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inferility Flashcards

1
Q

what is infertility?

A

failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor insemination

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2
Q

when can treatment be considered for women over 35?

A

after 6 months

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3
Q

what are 7 primary causes of infertility?

A
  1. Primary ovarian insufficinecy
  2. PCOS
  3. obesity
  4. weight changes
  5. excessive exercise
  6. thyroid dysfunction
  7. hyperprolactinemia
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4
Q

what hormone causes ovulation?

A

LH

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5
Q

what temperature should patients monitor for if they are using temperature to check if they are ovulating?

A

between 37°C and 36°C

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6
Q

what hormone is primarily working in the luteal phase?

A

progesterone

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7
Q

how long is teh normal range of a menstraul cycle?

A

25-35 days

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8
Q

what day does ovulation typically occur?

A

14

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9
Q

after ovulation, how long is the egg viable for? what about sperm?

A

24 hours; 5-7 days

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10
Q

what are 6 disease that may cause infertility?

A
  1. Endometriosis/ PID
  2. PCOS
  3. fibroids/polyps
  4. immune
  5. infectious- chlamydia
  6. unknown
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11
Q

what are 3 medications that are known to decraese sperm activity?

A
  1. anabolic steroids
  2. cocaine
  3. weed
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12
Q

what is a screening test that women should have performed?

A

thyroid function tests

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13
Q

true or false: males should be tested first if there is a concern for infertility

A

true

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14
Q

what are 6 things that women should be tested for?

A
  1. serum antimullerian hormone
  2. prolactin
  3. FSH
  4. estradiol
  5. serum prgesterone
  6. LH detection
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15
Q

what is the first treatment that can be used for infertilty?

A

non pharmacological treatment

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16
Q

what are 2 non pharm treatment options that can be used?

A
  1. avoid contributing medications/agents
  2. BMI <27 avoid excess exercise and dieting
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17
Q

what are 2 drug choices that are used to treat hyperprolactinemia?

A
  1. bromocriptine
  2. cabergoline
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18
Q

what is the first line treatment for infertility?

A

clomiphene citrate

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19
Q

what is the MOA of clomiphene citrate?

A

estrogen antagonist that inhibits negative feedback at the hypothalamus and increases the release of FSH

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20
Q

how is clomiphene citrate taken?

A

orally

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21
Q

when can you consider another therapy after the use of clomiphene?

A

after 6 cycles with no pregnancy

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22
Q

if you use clomiphene for longer than ___ months there is an increased risk of ovarian cancer

A

12

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23
Q

what are 2 positive predictors of clomiphene?

A
  1. age <30
  2. history of amenorrhea (vs oligomenorrhea)
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24
Q

what is the MOA of the aromatase inhibitors?

A

nonsteroidal competitive inhibitors of aromatase to prevent the conversion of androgen to estrogen

25
Q

what can teh aromatase inhibitors be combined with?

A

gonadotropins

26
Q

what drug can be used for insulin resistance that affects ovulatory function through hyperinsulinemia?

A

metformin

27
Q

what should you use metformin in combination with for a 90% success rate?

A

clomiphene

28
Q

how long does it take for metformin to show an effect?

A

6 months

29
Q

what are the 2 exogenous gonadotropins?

A
  1. FSH alone
  2. FSH + LH
30
Q

what do the exogenous gonadotropins result in?

A

a transient increase in FSH

31
Q

what are the 4 types of exogenous gonadotropins?

A
  1. human menotropins
  2. urofollitropin
  3. follitropin alfa
  4. follitropin beta
32
Q

HUMAN MENOTROPINS

A

REPONEX

33
Q

UROFOLLITROPIN

A

BREVELLE

34
Q

FOLLITROPIN ALFA

A

GONAL-F

35
Q

FOLLITROPIN BETA

A

FOLLISTIM

36
Q

what is a serious ADR of the gonadotropins?

A

ovarian hyperstimulation syndrome (OHSS)

37
Q

what are 2 risk factors for OHSS?

A
  1. high and repeated doses of exogenous gonadotropins
  2. PCOS
38
Q

what is an increase in dose based on with the gonadotropins?

A

Follicular development

39
Q

what medication is a chemical structure to LH?

A

chorionic gonadotropin

40
Q

when is the chorionic gonadotropin used?

A

after gonadotropins for ovulation induction

41
Q

what should patients not take if they are taking chorionic gonadotropin?

A

pregnancy tests

42
Q

when might the hcg trigger be withheld?

A

due to follicle number or high estradiol concentrations

43
Q

why would the aromatase inhibitors not be used?

A

they can be teratogenic

44
Q

what are the GnRH agonists/antagonists used for?

A
  1. stop the LH surge
  2. improve ovarian response
45
Q

what type of technologies are the GNRHs used?

A

ART or IVF

46
Q

what are the 2 GnRH agonists?

A
  1. leupolide
  2. naferelin
47
Q

what are the 2 GnRH antagonists?

A
  1. cetrorelix
  2. ganirelix
48
Q

which type of GnRH drugs take longer to work?

A

the antagonists

49
Q

what are 2 things that may occur with the use of the GnRH antagonist/agonists?

A
  1. pituitary suppression
  2. inadequate LH concentrations
50
Q

what should be used in addition to the GnRH drugs?

A

luteal support: progesterone (IM or intravaginal)

51
Q

how long can progesterone be used?

A

10-14 days

52
Q

what are 3 things that should be monitored in the gonadotropins?

A
  1. serial ultrasounds
  2. serum estradiol
  3. length of treatment
53
Q

what is the treatment algorithm for the gonadotropins?

A
  1. start doses low
  2. hcg trigger
  3. consider luteal support
  4. monitor for ADRs and response
54
Q

when may patients take birth control?

A

to get to day 0 to start treatment

55
Q

when should hcg be given?

A

24-36 hours before the egg is released

56
Q

when having ART or IVF, what is there an increased risk of? 3

A
  1. gestational diabetes
  2. preclampsia
  3. premature labor and/or delivery
57
Q

what type of patients are candidates for egg freezing?

A

oncology patients

58
Q

what are some abx that may be seen for prevention in surgical procedures?

A
  1. azithromycin
  2. doxycycline

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