OI and IUI Flashcards
WHO Classification of Ovulatory Disorders
I: Hypo-hypo (5-10%)
II: Normo-normo (75-85%)
III: Hyper-hypo (10-20%)
IV: Hyper PRL (5-10%)
Reqts
evidence of ovulation in the IUI cycle
at least 1 patent tube
>5-10M sperm motile (CPG)
no active infection
moa clomiphene
a selective estrogen receptor modulator that
binds to estrogen receptors for an extended period of time, this messes with receptor recycling and causes a feedback to your hypothalamus to stimulate GnRH and gonadotropin production because there is a perceived low level of estrogen –> this drives follicular development
in ovulatory women: inc pulse frequency
in anovulatory women: inc pulse amplitude
side effects clomiphene
dec cervical mucus quality
dec endometrial growth
% fecundability
expectant v cc v gonadotropins v ivf
2-4%
5-10%
7-10%
25-45%
T or F:
in anovulatory women, OI + IUI is not superior to OI + timed coitus if normal semen parameters
T
T or F:
in ovulatory women, OI + IUI is not superior to OI + timed coitus if normal semen parameters
F
add IUI to inc number of sperm
cycle fecundability for OI with CC in ANOVULATORY women
15-22%
side effects CC
hot flashes
VMS
headache
breast tenderness
pelvic pressure
n/v
visual disturbances (scotomata, light sensitivity, double vision)
afterimages (palinopsia)
photophobia
risks of CC
multiple pregnancy (7-10%)
no causal relationshop:
breast CA (high doses and multiple cycles)
endomCA (baka kasi yung anovulatory nature nung patient yung cause)
adjuvant
Glucocorticoids on D5-14
Prednison 5mg OD x 10 days
or
Dexa 0.5-2.0 mg OD x 10 days
Metformin
HCG trigger
(CC)
if not properly timed administration, results to atresia
given if lead follicle is 20 mm in diameter
ovulation 34-36hours after, IUI done at 36th hour
(as opposed to using LH kit, which detects the surge so 14-26 hours is ovulation –> next day ka mag IUI… usually 4-6pm ka nagtetest diba)
gonadotropins indications
- hypo-hypo (must contain both FSH and LH)
2.oral OI agents resistant (theoretically beneficial if FSH only so u dont augment LH)
- unexplained infertility
letrozole MOA
competitive nonsteroidal inhibitor of aromatase
block estrogen production in the periphery and brain –> stimulate gonadotropin secretion to stimulate follicular development
results to lower E2 and higher P4 during luteral phase = higher LBR
inc ovulation, PR, CPR for clomiphene resistant
no adverse endometrial effect
side effects letrozole
fatigue
dizziness
laparoscopic ovarian drilling
for anovulatory infertile women resistant to oral ovulation drugs
side effects:
adhesions
potential to decrease ovarian reserve
MOA: focal destruction of ovarian stroma will decrease intraovarian and systemic androgen concentrations
protocols
step up
low slow
step down
sequential
step up
75IU x 4-7 days between 5-8pm –> UTZ + serum E2 in the AM –> adjust –> if e2 inc, do utz q1-2 days, if 16-18mm lead follicle, trigger –> 36hrs after
low slow
37.5-75 IU
step down
150-225 IU (best if u know threshold)
e2 levels best for trigger
500-1500pg/ml
200-400/follicle
sequential
CC 50-150mg x 5 days then gonadotropins
EM must be
greater than or = 7mm on trigger day
risks of Gn tx
multiple pregnancy
PTB, LBW, GDM, PES
spontaneous miscarriage (25% v 15% in gen population)
cancel cycle if (Gn)
E 900-1400pg/ml
UTZ 4-6 > 10-14mm
3 >/=15
GnRH pulse tx indications and dose
hypo-hypo anovulatory women
2.5-5.0ug/pulse q60-90mins
pcos
pre-treat with GnRHa x 6-8weeks (to kill that high LH)
indications for IUI (CPG)
mild male factor infertility
unexplained infertility
abnormal cervical mucus
minimal and mild endometriosis
sexual dysfunction
CI to IUI
infection
stenosis/atresia
OAT
bilateral tubal obstruction
severe PEM (rASRM III/IV)
dense pelvic adhesions
DOR
complications of IUI
pelvic infection
uterine cramping
multifetal pregnancy
OHSS
oligo/asthenozoospermia preferred semen preparation technique
density gradient centrifugation because higher percentage of total motile sperm
aromatase inhibtors for EU-HYPO
testolactone 500-1000mg BID
anastrazole 1mg OD
MOA for glucocorticoids in IUI
androgen suppression
direct effect on developing oocytes
indirect effects on intrafollicular growth factors and cytokines
