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443-SRH and MSK > Medical Treatment of Infertility > Flashcards

Medical Treatment of Infertility Flashcards

1
Q

what is considered infertiltiy

A

Failure to conceive after 1yr of regular, unprotected intercourse

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2
Q

female causes of infertiltiy

A

ovarian dysfunction (aging, PCOS, premature ovarian failure, etc), tubal or pelvic factors, endometrial/ cervical

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3
Q

male causes of infertility

A

sperm motility, numbers, or morphology, antibodies, blockages/ obstruction

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4
Q

how to decresae prolactin

A

bromocriptine

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5
Q

what lifestyle mods can women make to try to conceive

A

Weight (BMI >19, <30)
Smoking cessation
<2 drinks/wk, avoid is best if trying to conceive
↓ caffeine intake
Avoid rec drugs like marijuana (🛆LH sec in both M and F)

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6
Q

what lifestyle mods can men make to try to conceive

A

Smoking cessation
<4 drinks/wk
Reduce heat: avoid hot tubs, restrictive clothing (ex- wear boxer shorts, etc)
Avoid rec drugs (ex- anabolic steroids)
Avoid drugs that affect male fertility/ ED
Avoid work contaminants- pesticides, herbicides

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7
Q

what lifestyle mods can the couple make together to try to conceive

A

Timing of intercourse: fertile window = intercourse on multiple days q2d
Use of ovulation tests, vaginal mucus discharge
Counseling to decrease emotional stress + cycles of hope and despair

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8
Q

what is the second intervention for infertility

A

Ovarian stimulation with oral agents- timed intercourse

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9
Q

Ovarian stimulation with oral agents- timed intercourse includes agents such as

A

antiestrogens like clomiphene citrate
reversible aromatase inhibitors like letrozole

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10
Q

why are antiestrogens used in infertility

A

negative feedback blocked = increase in GnRH, FSH, LH = stimulation of ovulation

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11
Q

MOA of letrozole

A

: aromatase inhibitor, blocks conversion of androgens to estrogen

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12
Q

what is the benefit of letrozole

A

no antiestrogen eff on cervix or uterus

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13
Q

letrozole dosing

A

start 2.5mg daily F5D on days 3-7 of cycle, can ↑ up to 7.5mg for subseq cycles

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14
Q

letrozole SEs

A

lack of energy, dizziness, HA, bone pain (10%), hot flashes (18%)

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15
Q

response to letrozole is lowered with

A

age, high/ low BMI, >6 cycles (most preg will occur in 3 cycles)
Not eff for women with limited ovarian reserve (women must have normal process)

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16
Q

what is the third tx for infertility

A

Ovarian stimulation with oral agents- IUI

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17
Q

what is IUI

A

Intrauterine insemination (IUI): sperm sample (with damaged removed) is placed in uterus through vagina using catheter

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18
Q

Ovarian stimulation with oral or injectable agents AND IUI is ____ effective than with timed intercourse

A

more

19
Q

IUI may not work if

A

severe male factors or women with blocked/ damaged fallopian tubes

20
Q

what is the 4th intervention for infertility

A

Ovarian stimulation with injectable agents (gonadotropins) + IUI

21
Q

what injectable agents can be used to stimulate follicular development

A

gonadotropins

22
Q

gonadotropins role and goal in interfility

A

Role: stimulate ovarian follicular development → goal: produce more than one mature follicle

23
Q

what should be monitored with gonadotrophins stimulating follicular development

A

follicle size via transvaginal ultrasound + E levels

24
Q

what 2 gonadotrophins are used to induce ovulation

A

rFSH- recombinant FSH (follitropin alpha or beta)
OR
hMG- human menopausal gonadotropin
Collected from urine of postmenopausal women, contains FSH an LH

25
Q

gonadotrophin SEs

A

pain and allergic rxns from proteins (w/ hMG only)

26
Q

what gonadotrophin is used to trigger ovulation

A

HCG: used for triggering ovulation- surrogate for LH surge

27
Q

follicular rupture is expected _____ later after HCG dose

A

36-40hrs

28
Q

after HCG injection, Follicular rupture 36-40hrs later, then ____ over next ___ days to coincide with ovulation or IUI

A

timed intercourse
2 days

29
Q

waht is the 5th treatment for infertiltiy

A

IVF

30
Q

IVF indications

A

Tubal (pathology, endometriosis), infertility >3yrs or women >36yrs old, male infertility, remains anovulatory after ovulation cycles

31
Q

IVF effectiveness is uncertain after ___ cycles

A

3

32
Q

steps for IVF

A
  1. Pituitary downreg/ suppression of women’s hormone production
  2. Gonadotropin for ovulation induction (and stimulation of more than one ovarian follicle)
  3. hCG hormone for final maturation of follicle and release of oocyte
  4. Oocyte retrieved from female 34-36hrs after hCG
  5. Oocyte cultured in incubator and exposed to sperm from male partner
  6. Fertilized ovum are incubated for 2-3 days
  7. If successful, will be placed into uterus
33
Q

what is used in IVF for pituitary downregulation and hormone downregultaion?

A

GnRH agonists (most common) or antagonists

34
Q

what is the long nd short protocol for GnRH agonists

A

Long protocol: started in luteal phase of prev cycle (day 21) to avoid flare
Short protocol or microflare dosing: started shortly after menstruation, small micro doses

35
Q

T or F: GnRH agonist depots should be used for suppression of women’s hormone production in IVF

A

F- use IN or SQ

36
Q

what is required right after retrievl if GnRH agonists are used

A

luteal phase support

37
Q

pros of using GnRH antagonist protocol in IVF

A

fewer injections and lower doses, shorter, no flare effect, no luteal support required

38
Q

cons of using GnRH antagonist protocol in IVF

A

expensive

39
Q

why is P supplementation required in IVF with GnRH agonists

A

to maintain uterine lining + support early preg

40
Q

why may E supplementation be required in IVF

A

to maintain adequate endometrial lining to support implantation
May be used with GnRH agonist protocols

41
Q

E supplementation n IVF is usually used with ______ protocols

A

GnRH agonist

42
Q

what is ICSI

A

Intracytoplasmic sperm injection (ICSI): single healthy sperm inj directly into oocyte to fertilize
Can overcome severe male factors for infertility or low sperm count

43
Q

what is the 6th step for infertility tx

A

IVF + ICSI

443-SRH and MSK (24 decks)

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