Infertility Flashcards
Risk Factors of Infertility
-age
-tobacco use
-weight (BMI >35 & <19)
-alcohol/caffeine/weed use
What medications can be taken for inferility?
-clomiphene citrate
-letrozole, anastrozole
-gonadotropins
-GnRH agonist or antagonists
-hcG
-supportive medications
MOA: Clomiphene Citrate
SERM, increases FSH and LH
What is the first line treatment for infertility due to PCOS?
clomiphene citrate or letrozole
Dosing: Clomiphene Citrate
administer 50 mg on day 2-5 days of menses x5 days
Adverse Effects: Clomiphene Citrate
-hot flashes
-breast discomfort
-abdominal pain
-N/V
-mood changes
-multiple gestations
-small risk of ovarian hyperstimulation syndrome (OHSS)
Which drugs for infertility are aromatase inhibitors?
letrozole and anastrozole
MOA: aromatase inhibitors
reduce circulating estrogen, increase FSH so a single dominant follicle can develop
Adverse Effects: aromatase inhibitors
-flushing, sweating
-headache
-nausea
-multiple gestations
-arthralgia
-small risk of OHSS
MOA: Exogenous Gonadotropins (FSH and LH)
stimulate ovarian growth and maturation
What is also prescribed with prescribed gonadotropins?
progestrone for luteal support or induce menses
Adverse Effects: Gonadotropins
-headache
-ovarian cyst/pain
-abdominal cramps
-OVARIAN HYPERSTIMULATION SYNDROME
-MULTIPLE GESTATIONS
Describe: Leuprolide
gonadotropin releasing hormone (GnRH) agonist
can be used to suppress natural cycle or lower doses can encourage FSH or LH production
-higher risk of OHSS
Describe: Cetrorelix and Ganirelix
GnRH antagonist
-suppress FSH and LH production early to late in follicular phase until hCG is given
Describe: Chorionic gonadotropin (Ovidrel, Pregnyl, Novarel)
recombinant/human hCG, structurally similar to LH to trigger ovulation, but hCG can be positive in blood for days after injection (be sure to warn pt of false positive pregnancy tests)
Describe: Ovarian Hyperstimulation
may occur when taking exogenous gonadotropin or high doses of hCG that can lead to illness or death (young women more at risk)
How can Ovarian Hyperstimulation be managed?
intake at least 1L of fluid/daily, antiemetics and analgesics
What are the symptoms of OHSS?
-weight gain >2.25kg within 24 h
-abdominal or pelvic pain
-N/V, diarrhea
-dyspnea, dizziness
-oliguria
What may also be prescribed to women with PCOS with clomiphene citrate?
metformin for women with PCOS and insulin resistance (50-70% of women with PCOS do)- dosing same as diabetes (500mg initially, titrate up to 1000 mg BID)
What is the use of aspirin in infertility pharmaceutical management?
may reduce risk of OHSS but limited data to show benefit
What are the monitoring parameters for infertility?
-detect ovulation (ovulation prediction kits, pelvic exam, lab tests (estradiol, LH, FSH, progesterone)
-monitor for OHSS
-adverse effects
