Infertility Flashcards
When should home saliva morning testing take place?
Collect saliva in the morning
How does home saliva testing work?
Whats the accuracy?
As estrogen increases theres an increase in NaCl in the mucus secreation
Accuracy: 40-98%
What does home saliva testing set out to prove?
Predicts ovulation
What does Basal body temperature set out to prove?
Confirms ovulation
How does Basal body temperature work?
After ovulation the female body temperature is 0.5 -1.6 F higher than the beginning cyle.
When should Basal body temperature take place?
Whats the accuracy?
BBT should begin “Day 1 “ of the cycle in the morning (do not drink or excercise before reading)
Accuracy: 74%
When should Home urinary LH kits be used?
Use morning urine (most concentrated)
The length of cycle tell you when to begin testing
What does Home urinary LH kits set out to prove?
accuracy?
Predicts ovulation
Accuracy 92%
How does Home urinary LH kit work?
Measures LH surge ( contains monoclonal antibies that bind to the LH in urine)
Which patient population does Home urinary LH kits accuracy decrease for?
PCOS, perimenopause,hyperthyroidism, and endometriosis.
Women: Non pharmacological treatment, whats recommend for diet and exercise?
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
Women: Non pharmacological treatment, whats recommend for surgery?
Laparocopic
- Remove fibroids,polyps, scar tissue, endometrious
- Reconstruction of the tubes
risk:damage to health tissue
Women: pharmacological treatment, whats recommend for ovulation induction?
- Clomiphene citrate
- Insulin sensitizers (metformin)
- Gonadotropines (FSH,LH)
- Human chronionic gonadotroopin (hCG)
- Aromatase inhibitors (Letrozole and anastrozole)
What is the brand name of Clomiphene Citrate?
Clomid
What is the mechanism of action of Clomiphene?
Stimulate FSH production
First line in patients with hormonal issues.
What’s the dose of clomiphene?
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
what are the side effects of clomiphene?
- HOT flashes
2. multiple gestation -5%
what are the contraindications for Clomiphene?
Liver disease
what’s the pregnancy category of Clomiphene?
Category X - make sure they’re not pregnant before next cycle of clomiphene
Why does Clomiphene have low pregnancy rates when used?
Ovulation - 80%
Pregancy - 40%
Ovulation - 80%
Pregnancy - 40%
Low pregnancy rate do to antiestrogenic effects, most preeminent in endometrim (poor curvical mucus)
What patients should use insulin sensitizers (metformin)?
Patients with PCOS (Polycystic ovary syndrome), Ovulation problems (hormone dysfuntion)
Whats the mechanism of action for metformin?
decrese hepatic glucose production
Increase menstrual cyclically
decrease andorgen levels
whats more effective metformin or Clomiphene?
Clomiphene
Can metformin be used in combination with clomiphene?
yes
What is the pregnancy rates in using metformin?
unknown, not enough data
what are the advantages in using metformin?
Cost: cheap
No known effects on the fetus
No need for strict monitoring
Side effects: minimum (GI symptoms)
What is the the mechanism of action of Aromatase inhibitors?
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)
What pregnancy category is Aromatase inhibitors?
Category X
What is the brand name of Letrozole?
Femara
What is the brand name of anastrozole?
Arimidex
what the dosing of Letrozole?
2.5-7.5 mg PO daily for 5 days (on Day 3 to Day 7)
what has better pregnancy rate Letrozole or clomiphene?
Letrozole has better pregnancy rate
what are some SE of aromatase inhibitors?
Vasodilation,HOT Flashes, mood changes, HTN, HA, N/V, Oseteoprosis
What is the indication of aromatase inhibitors?
FDA approved for breast cancer
off label: infertility (most data in patients with PCOS)
List the types of gonadotropins?
Fertinex - High purified FSH
Follistem and Gonal F - Recombinant FSH (common used)
How should gonadotropins be given?
Daily SQ injections
Administration should be under the direct supervision of a reproductive endocrinologist
When are gonadotropins used?
Used in patients who fail metformin and clomiphene
What are the gondotropins?
LH and FSH
Whats the dosing of gonadotropins?
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
What are the SE of gonadotropins?
HA, nausea, abdominal pain, injection site reaction, HOT Flashes, and breast tenderness
multiple pregnancies
OHSS (ovarian hyperstimulation syndrome)***
-Ovarian enlargement
Can Gonadotroins be use in combination with clomiphene or metformin?
YES, but lower does are used when used in combination
What sucks about Gonadotropins?
Cost: $2000-$4000
Time consuming: must be at Doctor q 3 days
Efficacy: 20% pregnancy per cycle
Name the Human chorionic gonadotroins (hCG)?
- Pregnyl
- Noverel
- Profasi
- Ovidrel (recombinant)
When should Human chorionic gonadotroins (hCG) be given?
Given after a certain amount of eggs are matured.
What is the dose of Human chorionic gonadotroins (hCG)?
5000-10,000 units IM x 1 or 250 mcg SQ
Ovulation will occur 24-36 hrs after adminstrationn
how does Human chorionic gonadotroins (hCG) work?
Luteinizing hormone obtained from the urine of pregnant women: stimulate ovulation (LH surge)
What are causes of infertility for woman?
(PCOS-Polycystic ovary syndrome
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
What are causes of infertility for woman?
Endometriosis
Endometriosis;
-Presense of endometrial tissue outside the uterine cavity(usually in the pelvis)
-Causes pelvic pain and infertility
what are Primary cause of infertile in women?
Tubular obstruction (PID,endometriosis,pelvic masses) Ovulation problems (PCOS) Idiopathic
Factors with cause infertile in men?
Age, lifestyle, stress, chronic illness, (alcohol,smoking,
Factors with cause infertile in women?
stress,thyroid disorders, (alcohol,smoking), Hx PID,obesity,diet, age
what are Primary cause of infertile in men?
Idopathic
Obstruction -Varicocele (enlargement of veins in scrotum)
Hormonal deficiency
Diagnosis Work up: Test for women
Laparoscopy
Hysterosalpingography
Transvaginal ultrasound
Ovarian function
Diagnosis Work up: Test for men
Semen analysis
what’s looked at in a Semen analysis
sperm:count, mobility, and motility
what’s looked at in a Ovarian function?
FSH and estradiol
what’s looked at in a Hysterosalpingography?
evaluate tubbal patency
what’s looked at in a Transvaginal ultrasound?
fibroids,polyps,abnormalities of the endometrium, masses
