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Endo yr 2 > infertility treatments > Flashcards

infertility treatments Flashcards

1
Q

what is another term for HYPOGONADOTROPHIC hypogonadism and what does it mean

A

secondary hypogonadism,deficiency of gonadotrophins (LH/FSH

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2
Q

what is the role of gonadotrophins

A

induce spermatogenesis

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3
Q

what does LH do in men

A

stimulated leydig cells to increase intratesticular testosterone levels

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4
Q

how much greater are test levels in testes vs blood?

A

x100

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5
Q

what does fsh do in men

A

stimulates semininferous tubule (tubule inside testes) development and spermatogenesis

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6
Q

symptoms of man with low testosterone

A

low libido, less shaving, less strong/ energetic, loss of morning erections

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7
Q

how to confirm low testosterone

A

2 early morninng fasting measurments
then investigate cause of low test

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8
Q

Testosterone Replacement options

A

Daily Gel. Care not to contaminate partner.
3 weekly intramuscular injection
3 monthly intramuscular injection
Less Common (Implants, oral preparations)

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9
Q

2 risks associated with givinf tesotsterone replacement

A

Increased Haematocrit (stimulates your blood count) (risk of hyperviscosity and stroke)
Prostate (Prostate Specific Antigen (PSA) levels) (complicated topic- if someone has prostate cancer you don t want to give testosterone )

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10
Q

what do you give to man who wants to restore fertility?

A

HCG injections (which act on LH-receptors (stimulates them))
If no response after 6 months, then add FSH injections

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11
Q

why shouldnt you give testosterone to men suffering from infertility?

A

Giving testosterone treatment could further reduce LH / FSH and worsen spermatogenesis!

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12
Q

what are some types of clinical hyperandrogenism?

A

acne or hirsutism (a lot of hair)

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13
Q

symptoms of PCOS

A

Hyperandrogenism
(Clinical or Biochemical)

pco morphology in ovary ultrasound

irregular periods

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14
Q

is acne and irregular periods enough to diagnose pcos?

A

yes you only need 2 symptoms to diagnose

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15
Q

what are the signs associated with hypothalamic amenorrhoea

A

low body weight
stress
excessive exercise
genetic susceptibility

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16
Q

what is the first line treatment in PCOS and HYpothalamic amenorrhoea?

A

lifestyle changes and weight loss by 5%, / weight gain and reduced exercise equivalently

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17
Q

list of drug treatment in PCOS after lifestyle changes in priority order

A

1) metformin
2) letrozole (aromatase inhibitor)
3) clomiphene (oestradiol receptor modulator)
4) FSH stimulation (injection)

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18
Q

risk of FSH stimulation (injection)= ovulation induciton and why it can be dangerous

A

hyperstimulation, getting more than one follicle developing, and a multiple pregnancy has risks for mother and baby during pregnancy

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19
Q

drugs for restoring ovulation in hypothalamic amenorrhoea

A

1) pulsatile GnRH pump
2. FSH stimulation
3. letrozole
4. clomiphene

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20
Q

what is the aim/ mehtod of ovulation induction

A

FSH stimulation/ injection: mehtod,
the aim is to cause a small increase in FSH in order to develop only ONE ovarian follicle

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21
Q

What is the chance of conception over 1 and 2 years without Contraception?

A

85%
92%

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22
Q

did IVF become more or less common since 1990

A

more

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23
Q

what is the first step of IVF

A

oocyte retrieval

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24
Q

what is the second step of IVF and how exactly is it done?

A

fertilisation in vitro by intra-cytoplasmic sperm injection

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25
Q

third and fourth step of IVF

A

embryo incubation and embryo transfer

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26
Q

What is the chance of conception over 1 year with fertility awareness / withdrawal?

(Fertility awareness: not having sex when fertile
Withdrawal: pulling out)

A

25%

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27
Q

WHAT PERCENTAGE OF pregnancies are unplanned

A

19-30%

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28
Q

what are the 5 mehtods of reversible contraception

A

Barrier: male / female condom / diaphragm or cap with spermicide
Combined Oral Contraceptive Pill (OCP)
Progestogen-only Pill (POP)
Long Acting Reversible Contraception (LARC)
Emergency Contraception

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29
Q

2 methods of permanent contraception

A

Vasectomy
Female sterilisation

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30
Q

positives of condoms

A

Protect against STI’s
Easy to obtain – free from clinics
/ No need to see a healthcare professional
No contra-indications as with some hormonal methods

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31
Q

negatives of condoms

A

Can interrupt sex
Can reduce sensation
Can interfere with erections
Some skill to use eg correct fit.
Two are not better than one

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32
Q

mechanism of action of combined OCP

A

1) contains oestrogen and progesterone
2) neg feedback to gnRH neurons in hypothalamus AND gonadotrophs in pit gland
3) decreased LH FSH release

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33
Q

how does the reduced LH and FSH from OCP prevent you from getting pregnant?

