Infertility

Question 1

Risk Factors of Infertility

Answer 1

-age
-tobacco use
-weight (BMI >35 & <19)
-alcohol/caffeine/weed use

Question 2

What medications can be taken for inferility?

Answer 2

-clomiphene citrate
-letrozole, anastrozole
-gonadotropins
-GnRH agonist or antagonists
-hcG
-supportive medications

Question 3

MOA: Clomiphene Citrate

Answer 3

SERM, increases FSH and LH

Question 4

What is the first line treatment for infertility due to PCOS?

Answer 4

clomiphene citrate or letrozole

Question 5

Dosing: Clomiphene Citrate

Answer 5

administer 50 mg on day 2-5 days of menses x5 days

Question 6

Adverse Effects: Clomiphene Citrate

Answer 6

-hot flashes
-breast discomfort
-abdominal pain
-N/V
-mood changes
-multiple gestations
-small risk of ovarian hyperstimulation syndrome (OHSS)

Question 7

Which drugs for infertility are aromatase inhibitors?

Answer 7

letrozole and anastrozole

Question 8

MOA: aromatase inhibitors

Answer 8

reduce circulating estrogen, increase FSH so a single dominant follicle can develop

Question 9

Adverse Effects: aromatase inhibitors

Answer 9

-flushing, sweating
-headache
-nausea
-multiple gestations
-arthralgia
-small risk of OHSS

Question 10

MOA: Exogenous Gonadotropins (FSH and LH)

Answer 10

stimulate ovarian growth and maturation

Question 11

What is also prescribed with prescribed gonadotropins?

Answer 11

progestrone for luteal support or induce menses

Question 12

Adverse Effects: Gonadotropins

Answer 12

-headache
-ovarian cyst/pain
-abdominal cramps
-OVARIAN HYPERSTIMULATION SYNDROME
-MULTIPLE GESTATIONS

Question 13

Describe: Leuprolide

Answer 13

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

Question 14

Describe: Cetrorelix and Ganirelix

Answer 14

GnRH antagonist
-suppress FSH and LH production early to late in follicular phase until hCG is given

Question 15

Describe: Chorionic gonadotropin (Ovidrel, Pregnyl, Novarel)

Answer 15

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)

Question 16

Describe: Ovarian Hyperstimulation

Answer 16

may occur when taking exogenous gonadotropin or high doses of hCG that can lead to illness or death (young women more at risk)

Question 17

How can Ovarian Hyperstimulation be managed?

Answer 17

intake at least 1L of fluid/daily, antiemetics and analgesics

Question 18

What are the symptoms of OHSS?

Answer 18

-weight gain >2.25kg within 24 h
-abdominal or pelvic pain
-N/V, diarrhea
-dyspnea, dizziness
-oliguria

Question 19

What may also be prescribed to women with PCOS with clomiphene citrate?

Answer 19

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)

Question 20

What is the use of aspirin in infertility pharmaceutical management?

Answer 20

may reduce risk of OHSS but limited data to show benefit

Question 21

What are the monitoring parameters for infertility?

Answer 21

-detect ovulation (ovulation prediction kits, pelvic exam, lab tests (estradiol, LH, FSH, progesterone)
-monitor for OHSS
-adverse effects