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Reproduction Final > Patho/Pharmacology of Infertility > Flashcards

Patho/Pharmacology of Infertility Flashcards

1
Q

Define infertility

A

Inability to conceive after 1 year of frequent contraception-free intercourse
15 months with oral contraceptive use

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2
Q

Define Primary infertility

A

Couple has never conceived a child

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3
Q

Define Secondary infertility

A

Couple has previously conceived a child and is unable to achieve a new pregnancy

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4
Q

About 10% of US women experience

A

Some degree of impaired fertility

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5
Q

Conception rates and male partners?

A

Conception rates decrease with age and 30-40% of couple infertility are the male’s fault

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6
Q

Why are normal menstural cycle necessary?

A

Sufficient estrogen in follicular phase so you have good endometrial lining and thin cervical mucus
Sufficient progesterone in luteal phase for oviducts and uterus accept the egg
Appropriate FSH and LH

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7
Q

Factors that contribute to female infertility?

A

Delay in childbearing
Contraceptive practices
High risk sexual practices
Increase in therapeutic abortions

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8
Q

What else can cause female infertility?

A 
Chronic hypothalamic dysfunction 
Hyperandrogencity, PCOS
Pelvic Inflammatory disease
Endometriosis/adhesion
Hyperprolactinemia
Drugs
Immunologic reactions
Age-related changes
Infectious disease 
Environmental toxins or recreational drugs
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9
Q

Define Chronic Hypothalamic Dysfunction

A

Causes anovulation and menstrual problems with normal prolactin and androgen levels
Cyclic secretion of GnRH is impaired which interferes with normal function of the HPO axis

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10
Q

Chronic Hypothalamic Dysfunction is caused by

A

Weight loss >15% or eating disorder

Intense exercise Stress

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11
Q

Define Hyperandrogenicity

A

Polycystic Ovarian Syndrome
Increased LH levels which cause stimulation of follicular production of androgens which leads to anovulation by enhancing follicular atresia

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12
Q

Define Hyperprolactinemia

A

Turns down GnRH secretion

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13
Q

Define Hypothyroidism

A

Leads to hyperprolactinemia

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14
Q

Drugs stimulate?

A

prolactin secretion

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15
Q

What decreases prolactin synthesis?

A

Dopamine

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16
Q

When will a patient workup for infertility occur

A

12 months after trying
OR known/suspected uterine/tubal disease or endometriosis, female >35, history of oligomenorrhea/amenorrhea or pelvic inflammatory disease, partner is known to be subfertile

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17
Q

Define Oligomenorrhea

A

Less than 9 periods a year

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18
Q

What is involved in a female evaluation

A 
Medical, surgical, family and social history
PE
Screen for chlamydia and gonorrhea
Confirm ovulation
Hysterosalpingogram
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19
Q

Define Hysterosalpingogram

A

Fluoroscopic and radiographic visualization of the interior of the upper genital tract

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20
Q

Basal Body Temperature Counseling

A

Each morning before any activity or getting out of bed
Measure to the nearest 0.1 degree
Rise of 0.4-0.6 indicated ovulation occured

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21
Q

Basal Body Temperature Charting

A

Progesterone production by the corpus luteum causes the BBT to raise during luteal phase (after ovulation

