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BPH P&T > Infertility > Flashcards

Infertility Flashcards

1
Q

When should home saliva morning testing take place?

A

Collect saliva in the morning

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2
Q

How does home saliva testing work?

Whats the accuracy?

A

As estrogen increases theres an increase in NaCl in the mucus secreation

Accuracy: 40-98%

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3
Q

What does home saliva testing set out to prove?

A

Predicts ovulation

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4
Q

What does Basal body temperature set out to prove?

A

Confirms ovulation

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5
Q

How does Basal body temperature work?

A

After ovulation the female body temperature is 0.5 -1.6 F higher than the beginning cyle.

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6
Q

When should Basal body temperature take place?

Whats the accuracy?

A

BBT should begin “Day 1 “ of the cycle in the morning (do not drink or excercise before reading)

Accuracy: 74%

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7
Q

When should Home urinary LH kits be used?

A

Use morning urine (most concentrated)

The length of cycle tell you when to begin testing

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8
Q

What does Home urinary LH kits set out to prove?

accuracy?

A

Predicts ovulation

Accuracy 92%

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9
Q

How does Home urinary LH kit work?

A

Measures LH surge ( contains monoclonal antibies that bind to the LH in urine)

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10
Q

Which patient population does Home urinary LH kits accuracy decrease for?

A

PCOS, perimenopause,hyperthyroidism, and endometriosis.

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11
Q

Women: Non pharmacological treatment, whats recommend for diet and exercise?

A

5% decrease in weight may restore ovulation

5% decrease in weight my decrease androgen level in patients with PCOS

Diet and exercise is better that pharmacy treatment for overweight/obese patients with hormone deficiecies

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12
Q

Women: Non pharmacological treatment, whats recommend for surgery?

A

Laparocopic

  • Remove fibroids,polyps, scar tissue, endometrious
  • Reconstruction of the tubes

risk:damage to health tissue

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13
Q

Women: pharmacological treatment, whats recommend for ovulation induction?

A
  1. Clomiphene citrate
  2. Insulin sensitizers (metformin)
  3. Gonadotropines (FSH,LH)
  4. Human chronionic gonadotroopin (hCG)
  5. Aromatase inhibitors (Letrozole and anastrozole)
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14
Q

What is the brand name of Clomiphene Citrate?

A

Clomid

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15
Q

What is the mechanism of action of Clomiphene?

A

Stimulate FSH production

First line in patients with hormonal issues.

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16
Q

What’s the dose of clomiphene?

A

25-50mg/daily for 5 days ( start on Day 3 or Day 5 of cycle)

Monitor if ovulation occurs, if it does not occur, increase the does by 50mg/daily,

Max: 150-200mg/daily

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17
Q

what are the side effects of clomiphene?

A
  1. HOT flashes

2. multiple gestation -5%

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18
Q

what are the contraindications for Clomiphene?

A

Liver disease

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19
Q

what’s the pregnancy category of Clomiphene?

A

Category X - make sure they’re not pregnant before next cycle of clomiphene

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20
Q

Why does Clomiphene have low pregnancy rates when used?

Ovulation - 80%
Pregancy - 40%

A

Ovulation - 80%
Pregnancy - 40%

Low pregnancy rate do to antiestrogenic effects, most preeminent in endometrim (poor curvical mucus)

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21
Q

What patients should use insulin sensitizers (metformin)?

A

Patients with PCOS (Polycystic ovary syndrome), Ovulation problems (hormone dysfuntion)

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22
Q

Whats the mechanism of action for metformin?

A

decrese hepatic glucose production

Increase menstrual cyclically

decrease andorgen levels

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23
Q

whats more effective metformin or Clomiphene?

A

Clomiphene

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24
Q

Can metformin be used in combination with clomiphene?

A

yes

25
Q

What is the pregnancy rates in using metformin?

A

unknown, not enough data

26
Q

what are the advantages in using metformin?

A

Cost: cheap

No known effects on the fetus

No need for strict monitoring

Side effects: minimum (GI symptoms)

27
Q

What is the the mechanism of action of Aromatase inhibitors?

A

Aromatase is an enzyme that converts androgens (testosterone and androstendione) to estradiol and estrone.

MOA: reduce estradiol level and therefore increase pituitary gonadroropin output (FSH)

28
Q

What pregnancy category is Aromatase inhibitors?

