Infertility Flashcards
How is infertility defined?
Failure to achieve pregnancy after 1 year of regular, unprotected intercourse (2x/week)
In women being worked up for infertility…..
What should the be supplemented with?
Folic Acid
Other than folic acid……
What Interventions should women take to increase chance of pregnancy?
- Glycemic Control (especially in DM)
- Abstience from alcohol
- Weight Reduction
- Smoking Cessation
- Avoid teratogens
What is the cornerstone of infertility work up in males?
Semen Analysis
***Abstinence for 2-7 days
How soon after collection does a semen analysis need to be evaluated?
Within 1 hour
What is a normal sperm count?
> 15 million per mL
If a male has a low sperm count…..
What should be included in their lab work up?
FSH Total Testosterone Free Testosterone LH Prolactin
Less than __% of male factor infertility can be overcome with management?
Less than 10%
T/F: Infertility due to varicocele typically responds to surgical management
True
A 31 year old infertile woman has menses every 45-120 days and reports excessive facial hair and acne. Her husband has a normal semen analysis.
What is her most likely diagnosis?
PCOS
A 31 year old infertile woman has menses every 45-120 days and reports excessive facial hair and acne. Her husband has a normal semen analysis.
What ‘factor’ is the likely cause of her infertility?
Ovarian Factor –> Ovulatory Dysfunction
A 31 year old infertile woman has menses every 45-120 days and reports excessive facial hair and acne. Her husband has a normal semen analysis. She is eventually diagnosed with PCOS.
What medication would most likely lead to pregnancy in this patient?
Clomiphene citrate—E antagonist
(Increases the secretion of FSH and LH by the pituitary leading to the development of one or more dominant follicles)
BONUS: Metformin is second line to decrease insulin levels which has been shown to promote ovulation and contraception
Ovarian factor is responsible for __% of infertility in women
40%
What is the first step in managing ovarian factor infertility in females?
Manage Com-morbidities first
What are some adverse effects of Clomiphene Citrate?
Vasomotor Symptoms (due to being estrogen antagonist) Visual Changes
T/F: There is an associated risk of ovarian cancer with Clomiphene Citrate
False
There is not a risk of ovarian cancer
What are the most common side effects of metformin?
GI Upest (N/V/D)
***Monitor for hepatotoxicity
What is the name of the aromatase inhibitor used in infertility?
Letrozole
What are the most common side effects of Letrozole?
Fatigue
Dizziness
T/F: Letrozole is potentially teratogenic
True
What are concerning ‘side effect’ of giving exogenous gonadotropins (FSH +/- LH) for infertility?
Ovarian Hyperstimulation Syndrome
Multifetal Gestation
What is the surgical approach to pituitary adenoma removal?
Transphenoidal
***This is commonly done when a women is pregnant to d/c dopamine agonist medication
