Lecture 6 pt 2 Exam 5

Question 1

primary vs secondary infertility

Answer 1

primary- you have never had a pregnancy
secondary- have been pregnant before or had a miscarriage

Question 2

Define infertility

Answer 2

Inability to be pregnant after 12 months of trying

Question 3

Name the 4 factors that affect female infertility along with the percent of prevalence

Answer 3

Cervical factors (<10%)
Uterine factors(<10%)
Tubal & peritoneal factors (40%)
Ovulatory factors(40%)

unexplained (less than 10%)

Question 4

how do cervical factors affect female infertility

Answer 4

Cervical mucus not receptive to sperm

Question 5

What are some tubal and peritoneal factors that affect female infertility

Answer 5

Blocked fallopian tube
interference with normal movement of fallopian tube
barrier

Question 6

What are some ovulatory factors that affect female infertility

Answer 6

Hypothalamic pituitary failure (decrease in GnRH production) (5-10% of anovulation)
dysfunction of hypothalamic pituitary ovarian axis
PCOS

Question 7

Non pharmacologic treatments for infertility

Answer 7

weight adjustment
avoid smoking
reduce stress

Question 8

When does expectant management work? why?

Answer 8

Works for women with regular menstrual cycle, it confirms evidence of ovulation

Question 9

Name the 5 expectant management procedures

Answer 9

Time intercourse
Urine ovulation
Change in cervical mucus
basal body temp
FSH levels

Question 10

What are ovulation predictor kits and how do they work

Answer 10

Expectant management techniques that detect the surge in LH levels , test morning urine daily

Question 11

What is timed intercourse? when is the critical period of timed intercourse

Answer 11

Fertile window is 5 days before ovulation and 1 day after

Question 12

What change in mucus indicates most fertile?

Answer 12

Normal mucus is a protective barrier
During ovulation, it allows sperm to pass through cervix
most fertile when mucus is clear, slippery and stretchy

Question 13

How long should women below 35 wait to be evaluated if unable to get pregnant

Answer 13

12 months

Question 14

In women between 35-40, how long should they wait before seeking an evaluation if unable to get pregnant after trying?

Answer 14

6 months

Question 15

In women above 40 yo, how long should they wait to be evaluated if unable to get pregnant after trying?

Answer 15

less than 6 months

Question 16

pharmacologic treatments for infertility in order of preference

Answer 16

Aromatase inhibitors like leterozole and anastrozole (controlled ovarian hyperstimulation)

Gonadotropins

human chronic gonadotropin

Assisted reproductive techniques

Question 17

What are some assisted reproductive techniques

Answer 17

Intrauterine insemination (IUI)
Invitro fertilization (IVF)

Question 18

Dosing of letrozole and anastrozole

Answer 18

Letrozole- 2.5-10 mg X 5 days starting day 3 of menses
anastrozole- 1 mg Po X 5 days staring day 3 of menses