A

Category X

29
Q

What is the brand name of Letrozole?

A

Femara

30
Q

What is the brand name of anastrozole?

A

Arimidex

31
Q

what the dosing of Letrozole?

A

2.5-7.5 mg PO daily for 5 days (on Day 3 to Day 7)

32
Q

what has better pregnancy rate Letrozole or clomiphene?

A

Letrozole has better pregnancy rate

33
Q

what are some SE of aromatase inhibitors?

A

Vasodilation,HOT Flashes, mood changes, HTN, HA, N/V, Oseteoprosis

34
Q

What is the indication of aromatase inhibitors?

A

FDA approved for breast cancer

off label: infertility (most data in patients with PCOS)

35
Q

List the types of gonadotropins?

A

Fertinex - High purified FSH

Follistem and Gonal F - Recombinant FSH (common used)

36
Q

How should gonadotropins be given?

A

Daily SQ injections

Administration should be under the direct supervision of a reproductive endocrinologist

37
Q

When are gonadotropins used?

A

Used in patients who fail metformin and clomiphene

38
Q

What are the gondotropins?

A

LH and FSH

39
Q

Whats the dosing of gonadotropins?

A

lowest effective dose should be identified to avoid multiple follicular development (based on weight and AGE)

-Start on DAY 2 or Day 3 of cycle and continue for 12-14 days

Duration of treatment- Every 3 days

40
Q

What are the SE of gonadotropins?

A

HA, nausea, abdominal pain, injection site reaction, HOT Flashes, and breast tenderness

multiple pregnancies

OHSS (ovarian hyperstimulation syndrome)***
-Ovarian enlargement

41
Q

Can Gonadotroins be use in combination with clomiphene or metformin?

A

YES, but lower does are used when used in combination

42
Q

What sucks about Gonadotropins?

A

Cost: $2000-$4000
Time consuming: must be at Doctor q 3 days
Efficacy: 20% pregnancy per cycle

43
Q

Name the Human chorionic gonadotroins (hCG)?

A
  1. Pregnyl
  2. Noverel
  3. Profasi
  4. Ovidrel (recombinant)
44
Q

When should Human chorionic gonadotroins (hCG) be given?

A

Given after a certain amount of eggs are matured.

45
Q

What is the dose of Human chorionic gonadotroins (hCG)?

A

5000-10,000 units IM x 1 or 250 mcg SQ

Ovulation will occur 24-36 hrs after adminstrationn

46
Q

how does Human chorionic gonadotroins (hCG) work?

A

Luteinizing hormone obtained from the urine of pregnant women: stimulate ovulation (LH surge)

47
Q

What are causes of infertility for woman?

(PCOS-Polycystic ovary syndrome

A

PCOS: inappropratite secretion of gonadotropins

  • Decrease in FSH
  • Premature LH surge
  • Increase in androgen
  • decrease in insulin action or secretion

Amenorrhea or oligomenorreha

Decrease feretility

48
Q

What are causes of infertility for woman?

Endometriosis

A

Endometriosis;
-Presense of endometrial tissue outside the uterine cavity(usually in the pelvis)

-Causes pelvic pain and infertility

49
Q

what are Primary cause of infertile in women?

A 
Tubular obstruction (PID,endometriosis,pelvic masses)
Ovulation problems (PCOS)
Idiopathic
50
Q

Factors with cause infertile in men?

A

Age, lifestyle, stress, chronic illness, (alcohol,smoking,

51
Q

Factors with cause infertile in women?

A

stress,thyroid disorders, (alcohol,smoking), Hx PID,obesity,diet, age

52
Q

what are Primary cause of infertile in men?

A

Idopathic
Obstruction -Varicocele (enlargement of veins in scrotum)
Hormonal deficiency

53
Q

Diagnosis Work up: Test for women

A

Laparoscopy

Hysterosalpingography

Transvaginal ultrasound

Ovarian function

54
Q

Diagnosis Work up: Test for men

A

Semen analysis

55
Q

what’s looked at in a Semen analysis

A

sperm:count, mobility, and motility

56
Q

what’s looked at in a Ovarian function?

A

FSH and estradiol

57
Q

what’s looked at in a Hysterosalpingography?

A

evaluate tubbal patency

58
Q

what’s looked at in a Transvaginal ultrasound?

A

fibroids,polyps,abnormalities of the endometrium, masses

BPH P&T (8 decks)

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