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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
Q

First response monitors

A

FSH on day 3

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26
Q

OvWatch measures

A

chloride levels in sweat

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27
Q

SpermCheck

A

MALE sperm count test

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28
Q

Define Hyperprolactinemia

A

Depresses GnRH secretion; lowers LH and FSH secretion; compromises testosterone and sperm

29
Q

What can cause Male Infertility?

A 
Endocrine disorder
Anatomical or ejaculation problems 
Low sperm count or immotile sperm 
Psychological problems
Lifestyle issues (tight unders
30
Q

Semen Analysis

A

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
Q

Non-pharm treatment of Male infertility

A

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
Q

Intrauterine Insemination

A

Sperm are separated from semen and better quality sperm are extracted for insemination
Sperm is injected trans-cervically into uterus
AFTER ovulation

33
Q

Assisted Reproductive Therapy (ART)

A

Direct retrieval of oocytes and manipulation of sperm to achieve pregnancy
Not very common
1+ Egg transferred

34
Q

Types of ART

A

In Vitro Fertilization and Embryo Transfer
Gamete Intrafallopian Transfer (GIFT)
Zygote Intrafallopian Transfer (ZIFT)

35
Q

What is GIFT/ZIFT?

A

Placement of human ova and sperm or zygote into the distal end of the oviduct
Fertilization occurs within the Fallopian tubes

36
Q

What is IVF

A

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
Q

Clomiphene citrate

A

Non-steroidal estrogen receptor modulator
Blocks feedback inhibition of the hypothalamus
Raise FSH and LH levels

38
Q

Gonadotropin therapy Examples

A

Menotropin and urofollitropin

39
Q

Clomiphene citrate MOA

A

Anti-estrogen
Blocks estrogen inhibitory activity at pituitary and hypo and releases feedback inhibition at these tissues
Upregulates LH, FSH and GnRH

40
Q

What does upregulation of LH, FSH, GnRH cause?

A

Enlargement of the ovaries and drug induced ovulation

41
Q

How is clomiphene citrate eliminated?

A

Metabolites via CYP 2D6

5-7 day plasma life

42
Q

Common adverse reactions in clomiphene citrate?

A

Hot flashes
Ab discomfort, visual blurring
Reversible ovarian enlargement and cyst formation

43
Q

Letrozole (Femara) is what class?

A

Aromatase inhibitor

44
Q

Letrozole (Femara) MOA

A

Inhibit testosterone to estradiol

Decrease estrogen stimulates release of FSH and LH

45
Q

Letrozole (Femara) Side Effects

A

Hot flashes
Headaches
Breast tenderness

46
Q

Counseling points for Clomiphene and Letrozole

A

Ovulation expected 5-10 days after last dose and intercourse should occur every other day for 1 week
Monitor ovulation is key

47
Q

Gonadotropins

A

Relatively safe
Expensive and IV
Require extensive monitoring

48
Q

Gonadotropins include:

A

LH, FSH and hCG

49
Q

Gonadotropins Structure

A

Each hormone is glycosylated heterodimer and contains a common alpha and beta subunits

50
Q

Gonadotropins MOA

A

Male: stimulates spermatogenesis
Female: FSH - maturation and development of the follicle; LH - ovulaiton and stimulates corpus luteum

51
Q

Requirement for gonadotropin treatment?

A

Ovaries must be able to respond normally to FSH and LH

52
Q

hCG works well in?

A

Women who have infertility due to lack of midcycle gonadotropin surge

53
Q

hCG works how?

A

Identical action as LH with a longer half life

Male: spermatogenesis who have hypofunction in pituitary

54
Q

hCG Adverse Effects

A 
Headache
Irritability
Restlessness
Fatigue
Edema
Gynecomastia
Pain at injection site
55
Q

GnRH

A

Gonadorelin (Lutrepulse)
Administered via portable pump (SC/IV)
EXPENSIVE

56
Q

GnRH Drugs Advantage?

A

They match the natural ovulation induction more closely and minimal monitoring

57
Q

GnRH Side Effects

A

Tachyphylaxis (pituitary cells are less responsive)
Hyperstimulation
Multiple gestations

58
Q

Define Ovarian Hyperstimulation Syndrome

A

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
Q

GnRH Agonists Examples

A 
Goserlin (Zoladex)
Nafarelin (synarel)
Histerlin (Vantas, Supprelain)
Buserelin (Suprefact)
Triptorelin (Relstar)
Leuprolide (Lupron
END IN -LIN
60
Q

GnRH Agonists Advantage

A

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
Q

GnRH Agonists AE

A

Vaginal blleding and breast tenderness

Hot flashes, headache vaginal dryness

62
Q

GnRH Antagonists Examples

A

Abarelix (Plenaxis)
Cetrorelix (Cetrotide)
Ganirelix (Antagon)

63
Q

Use of GnRH Antagonists?

A

Prevent premature LH surge or premature ovulation

Suppresses LH surge

64
Q

Estrogen use

A

Stimulate endometrial growth and cervical mucus production

65
Q

Progestin use

A

Promote endometrial development and maintenance during luteal

66
Q

Metformin use

A

Restore menstrual cycle and ovarian function

67
Q

Guanifenesin use

A

Can help improve cervical mucus quality

68
Q

Dopamine agonists use

A

Treat infertility related to hyperprolactinemia

69
Q

Aspirin use

A

Increase uterine and ovarian blood flow velocity

Reproduction Final (6 decks)

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