Infertility Flashcards
Definition of infertility?
inability to conceive after 1 year of trying
Primary vs secondary infertility?
Primary= has never had a kid
When to investigate for infertility?
> 12 months if <35
6 months if >35
When does fertility start to decline?
> 30
What are the three characteristics of PCOS?
hyperandrogegism, ovulatory dysfunction, polycystic ovaries
Potential causes of PCOS?
hyperinsulin= more androgens
genetic
Sx of PCOS?
amenorrhea, hirituism, ance, obese, high T levels
Non pharm for PCOS?
diet and exercise
What route of OC is worse for obese?
patch
1st line for PCOS?
OC- help with androgen sx and regulates menstration
Alternative to 1st line therapy for PCOS?
POP
Metformin= reduces androgens and may restore ovulation cycles
Does POP help with androgen sx?
NO
How long should you try a OC for?
6 months
What other options can you try for hirsutism?
other than OC
spironolactone and finnasteride
What is important if a women is on finasteride?
CONTRACEPTION
1st line for infertility due to anovulation?
Letrozole
MOA of letrozole?
aromatase inhibitor= high E= stem follicles
Dosing of letrozole?
2.5 mg for 5 days on day 3-7 or 5-9 of cycle
s/e of letrozole?
hotflash, tired, nausea, multiple births
CI of letrozole?
PREGNANCY
How does clomiphene work?
SERM= more FSH
S/e of clomiphene?
hot flashes, gi, vision issues
When can you expect ovulation if taking letrozole or clomiphene?
5-10 days after last dose
Which is more effective, letrozole or clomiphene?
letrozole
How long does it take to replenish ejaculate?
1-2 days
optimal timing for sex?
4-5 days before ovulation and every 24-48 hours
Letrozole and clomiphene are inferior to what drugs?
gonadotropin drugs
What his luteal phase defect?
low P so no implantation
How do we treat luteal phase defect?
P duh
How can we improve fertility if endometriosis or PID?
IVF or ovarian stimulation
How much of a temperature increase when ovulation?
0.2-0.5
When to take BBT?
right when you wake up
How do ovulation prediction tests work?
detect LH surge in pee
When is a woman’s most fertile period?
14 days before menses
What is used in ovulation induction?
Letrozole or clomiphene
What is super ovulation and what is it often combined with?
stimulate with hormones to get a bunch of eggs
combined with IUI
What is the process of IUI?
checked for quality then put in
What is ICSI?
injecting sperm into egg
When is ICSI used?
when sperm is the issue
Why are patients on COC for a bit before IVF?
to control when the start of cycle happens
What are the stages of IVF?
ovary stim
egg retrive
retrieve sperm
fertilization
transfer
How long does ovarian stimulation in IVF last for and what drugs used?
8-14 days
follitropin
Where do we get the hormones for IVF?
urine of pregnant or post menopausal
or recombinant
If using urine as a source for hormones what do you get?
ALWAYS get LH and FSH
Why in ovarian stimulation do we use GNRH agonists/antagonists to prevent premature ovulation?
Do get multiple eggs retrived
GNRH antagonist drugs?
“relix”
GNRH agonists?
‘relin’
leuprolide
Why would we want GNRH antagonists over agonists to prevent premature ovulation?
agonists= flare up= surge of hormones first
antagonists work faster and don’t have flare
What is a risk when stiming the ovaries?
hyperstim syndrome= very painful
What is goal for egg retrieval that has the least risk of hyperstim syndrome?
<15
In the step for egg retrieval why do we need an HCG trigger shot?
quickly mature eggs
If needing a trigger shot what must we counsel on?
WILL cause false positive pregnancy test
When does egg retrieval happen after trigger shot?
34-36 hours TIGHT WINDOW
What is also given during egg retrieval?
progesterone to support pregnancy
How long to get fertilization after introducing sperm in IVF?
<1 day
After fertilization what is done with embryos?
assess and incubate for 24 hours
How many embryos are transferred?
1-2
When is it considered an embryo transfer vs a blastocyte?
day 2/3= embryo
day 5= blastocyte
S/e of medications used in IVF?
headache, mood change, hot flash, bloat. nausea
Success rate of IVF?
60-70%
Why cryofreeze embryos?
better success= let body reset hormones
