Hormonal treatments for infertility

Question 1

How many couples in the UK have difficulty conceiving?

Answer 1

In the UK ~ 1 in 7 couples will have difficulties conceiving.

Question 2

What are the main reasons for infertility?

Answer 2

~ 30% idiopathic

~ 25% male factor (low or no sperm production)

~ 45% female factors (~25% ovulatory failure)

Question 3

Describe the diagnosis of Anovulation

Answer 3

• Hormonal: mid-luteal phase progesterone levels measured to confirm lutenisation of follicle (NOT ovulation).
• Ultrasound: direct visualisation of ovaries to measure number and size of follicles.

Question 4

What are the treatments for anovulation?

Answer 4

Purpose: Induction of ovulation

• Anti-oestrogen therapy
• Gonadotrophin therapy
• GnRH therapy

Question 6

Describe Anti-Oestrogen Therapy

Answer 6

Blocks negative feedback of Oestrogen onto the hypothalamus & pituitary.

CLOMIPHENE: first line therapy

Question 8

Explain anti-oestrogen therapy

Answer 8

• Displaces endogenous oestrogen from hypothalamic receptors.
• Decreases sensitivity of gonadotrophs in anterior pituitary to Oestrogen.
• Increases FSH levels.
• Stimulates follicles to grow
• →Ovulation

Question 9

What does anti-oestrogen therapy require to be effective?

Answer 9

Requires intact HPG axis to be effective

Question 10

What can anti-oestrogen therapy be used in combination with?

Answer 10

Can be used in combination with hCG.

hCG functionally similar to LH→LH surge promotes ovulation.

Question 11

Describe Gonadotrophin therapy

Answer 11

Used when HPG axis is non-function (e.g. acquired or congenital gonadotrophin deficiency

Question 13

Explain Gonadotrophin therapy

Answer 13

human Menopausal Gonadotrophin (hMG)

provides exogenous FSH & LH

bypasses hypothalamic-pituitary regulation

Stimulates follicles to grow

→ Ovulation

Question 14

What can gonadotrophin therapy be used in combination with?

Answer 14

can be used in combination with hCG to promote ovulation.

Question 15

Describe GnRH Therapy

Answer 15

Used when there is absolute or relative deficiency of endogenous GnRH.

(e.g. congenital or ammenhorrhoea caused by low body weight, stress, intensive exercise, hypothalamic disease, surgery, trauma).

BUT continuous GnRH actually inhibits

FSH and LH secretion: pulsatile

Question 16

What is the success rate for Anti-oestrogen therapy (Clomiphene) ?

Answer 16

30%

Question 17

What is the success rate for Gonadotrophin therapy?

Answer 17

10-40%

Question 18

Gonadotrophin therapy for GnRH therapy?

Answer 18

25-30%