Infertility

Question 1

Definition of infertility?

Answer 1

inability to conceive after 1 year of trying

Question 2

Primary vs secondary infertility?

Answer 2

Primary= has never had a kid

Question 3

When to investigate for infertility?

Answer 3

> 12 months if <35
6 months if >35

Question 4

When does fertility start to decline?

Answer 4

> 30

Question 5

What are the three characteristics of PCOS?

Answer 5

hyperandrogegism, ovulatory dysfunction, polycystic ovaries

Question 6

Potential causes of PCOS?

Answer 6

hyperinsulin= more androgens
genetic

Question 7

Sx of PCOS?

Answer 7

amenorrhea, hirituism, ance, obese, high T levels

Question 8

Non pharm for PCOS?

Answer 8

diet and exercise

Question 9

What route of OC is worse for obese?

Answer 9

patch

Question 10

1st line for PCOS?

Answer 10

OC- help with androgen sx and regulates menstration

Question 11

Alternative to 1st line therapy for PCOS?

Answer 11

POP
Metformin= reduces androgens and may restore ovulation cycles

Question 12

Does POP help with androgen sx?

Answer 12

NO

Question 13

How long should you try a OC for?

Answer 13

6 months

Question 14

What other options can you try for hirsutism?

Answer 14

other than OC
spironolactone and finnasteride

Question 15

What is important if a women is on finasteride?

Answer 15

CONTRACEPTION

Question 16

1st line for infertility due to anovulation?

Answer 16

Letrozole

Question 17

MOA of letrozole?

Answer 17

aromatase inhibitor= high E= stem follicles

Question 18

Dosing of letrozole?

Answer 18

2.5 mg for 5 days on day 3-7 or 5-9 of cycle

Question 19

s/e of letrozole?

Answer 19

hotflash, tired, nausea, multiple births

Question 20

CI of letrozole?

Answer 20

PREGNANCY

Question 21

How does clomiphene work?

Answer 21

SERM= more FSH

Question 22

S/e of clomiphene?

Answer 22

hot flashes, gi, vision issues

Question 23

When can you expect ovulation if taking letrozole or clomiphene?

Answer 23

5-10 days after last dose

Question 24

Which is more effective, letrozole or clomiphene?

Answer 24

letrozole

Question 25

How long does it take to replenish ejaculate?

Answer 25

1-2 days

Question 26

optimal timing for sex?

Answer 26

4-5 days before ovulation and every 24-48 hours

Question 27

Letrozole and clomiphene are inferior to what drugs?

Answer 27

gonadotropin drugs

Question 28

What his luteal phase defect?

Answer 28

low P so no implantation

Question 29

How do we treat luteal phase defect?

Answer 29

P duh

Question 30

How can we improve fertility if endometriosis or PID?

Answer 30

IVF or ovarian stimulation

Question 31

How much of a temperature increase when ovulation?

Answer 31

0.2-0.5

Question 32

When to take BBT?

Answer 32

right when you wake up

Question 33

How do ovulation prediction tests work?

Answer 33

detect LH surge in pee

Question 34

When is a woman's most fertile period?

Answer 34

14 days before menses

Question 35

What is used in ovulation induction?

Answer 35

Letrozole or clomiphene

Question 36

What is super ovulation and what is it often combined with?

Answer 36

stimulate with hormones to get a bunch of eggs combined with IUI

Question 37

What is the process of IUI?

Answer 37

checked for quality then put in

Question 38

What is ICSI?

Answer 38

injecting sperm into egg

Question 39

When is ICSI used?

Answer 39

when sperm is the issue

Question 40

Why are patients on COC for a bit before IVF?

Answer 40

to control when the start of cycle happens

Question 41

What are the stages of IVF?

Answer 41

ovary stim egg retrive retrieve sperm fertilization transfer

Question 42

How long does ovarian stimulation in IVF last for and what drugs used?

Answer 42

8-14 days follitropin

Question 43

Where do we get the hormones for IVF?

Answer 43

urine of pregnant or post menopausal or recombinant

Question 44

If using urine as a source for hormones what do you get?

Answer 44

ALWAYS get LH and FSH

Question 45

Why in ovarian stimulation do we use GNRH agonists/antagonists to prevent premature ovulation?

Answer 45

Do get multiple eggs retrived

Question 46

GNRH antagonist drugs?

Answer 46

"relix"

Question 47

GNRH agonists?

Answer 47

'relin' leuprolide

Question 48

Why would we want GNRH antagonists over agonists to prevent premature ovulation?

Answer 48

agonists= flare up= surge of hormones first antagonists work faster and don't have flare

Question 49

What is a risk when stiming the ovaries?

Answer 49

hyperstim syndrome= very painful

Question 50

What is goal for egg retrieval that has the least risk of hyperstim syndrome?

Answer 50

<15

Question 51

In the step for egg retrieval why do we need an HCG trigger shot?

Answer 51

quickly mature eggs

Question 52

If needing a trigger shot what must we counsel on?

Answer 52

WILL cause false positive pregnancy test

Question 53

When does egg retrieval happen after trigger shot?

Answer 53

34-36 hours TIGHT WINDOW

Question 54

What is also given during egg retrieval?

Answer 54

progesterone to support pregnancy

Question 55

How long to get fertilization after introducing sperm in IVF?

Answer 55

<1 day

Question 56

After fertilization what is done with embryos?

Answer 56

assess and incubate for 24 hours

Question 57

How many embryos are transferred?

Answer 57

1-2

Question 58

When is it considered an embryo transfer vs a blastocyte?

Answer 58

day 2/3= embryo day 5= blastocyte

Question 59

S/e of medications used in IVF?

Answer 59

headache, mood change, hot flash, bloat. nausea

Question 60

Success rate of IVF?

Answer 60

60-70%

Question 61

Why cryofreeze embryos?

Answer 61

better success= let body reset hormones