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22
Q

Counseling for Ovulation Kits

A

Measures LH in urine

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23
Q

Clear blue fertility monitoring

A

Daily monitoring

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24
Q

Fertility scope monitors via

A

saliva

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25
First response monitors
FSH on day 3
26
OvWatch measures
chloride levels in sweat
27
SpermCheck
MALE sperm count test
28
Define Hyperprolactinemia
Depresses GnRH secretion; lowers LH and FSH secretion; compromises testosterone and sperm
29
What can cause Male Infertility?
``` Endocrine disorder Anatomical or ejaculation problems Low sperm count or immotile sperm Psychological problems Lifestyle issues (tight unders ```
30
Semen Analysis
Abstain from ejaculation for 2-3 days before test - Volume, viscosity, density, morphology and motility - Abnormal results should be confirmed on 2-3 evals
31
Non-pharm treatment of Male infertility
Reduce BMI <30 Females avoid NSAIDs and ASA before or around the time of ovulation Anything that causes hyperprolactinemia or impair spermatogenesis Avoid lubricants
32
Intrauterine Insemination
Sperm are separated from semen and better quality sperm are extracted for insemination Sperm is injected trans-cervically into uterus AFTER ovulation
33
Assisted Reproductive Therapy (ART)
Direct retrieval of oocytes and manipulation of sperm to achieve pregnancy Not very common 1+ Egg transferred
34
Types of ART
In Vitro Fertilization and Embryo Transfer Gamete Intrafallopian Transfer (GIFT) Zygote Intrafallopian Transfer (ZIFT)
35
What is GIFT/ZIFT?
Placement of human ova and sperm or zygote into the distal end of the oviduct Fertilization occurs within the Fallopian tubes
36
What is IVF
Fertilization of the egg is done in the lab and then fertilized egg is placed in the fallopian tube If it works, it will then implant into the uterus
37
Clomiphene citrate
Non-steroidal estrogen receptor modulator Blocks feedback inhibition of the hypothalamus Raise FSH and LH levels
38
Gonadotropin therapy Examples
Menotropin and urofollitropin
39
Clomiphene citrate MOA
Anti-estrogen Blocks estrogen inhibitory activity at pituitary and hypo and releases feedback inhibition at these tissues Upregulates LH, FSH and GnRH
40
What does upregulation of LH, FSH, GnRH cause?
Enlargement of the ovaries and drug induced ovulation
41
How is clomiphene citrate eliminated?
Metabolites via CYP 2D6 | 5-7 day plasma life
42
Common adverse reactions in clomiphene citrate?
Hot flashes Ab discomfort, visual blurring Reversible ovarian enlargement and cyst formation
43
Letrozole (Femara) is what class?
Aromatase inhibitor
44
Letrozole (Femara) MOA
Inhibit testosterone to estradiol | Decrease estrogen stimulates release of FSH and LH
45
Letrozole (Femara) Side Effects
Hot flashes Headaches Breast tenderness
46
Counseling points for Clomiphene and Letrozole
Ovulation expected 5-10 days after last dose and intercourse should occur every other day for 1 week Monitor ovulation is key
47
Gonadotropins
Relatively safe Expensive and IV Require extensive monitoring
48
Gonadotropins include:
LH, FSH and hCG
49
Gonadotropins Structure
Each hormone is glycosylated heterodimer and contains a common alpha and beta subunits
50
Gonadotropins MOA
Male: stimulates spermatogenesis Female: FSH - maturation and development of the follicle; LH - ovulaiton and stimulates corpus luteum
51
Requirement for gonadotropin treatment?
Ovaries must be able to respond normally to FSH and LH
52
hCG works well in?
Women who have infertility due to lack of midcycle gonadotropin surge
53
hCG works how?
Identical action as LH with a longer half life | Male: spermatogenesis who have hypofunction in pituitary
54
hCG Adverse Effects
``` Headache Irritability Restlessness Fatigue Edema Gynecomastia Pain at injection site ```
55
GnRH
Gonadorelin (Lutrepulse) Administered via portable pump (SC/IV) EXPENSIVE
56
GnRH Drugs Advantage?
They match the natural ovulation induction more closely and minimal monitoring
57
GnRH Side Effects
Tachyphylaxis (pituitary cells are less responsive) Hyperstimulation Multiple gestations
58
Define Ovarian Hyperstimulation Syndrome
Enlarged ovaries with multiple developing follicles Increased level of growth factor and hormone which increase permeability of blood vessels which moves the fluid form the vascular to the abdominal and pleural cavities
59
GnRH Agonists Examples
``` Goserlin (Zoladex) Nafarelin (synarel) Histerlin (Vantas, Supprelain) Buserelin (Suprefact) Triptorelin (Relstar) Leuprolide (Lupron END IN -LIN ```
60
GnRH Agonists Advantage
After stimulation of Gn they down regulat the receptor and inhibit secretion which is good in PCOS due to decrease number of oocytes are released prematurely and increased quality
61
GnRH Agonists AE
Vaginal blleding and breast tenderness | Hot flashes, headache vaginal dryness
62
GnRH Antagonists Examples
Abarelix (Plenaxis) Cetrorelix (Cetrotide) Ganirelix (Antagon)
63
Use of GnRH Antagonists?
Prevent premature LH surge or premature ovulation | Suppresses LH surge
64
Estrogen use
Stimulate endometrial growth and cervical mucus production
65
Progestin use
Promote endometrial development and maintenance during luteal
66
Metformin use
Restore menstrual cycle and ovarian function
67
Guanifenesin use
Can help improve cervical mucus quality
68
Dopamine agonists use
Treat infertility related to hyperprolactinemia
69
Aspirin use
Increase uterine and ovarian blood flow velocity

Reproduction Final (6 decks)

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