Pharmacology, preventing or causing pregnancy Flashcards
What is the most effective form of contraception (besides abstinence)?
Norplant
What is the mechanism of action of an IUD?
- Causes sterile inflammation in the uterus
- Sperm is destroyed by PMNs
- Thickens cervical mucous
- Inhibits ovulation
- Thins endometrial lining, decreasing menstrual volume
What are the benefits and side effects of IUDs?
- *Benefits:**
- Ease of use
- No systemic exposure to hormones
- Lower menstrual blood loss
- May decrease endometrial cancer risk
- May be used during breast feeding
- *Side Effects:**
- Need to check string
- Increased risk of acne
- Changes in menstrual flow
- Risk of uterine perforation
- Risk of pelvic infection
What is the MoA for Depo Provera?
- Inhibits ovulation
- thickens cervical mucus
- Thins endometrial lining
What are the benefits and side effects of Depo Provera?
- *Benefits:**
- Easy use (injection every 3 months)
- Decreases anemia
- Decreases PID
- Decreases ectopic pregnancy
- May decreased endometrial cancer
- Can be used during breast feeding
- *Side Effects:
- **Irregular menstrual bleeding
- Amenorrhea
- Acne
- Mood changes
- Headache
- Possible weight gain
What is the MoA of Oral Contraceptives?
- Inhibits mid-cycle LH surge (preventing ovulation)
- Thickens cervical mucous
- Disrupts tubal and uterine motility
- Alters glycogen production in endometrium
What are the benefits and side effects of oral contraceptives?
- *Benefits:**
- Decreased menstual blood loss
- Decreased PMS
- Decreased acne
- Decreased ectopic pregnancy
- Decreased symptomatic functional cysts
- Decreased PID
- *Side Effects:**
- Increased cervical dysplasia
- Increased risk of thromboembolism
- Breast tenderness, nausea, fluid retention (all increase with increased estradiol)
What is the MoA of vaginal contraception (the ring)?
- Circular silastic capsule releases:
15 ug ethinyl estradiol daily
120 ug etonogestrel daily - Kept in place for 3 weeks, 1 week off
- Inhibits ovulation
- Thickens cervical mucus
- May alter endometrial glycogen
What are the benefits and side effects of vaginal contraception (the ring)?
- *Benefits:**
- Ease of use
- Lower hormonal exposure
- Less impact on liver
- Improved menstrual cycle control
- May help with ovarian/endometrial cancer prevention
- *Side Effects:**
- Vaginitis
- Break-through bleeding
- Nausea
- Breast tenderness
- Possible increased cervical dysplasia or thromboembolism
What is the MoA of emergency contraception?
It is, essentially, a massive load of estrogen on the system
- Alterations in tubal transport
- Interference with corpus luteum function
- Direct interference with fertilization
- Disrupts implantation
What are the side effects of emergency contraception?
- Nausea/vomiting
- Breast tenderness
- Headache
- Dizziness
- Not effective for established pregnancies
What are the factors that determine what treatment is required for infertility?
Treatment depends on Infertility Diagnosis:
- Unexplained infertility
- Anovulation/PCOS
- Tubal Factor
- Endometriosis
- Recurrent Pregnancy Loss
- Male Factor
What is fecundability?
Probability that a cycle will result in pregnancy
What is fecundity?
Probability that cycle will result in a live birth
What is the recommendation for all couples - regardless of diagnosis of infertility?
- *Maintain good health in both partners**
- BMI in normal range
- Avoid tobacco, heavy alcohol, other substances
- Limit caffeine consumption
- *Maximize Intercourse Timing**
- Intercourse every other day around time of ovulation
What does a diagnosis of unexplained infertility require?
- Evidence of ovulation
- Normal ovarian reserve and uterine cavity
- Patent fallopian tubes
- Normal semen parameters
What are the treatment options for unexplained infertility?
- Natural cycle timed intercourse
- Natural cycle Intrauterine insemination
- Clomiphene citrate (CC) alone
- CC and IUI
- Injectable gonadotropins and IUI
- In Vitro Fertilization
What is the standard recommendation for unexplained infertility?
3-6 months of CC/IUI, then proceed with IVF
What is required for the diagnosis of Anovulatory/PCOS WHO Group I? What is the infertility treatment?
Hypogonadotropic Hypogonadal Anovulation - Inadequate central gonadotropin function
Treatment:
- Often requires gonadotropin injections
What is requried for the diagnosis of Anovulatory/PCOS WHO Group III? What is the treatment?
Hypergonadotropic Anovulation - Classically premature ovarian insufficiency
Treatment:
- Requires donor oocyte IVF
What is required for the diagnosis of Anovulatory/PCOS WHO Group II? What is the treatment?
Eugonadotropic, Euestrogenic Anovulation - Classical PCOS
Required for diagnosis:
- Oligomenorrhea (fewer than 9 cycles/year)
- Ultrasound evidence of PCO
- Clinical or laboratory evidence of high androgens
Treatment:
- Weight loss in obese patients
- Metformin (thiazolidinedione)
Can increase ovulation in some women with PCOS by correcting androgen levels in ovary
What can be used to treat tubal factor infertility?
Tubal anastomosis
- Other surgery to open blocked tubes in controversial
IVF
- initially developed for tubal factor infertility
What is the treatment for endometriosis infertility?
Surgical excision of minimal/mild endometriosis appears to improve pregnancy rates (moderate/severe benefits unclear)
What are treatments of male factor infertility?
Vasectomy:
- Vasectomy reversal if no other infertility factors
- -> second option is surgical sperm retrieval for IVF/ICSI
Oligospermia:
- Consider IVF/ICSI
