inferility Flashcards
what is infertility?
failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination
when can treatment be considered for women over 35?
after 6 months
what are 7 primary causes of infertility?
- Primary ovarian insufficinecy
- PCOS
- obesity
- weight changes
- excessive exercise
- thyroid dysfunction
- hyperprolactinemia
what hormone causes ovulation?
LH
what temperature should patients monitor for if they are using temperature to check if they are ovulating?
between 37°C and 36°C
what hormone is primarily working in the luteal phase?
progesterone
how long is teh normal range of a menstraul cycle?
25-35 days
what day does ovulation typically occur?
14
after ovulation, how long is the egg viable for? what about sperm?
24 hours; 5-7 days
what are 6 disease that may cause infertility?
- Endometriosis/ PID
- PCOS
- fibroids/polyps
- immune
- infectious- chlamydia
- unknown
what are 3 medications that are known to decraese sperm activity?
- anabolic steroids
- cocaine
- weed
what is a screening test that women should have performed?
thyroid function tests
true or false: males should be tested first if there is a concern for infertility
true
what are 6 things that women should be tested for?
- serum antimullerian hormone
- prolactin
- FSH
- estradiol
- serum prgesterone
- LH detection
what is the first treatment that can be used for infertilty?
non pharmacological treatment
what are 2 non pharm treatment options that can be used?
- avoid contributing medications/agents
- BMI <27 avoid excess exercise and dieting
what are 2 drug choices that are used to treat hyperprolactinemia?
- bromocriptine
- cabergoline
what is the first line treatment for infertility?
clomiphene citrate
what is the MOA of clomiphene citrate?
estrogen antagonist that inhibits negative feedback at the hypothalamus and increases the release of FSH
how is clomiphene citrate taken?
orally
when can you consider another therapy after the use of clomiphene?
after 6 cycles with no pregnancy
if you use clomiphene for longer than ___ months there is an increased risk of ovarian cancer
12
what are 2 positive predictors of clomiphene?
- age <30
- history of amenorrhea (vs oligomenorrhea)
what is the MOA of the aromatase inhibitors?
nonsteroidal competitive inhibitors of aromatase to prevent the conversion of androgen to estrogen
what can teh aromatase inhibitors be combined with?
gonadotropins
what drug can be used for insulin resistance that affects ovulatory function through hyperinsulinemia?
metformin
what should you use metformin in combination with for a 90% success rate?
clomiphene
how long does it take for metformin to show an effect?
6 months
what are the 2 exogenous gonadotropins?
- FSH alone
- FSH + LH
what do the exogenous gonadotropins result in?
a transient increase in FSH
what are the 4 types of exogenous gonadotropins?
- human menotropins
- urofollitropin
- follitropin alfa
- follitropin beta
HUMAN MENOTROPINS
REPONEX
UROFOLLITROPIN
BREVELLE
FOLLITROPIN ALFA
GONAL-F
FOLLITROPIN BETA
FOLLISTIM
what is a serious ADR of the gonadotropins?
ovarian hyperstimulation syndrome (OHSS)
what are 2 risk factors for OHSS?
- high and repeated doses of exogenous gonadotropins
- PCOS
what is an increase in dose based on with the gonadotropins?
Follicular development
what medication is a chemical structure to LH?
chorionic gonadotropin
when is the chorionic gonadotropin used?
after gonadotropins for ovulation induction
what should patients not take if they are taking chorionic gonadotropin?
pregnancy tests
when might the hcg trigger be withheld?
due to follicle number or high estradiol concentrations
why would the aromatase inhibitors not be used?
they can be teratogenic
what are the GnRH agonists/antagonists used for?
- stop the LH surge
- improve ovarian response
what type of technologies are the GNRHs used?
ART or IVF
what are the 2 GnRH agonists?
- leupolide
- naferelin
what are the 2 GnRH antagonists?
- cetrorelix
- ganirelix
which type of GnRH drugs take longer to work?
the antagonists
what are 2 things that may occur with the use of the GnRH antagonist/agonists?
- pituitary suppression
- inadequate LH concentrations
what should be used in addition to the GnRH drugs?
luteal support: progesterone (IM or intravaginal)
how long can progesterone be used?
10-14 days
what are 3 things that should be monitored in the gonadotropins?
- serial ultrasounds
- serum estradiol
- length of treatment
what is the treatment algorithm for the gonadotropins?
- start doses low
- hcg trigger
- consider luteal support
- monitor for ADRs and response
when may patients take birth control?
to get to day 0 to start treatment
when should hcg be given?
24-36 hours before the egg is released
when having ART or IVF, what is there an increased risk of? 3
- gestational diabetes
- preclampsia
- premature labor and/or delivery
what type of patients are candidates for egg freezing?
oncology patients
what are some abx that may be seen for prevention in surgical procedures?
- azithromycin
- doxycycline
