infertility treatment

Question 1

ICSI

Answer 1

Intracytoplasmic Sperm Injection (ICSI): Injection of a single sperm into a single oocyte retrieved during IVF

Question 2

PCOS treatment

Answer 2

1) weight loss is first line treatment
lowers androgens, glucose and lipids
Improves menses and pregnancy
2) First drug of choice: Clomiphene Citrate (CC) or Letrozole

3) if not responsive to CC, consider: Addition of Metformin, switching to Letrozole, ovarian drilling, gonadotropin injections or IVF

Question 3

Clomiphene Citrate

Answer 3

a SERM (Selective Estrogen Receptor Modulator)

Competes with estrogen receptors reducing central estrogen negative feedback; stimulates pituitary gonadotropin release

o Side effects = Hot flashes, Moods, Headache, Blurred vision, Scotomata (1%) –> Stop medication,

Question 4

Letrozole

Answer 4

Aromatase Inhibitor
o Inhibit conversion of androgens to estrogens;

induce ovulation or treat ER+ breast cancer

Question 5

two uses of aromatase inhibitors

Answer 5

induce ovulation or treat ER+ breast cancer

inhibits conversion of androgens to estrogens (releasing hypothalamus from estrogen - feedback)

Question 6

• Metformin

Answer 6

Biguanide anti-hyperglycemic agent
o Can increase ovulation rates

o May help with weight loss, decrease blood pressure and cholesterol (thereby reducing risks of metabolic syndrome)
o Side effects: GI disturbances

Question 7

recombinant gonadotropins

Answer 7

recombinant LH and FSH
Act directly on ovary to stimulate follicular development

use to rescue follicular atresia (due to high levels of FSH )

Question 8

COH

Answer 8

controlled ovarian hyperstimulation

timed intercourse

Question 9

intrauterine synechiae

Answer 9

ashermans syndrome = uterine scarring
due to D&C usually –> defective regeneration

can cause infertility

Question 10

standard recommendation to treat unexplained fertility

Answer 10

3-6 months of CC/IUI, then proceed with IVF

Question 11

at what size do you consider removing intramural uterine fibroid (when it starts decreasing pregnancy rate)?

Answer 11

> 4cm

Question 12

o Hypogonadotropic Hypogonadal Anovulation

Answer 12

Inadequate central gonadotropin function

CC doesnt work; requires gonadotropin injections (esp. Kallman’s patients)

Question 13

o Eugonadotropic Euestrogenic Anovulation

Answer 13

Classically PCOS
o Require 2 of the following 3 for diagnosis
1 Oligomenorrhea (fewer than 9 cycles/year)
2 Evidence of high androgens
3 Ultrasound evidence of polycystic ovaries
–12 or more antral follicles (2-9mm) OR
–Ovarian volume >7-7.5mL