A

1) anovulation
2) thickening of cervical mucus
3) thinning of endometrial llining to reduce implantation

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34
Q

lifestyle related positives of OCP

A

Easy to take – one pill a day (any time of day)

Doesn’t interrupt sex

avoid withdrawal bleeds

Weight Neutral in 80%
(10% gain, 10% lose)

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35
Q

other positives of cop (dose and biochem related)

A

effective

Can take several packets back to back

Reduce Endometrial and Ovarian Cancer

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36
Q

negatives of OCP

A

It can be difficult to remember
No protection against STIs
P450 Enzyme Inducers may reduce efficacy because its metabolised in the liver
Not the best choice during breast feeding

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37
Q

cons of ocp

A

It can be difficult to remember
No protection against STIs
P450 Enzyme Inducers may reduce efficacy because its metabolised in the liver
Not the best choice during breast feeding

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38
Q

possible side effects of pop and ocp

A

Spotting (bleeding in between periods)
Nausea
Sore breasts
Changes in mood or libido
Feeling more hungry
(try different OCPs to see which suits best)

39
Q

are all OCPs the same on everyone?

A

no, you can try different OCPs to see which suits best)

40
Q

Extremely rare side effects od OCPs and whos more likely to have it

A

Blood clots in the legs or lungs (2 in 10,000)
more in women with incr BMI

41
Q

what is painful periods medical term

A

dysmenorrhoea

42
Q

what is heavy periods medical term

A

menorrhagia

43
Q

non contraceptive uses of OCP

A

1) MAKING PERIODS LESS PAINFUL - enodmetriosis
Dysmenorrhoea (painful periods)
Menorrhagia (heavy periods)

  1. Regular Withdrawal Bleeds / or no Bleeds
  2. PCOS: OCP can helps reduce LH and hyperandrogenism (acne / hirsutism
44
Q

what is the purpose of withdrawal bleeds

A

The purpose of this withdrawal bleed is largely for user comfort and to help people feel more connected to their natural menstrual cycle, even though they are not experiencing true menstruation while using hormonal contraception.

45
Q

what are the diff of POP to OCP and what is their significance/ consequence

A
  • pop contains only progesterone so is used when oestrogen cant be fiven
  • same mechanism of action as ocp but less reliable at stopping ovulation
    -CAN be used when breastfeeding
46
Q

unique negatives of pop

A

shorter acting needs to be taken at same time each day

47
Q

2 types of long acting reversible contraceptives

A

1) coils
2) progestrogen- only: a) injectable contraceptives or b) subdermal implants

48
Q

benefits of coils

A

Suitable for most women

Prevent implantation of conceptus – important for some religions

Can be used as emergency contraception

49
Q

rare risk of coils

A

ectopic preg

50
Q

2 types of coils

A

1) Intra-Uterine Device (IUD) ie Copper Coil-

2) Intra-Uterine Systems (IUS)which secretes progesterone (eg Mirena Coil)

51
Q

Intra-Uterine Systems (IUS)mechanism and how long it lasts

A

thin lining of the womb and thicken cervical mucus (5 yrs)

52
Q

other function of Intra-Uterine Systems (IUS)mechanism

A

can be used to help with heavy bleeding

53
Q

copper coil mech and how long it lasts

A

mechanically prevent implantation, decrease sperm / egg survival. Lasts 5-10yrs.

54
Q

risks/ negatives of copper coil

A

Can cause heavy periods,

5% can come out especially during first 3months with periods

55
Q

most effective form of emergency contraception and how quickly it needs to be done

A

Copper intrauterine device (IUD) most effective
can be fitted up to 5 days after unprotected sex (<1% chance of pregnancy)

56
Q

2 types of emergency contraceptive pills, which is most effective in which group of people particularly

A

Ulipristal acetate 30mg (ellaOne). Levonorgestrel 1.5mg (Levonelle) less effective (esp if incr BMI >27 kg/m2)

57
Q

Ulipristal acetate 30mg (ellaOne) mechanism
and how quickly it needs to be taken

A

Ulipristal acetate stops progesterone working normally and prevents ovulation.
Must be taken within 5 days of unprotected intercourse

58
Q

when might ulipristal acetate 30 mg not work taking into consideration its mechanism?

A

1-2% can get pregnant if ovulation has already occurred.

59
Q

Levonorgestrel 1.5mg (Levonelle) mechanism and when u need to take it and failure rate

A

Synthetic Progesterone prevents ovulation (don’t cause abortion).
Must be taken within 3 days of unprotected intercourse. 1-3% failure rate.

