast feeding or 35+ and smokeProgestin is responsible for the acne and weight gain seen
How are transdermal patches given?
New patch each week for 3 weeks, then patch-free for one weekNote that transdermal patches deliver both ethinyl estradiol and progestin
What are some of the AEs of transdermal patch contraceptives?
-the patch is less effective in women 90+ kg becuase of adipose tissue-breakthrough bleeding is more common in the first 2 cycles-skin irriation may be a problem
How are vaginal contraceptive rings given?
Inserted intravaginally by the pt. and left in palce for 3 weeks and take out for 1 week. During those three weeks the ring should not be removed for more than 3 hrs and is not effective until in palce for 7+ daysNOTE: This delivers both ethinyl estradiol and progestin
T or F. There is a rapid return to fertility after removal of a vaginal contraceptive ring
What hormones do injectable contraceptives give?
progesterone only- usually medroxyprogesterone. Injected every 3 monthsDiscontinue after 2 yrs unless no alternative
AEs of injectable contraceptives?
Amenorrhea common, irregular bleeding can occurweight gain, HA, and decreased bone densitydelayed return to fertility (6-12 months)
Implants hormonal contraceptives give what hormone?
progesterone only, usually etonogestrel given as a signle rod implanted under the skin in the upper armSame AEs as all progestins
How long are implanted hormonal contraceptives effective for?
3 yrs
What are the types of IUD?
Copper containing (copper is spermacidal)and progestin releasing (levonorgestrel)
T or F. Fertility is quickly restored after using an IUD
T. There is a high initial cost, but very low overall cost
What are the AEs of an IUD?
less blood loss; FDA approved for dysmenorrheacooper may cause crampingprogestin may cause irregular bleeding (6-12 mo)
What is the most common spermicide?
Nonoxynol-9, a surfactant available in foams, gels, creams, suppositories. NOTE: These are only effective for about 1 hr so reapplication is necessary and they MUST be in contact with the cervix to work
What are the potential AEs of spermacides?
less effective than others, irriations of vaginal mucosa, toxic shock syndrome
What is a ‘sponge’?
barrier form of protection containing nonoxynol-9 that is moistned in water and palced over the cervix. This is immediately effective and is effective for up to 24 hrs but must remain in place 6 hrs after intercourse (inferior to diaphragms)
Emergency contraception is most effective if taken within ____ hrs of intercourse
72- Use progetins to delay ovulation
What do PlanB and Preven consist of?
two doses of levonorgestrel seperated by 12 hrs (first dose should be within 72 hrs of intercourse)
What type of delivery of androgens is most effective/
IM
What are the AEs of testosterone abuse?
lower testosterone levelsdecreased libidodecreased spermatogenesishepatotoxicity
What is Oxandrolone (Oxandrin)?
an anabolic steroid that has less conversion to estrogens and less inhibition of testosterone synthesis
What is Cyproterone acetate?
Competes with DHT for androgen receptor binding, preventing translocation into the nucleus for tx of acne, baldness, hirsutism, virilizing syndrome, and inhibitng libidio in sexually deviant men
Why is nicalutamide better than flutamide?
lower hepatic toxicity and once a day administration
Notes aboutFinasteride
Should not be touched by pregnant women, absorbed through skin and can cause birth defect in male fetus. Men taking this should not donate blood
