Infertility Treatments

Question 1

What does fecundability mean?

Answer 1

Probability that a cycle/month will result in pregnancy

Question 2

What does fecundity mean?

Answer 2

Probably of live birth in a cycle/month

Question 3

What is the best time to have intercourse in terms of when you ovulate if you want to get pregnant?

Answer 3

2 days BEFORE you ovulate

Question 4

1 cause of male infertility?

Answer 4

Vasectomy

Question 5

Why can giving testosterone to a man with low testosterone backfire?

Answer 5

The concentration of testosterone in the testicle is 100x greater than peripheral testosterone. When you give exogenous testosterone, it can 1) feedback on the hypothalamus to shut up LH release and 2) be converted to estradiol peripherally which will shut off GnRH production and further reduce the man’s ability to make endogenous testosterone.

Question 6

What do we look at when we do a semen analysis?

Answer 6

Total motile count=Volumeconcentration%motile

should be >20 million

Question 7

In a man with prior vasectomy, what are his options for reversal?

Answer 7

1. Vasectomy reversal (ha, no shit)
2. Surgical sperm retrieval: MESA, TESE which are then used during IVF or ICSI cycles

MESA: Microsurgical Epididymal Sperm Aspiration
TESE: Testicular Sperm Extraction
ICSI: Intracytoplasmic Sperm Injection (single sperm injected into a single oocyte that they got from IVF)

Question 8

What classifies someone as having oligospermia

Answer 8

Mild: 10-20 million
Moderate: 5-10 million
Severe: less than 5 million

Question 9

What are examples of ART: Assisted Reproductive Technology

Answer 9

1. IVF
2. Intra-cytoplasmic Sperm Injection (ICSI)

these are methods that combine sperm and egg OUTSIDE the body.

Question 10

What is IUI: Intrauterine Insemination ?

Answer 10

Intrauterine insemination:
Motile Sperm is taken from the male (or donor).
The woman’s time of ovulation is identified by blood tests and then the concentrated and washed sperm is injected into her uterus 36-40 hours after ovulation is triggered or started naturally.

Question 11

What is COH: Controlled Ovarian Hyperstimulation?

Answer 11

COH: Inducing the ovulation of many follicles

Question 12

What is Clomiphene Citrate used for and how does it work?

Answer 12

It is a SERM so it competes with endogenous estrogen receptors, reducing estrogen feedback inhibition causing increased GnRH and therefore increased LH/FSH release. This stimulates ovulation.

Question 13

What is Letrozole? How does it work?

Answer 13

It is an aromatase inhibitor that inhibits the conversion of androgens to estrogen. Again, this blocks the negative feedback of estrogen so your body is more likely to ovulate (more FSH/LH)

Question 14

Why would you use metformin to treat infertility??? So confussseeedddddd

Answer 14

Yes this is an anti-hyperglycemic, as you know

It is used in patients with PCOS who are typically obese (but not always). This can help correct androgen levels, and also help with weight loss and decrease BP and cholesterol

Question 15

Can you just use recombinant FSH and LH to help women ovulate?

Answer 15

Yes. Yes you can.

Question 16

What’s the different between IVF and ICSI

Answer 16

In IVF you just take an egg from the female and place bunch of sperm around it and let them at it.

In ICSI, if the male doesn’t have that many motile sperm, you can identify the motile ones and then directly inject it into the cytoplasm of the egg.

Question 17

Whats the difference between WHO Group I, II and III anovulation?

Answer 17

WHO Group I: not enough gonadotropins so tx by giving them
WHO Group II: Normal estrogen levels, but anovulation is present, classically a case of PCOS
WHO Group III: hypergonadotropic (at menopausal ranges) so tx with IVF

Question 18

What is tubal factor infertility?

Answer 18

If there is damage to the tubes from ectopic pregnancies, the best treatment course is IVF, because opening up a closed tube won’t really fix the problem (it will just scar and close up again)

Question 19

Why do you not want to get endometriosis other than the fact that getting endometriosis is bad.

I’m tired. I’m sorry.

Answer 19

Infertility is greater in these pts. IVF is only half as successful as in tubal factor pts possibly due to scarring or an oocyte problem.

Treat these pts with excision of mild endometriosis but for moderate/severe pts surgery has unclear benefits

Question 20

Leiomyomas can cause infertility if they are located ____________

Answer 20

Submucosal or intracavitary (decreased pregnancy rate by 30-50%). Treat with resection.

Intramural ones will be removed if >4cm

Pedunculated ones are usually only treated if symptomatic

Question 21

What’s a disease that causes really bad uterine scar tissue usually after a D&C that can cause infertility?

Answer 21

Asherman’s syndrome

Question 22

What are the 3 reasons for undisputed pregnancy loss?

Answer 22

1. Genetic
2. Anatomic
3. Immunologic (antiphospholipid syndrome)

Question 23

What are the most common genetic abnormalities that lead to miscarriage? How do you treat?

Answer 23

Trisomies (specifically 16)
Turner’s syndrome

Tx: genetic counseling, identifying normal eggs and using those

Question 24

What is an anatomic reason for pregnancy loss?

Answer 24

Uterine abnormalities

Question 25

What can you give to patients that have immunologic reasons for pregnancy loss such as Lupus or antiphospholipid syndrome?

Answer 25

1. Aspirin and Heparin (together)
2. Lovenox
3. IVIG or prednisone (immunosuppressive therapy–does not improve pregnancy)

Question 26

Thyroid function (low or high) can effect pregnancy loss. How should you treat it if she’s hypo and what level should TSH be at?

Answer 26

Levothyroixine (if hypo). Keep TSH below 2.5uU/mL prior to and during pregnancy

Question 27

DM is associated with pregnancy loss (And caudal regression remember??). How do you treat?!

Answer 27

Manage glucose. Just put this in so you associate DM with pregnancy loss.

Question 28

Hyerpolactinemia can cause pregnancy loss too. How do you treat?

Answer 28

Bromocriptine or cabergoline.

Again just remember hyperprolactinemia is associated with pregnancy loss because of the excess prolactin increasing GnRH and messing up HPO axis

Question 29

What environmental factors can lead to pregnancy loss?

Answer 29

1. Smoking
2. Alcohol
3. Caffeine (>300 mg/day=2 fold increase in miscarriage)