L74

Question 1

Def of infertility

Answer 1

1 year with unprotected intercourse

Question 2

Normal: talk through the hormonal axis to getting a dominant follicle

Answer 2

1. GnRH from hypothalamus -> ant pit released FH
2. FH acts at ovary to move multiple follicles into development
3. Surge in E form these = -FB onto ant pit = ↓FSH
4. Dominant follicle chosen = E spike = +FB = ↑LH to stimulate OVULATION

Question 3

Normal: describe the hormones involved after ovulation

Answer 3

CL makes P = -FB on ant pit + hypothalamus

No pregnancy = progresterone drops = period

Question 4

Hormones you want to check if a woman is ovulation

Answer 4

Day 3 FSH - elevated concerned for early menopause
Day 21 progesterone- ovulate around day 14, should be elevated at 21
Prolactin - ↑ed means you won’t ovulate

Question 5

How does body temp predict fertility

Answer 5

Progesterone ↑body temp

You can have sex during this period aka you’ve already ovulated

Question 6

What is the fertility window?

Answer 6

3-5 days before ovulation - sperm can remain in repro tract

24 hrs after ovulation

Question 7

Meds to make a woman ovulate

Answer 7

Clomiphene citrate
FSH
Menopausal gonadotropin - make you think you’re menopausal = overproduced FSH

Question 8

Mechanism of clomiphene citrate

Answer 8

Lose the -FB to hypothalamus from the ↑P from dominant follicle
↑FSH to overstim ovaries
Give d5-10

Question 9

What is a hysterosalpingogram? Who do you do it for?

Answer 9

Check uterus and tubes for scarring
+ Contrast, take XR
Do it after menstruation before ovulation (not to disrupt an existing pregnancy)

Question 10

What is a sonohytserogram? What is the main cons?

Answer 10

US after injecting saline into the tubes

Good for tubes, bad for uterus eval

Question 11

What does PID put you at risk for?

Answer 11

Tubal infertility

Question 12

How would you use laperoscopy to eval patency of tubes?

Answer 12

Camera in
Retrograde fill tubes with dye
Should spill into abdomen if patent

Question 13

What is a hysteroscopy?

Answer 13

Camera in through cervix

Doesn’t help you eval the tubes

Question 14

Treat tubal cause of infertility if both tubes effected

Answer 14

Take eggs out - fertilize out of body - implant into uterus

Question 15

Why is there a delay in male fertility?

Answer 15

Takes 3 months to produce viable sperm

Overturn sperm every 3 months anyways

Question 16

Describe the -FB in male fertility

Answer 16

1. Hypothalamus - GnRH
2. Anti pit - LH + FSH
3. Make sperm via leydig (LH) and sertoli cells (FSH)
4. Testosterone shuts off the hypothalamus one the sperm are make

Question 17

What is the male workup for fertility?

Answer 17

Sperm analysis - count, motility, morphology

Question 18

Where does fertilization happen?

Answer 18

In the tubes - why most common site of ectopic

Question 19

Treat male infertility

Answer 19

↑# via multiple ejaculation + cryopreseration
Steroids if Abs vs sperm
Treat ED
Surg if obstruction
\+Hormones if defiicient

Question 20

How test cervical mucus problem?

Answer 20

After sex - see how long takes sperm to get through

Question 21

What is the risk of clomiphene?

Answer 21

Multiple kids in a pregnancy - twins, triples