60
Q

does it matter if you take these pills earlier or later in the suggested time?

A

yes, earlier better

61
Q

Side effects of morning after pills

A

headache, abdominal pain, nausea.

62
Q

what can make the morning after pills less or not effective?

A

Liver P450 Enzyme inducer medications make it less effective.
If vomit within 2-3hrs of taking it, need to take another.

63
Q

rank diaphragm vaginal ring pop ocp male condoms and female condoms for chance of reg per year from the least to most (user dependence taken into account)

A

female condoms

OCP=POP

VAGINAL ring

male condoms

diaphragm

64
Q

when to avoid OCP/ contraindications

A

Migraine with aura (risk of stroke)
Smoking (>15/day) at age >35yrs
Stroke or CVD history
Current Breast cancer

65
Q

conditions that may benefit from OCP

A

Menorrhagia / Endometriosis / Fibroids
/ PMS (Pre-Menstrual Syndrome) / acne or hirsutism

66
Q

what medications do you need be concerned about being taken with ocps

A

P450 liver enzyme-inducing drugs (eg anti-epileptics, antibiotics) effect efficacy of OCP.
Teratogenic drugs (eg lithium or warfarin), more effective methods of contraception needed
(eg progestogen-only implant, or intrauterine contraception).

67
Q

what are these symptoms pointing at Flushing, Sweats, Disturbed Sleep,
Decreased Libido, Low Mood in 53 yo woman?

A

menopause

68
Q

when are you considered menopausal

A

Time at 12 months of LMP (last menstrual period)

69
Q

when are you perimenopausal

A

Within the years leading up to menopause

70
Q

Benefits of HRT as menopause hormone treatment

A

Symptom Relief due to low oestrogen
eg Flushing, Sweats, Disturbed Sleep,
Decreased Libido, Low Mood

Reduction in Osteoporosis related fractures

71
Q

Risks of HRT

A
  1. Venous Thrombo-embolism: Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE)
  2. hormone sensitive cancers
  3. cardiovascular disease
  4. risk of stroke
72
Q

are oral or transdermal estorgens safer relatign to VTE and why

A

transdermal are safer because oral undergo first pass metabolism in liver so increase clotting factors

73
Q

when should you avoid oral oestrogens considering VTE

A

bmi> 30

74
Q

what types of HRT is higher risk for breast cancer

A

combined hrt (progesterone AND oestrogen)
and continuous rather than sequential

75
Q

does your risk change while you are taking HRT and after stopping it?

A

Risk related to duration of treatment and reduces after stopping

76
Q

what happens to your risk of ovariuain cancer with HRT?

A

Small Increase in risk after long-term use.

77
Q

what to do to decrease risk of endometrial cancer when on hrt

A

Must prescribe Progestogens in all women with an endometrium !

78
Q

what are progestogens

A

synthetic progestins
and the natural hormone progesterone.

79
Q

what is an indication of endometrial cancer post menopause

A

bleeding

80
Q

when do women have increased risk of cardiovascular disease form hrt?

A

Improved risk in Younger Women & Sooner after Menopause
Increased risk if started later i.e. 10 years after menopause
even better if you have started it at younger age for premature ovarian insufficiency

81
Q

is the risk of stroke big from HRT?

A

small risk of stroke

82
Q

types of HRT safer for stroke

A

Oral have more risk than transdermal oestrogens
Combined (E2+P (progesterone) ) more risk than oestrogen only

83
Q

what is gender dysmorphia?

A

when you are gender non conforming (gender does not match assigned sex) and that causes you stress

84
Q

are transgender men or women more common?

A

women 3x more common

85
Q

what is given in transgender prepubertal young people to start their hormonal treatment

A

GnRH agonist (desensitizes HPG axis- low LH and TESTOSTERONE) to delay puberty

86
Q

waiting list time for specialist clinic for transgender people

A

4 yrs

87
Q

is post treatment regret common in transgenders>how common?

A

no- 1-2%

88
Q

how long after hormonal treatment is reassignment surgery?

A

1-2 years

89
Q

what is the hormone therapy for transgender men?

A

1) testosterone (injections or gel)
2) progesterone given to supress mensturation if needed

90
Q

chance of endometrial hyperplasia after giving progesterone to transgender men?

A

15%

91
Q

things done for transgender women hormone therapy

A

stop testosterone
start estrogen

92
Q

how is testosterone reduced in transgender women hormone therapy

A

:
a) gnrh agonists
b) anti androgen meds

93
Q

how is estrogen given for trans women hormmone therapy, what dose and how often? side effects?

A

(transdermal, oral, intramuscular)
High dose oestrogen eg 4-5mg per day, higher risk of VTE 2.6%)

Endo yr 2 (11 decks)

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