Pharmacology, preventing or causing pregnancy

Question 1

What is the most effective form of contraception (besides abstinence)?

Answer 1

Norplant

Question 2

What is the mechanism of action of an IUD?

Answer 2

• Causes sterile inflammation in the uterus
• Sperm is destroyed by PMNs
• Thickens cervical mucous
• Inhibits ovulation
• Thins endometrial lining, decreasing menstrual volume

Question 3

What are the benefits and side effects of IUDs?

Answer 3

• *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

Question 4

What is the MoA for Depo Provera?

Answer 4

• Inhibits ovulation
• thickens cervical mucus
• Thins endometrial lining

Question 5

What are the benefits and side effects of Depo Provera?

Answer 5

• *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

Question 6

What is the MoA of Oral Contraceptives?

Answer 6

• Inhibits mid-cycle LH surge (preventing ovulation)
• Thickens cervical mucous
• Disrupts tubal and uterine motility
• Alters glycogen production in endometrium

Question 7

What are the benefits and side effects of oral contraceptives?

Answer 7

• *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)

Question 8

What is the MoA of vaginal contraception (the ring)?

Answer 8

• 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

Question 9

What are the benefits and side effects of vaginal contraception (the ring)?

Answer 9

• *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

Question 10

What is the MoA of emergency contraception?

Answer 10

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

Question 11

What are the side effects of emergency contraception?

Answer 11

• Nausea/vomiting
• Breast tenderness
• Headache
• Dizziness
• Not effective for established pregnancies

Question 12

What are the factors that determine what treatment is required for infertility?

Answer 12

Treatment depends on Infertility Diagnosis:

• Unexplained infertility
• Anovulation/PCOS
• Tubal Factor
• Endometriosis
• Recurrent Pregnancy Loss
• Male Factor

Question 13

What is fecundability?

Answer 13

Probability that a cycle will result in pregnancy

Question 14

What is fecundity?

Answer 14

Probability that cycle will result in a live birth

Question 15

What is the recommendation for all couples - regardless of diagnosis of infertility?

Answer 15

• *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

Question 16

What does a diagnosis of unexplained infertility require?

Answer 16

• Evidence of ovulation
• Normal ovarian reserve and uterine cavity
• Patent fallopian tubes
• Normal semen parameters

Question 17

What are the treatment options for unexplained infertility?

Answer 17

• Natural cycle timed intercourse
• Natural cycle Intrauterine insemination
• Clomiphene citrate (CC) alone
• CC and IUI
• Injectable gonadotropins and IUI
• In Vitro Fertilization

Question 18

What is the standard recommendation for unexplained infertility?

Answer 18

3-6 months of CC/IUI, then proceed with IVF

Question 19

What is required for the diagnosis of Anovulatory/PCOS WHO Group I? What is the infertility treatment?

Answer 19

Hypogonadotropic Hypogonadal Anovulation - Inadequate central gonadotropin function

Treatment:
- Often requires gonadotropin injections

Question 20

What is requried for the diagnosis of Anovulatory/PCOS WHO Group III? What is the treatment?

Answer 20

Hypergonadotropic Anovulation - Classically premature ovarian insufficiency

Treatment:
- Requires donor oocyte IVF

Question 21

What is required for the diagnosis of Anovulatory/PCOS WHO Group II? What is the treatment?

Answer 21

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

Question 22

What can be used to treat tubal factor infertility?

Answer 22

Tubal anastomosis
- Other surgery to open blocked tubes in controversial

IVF
- initially developed for tubal factor infertility

Question 23

What is the treatment for endometriosis infertility?

Answer 23

Surgical excision of minimal/mild endometriosis appears to improve pregnancy rates (moderate/severe benefits unclear)

Question 24

What are treatments of male factor infertility?

Answer 24

Vasectomy:

• Vasectomy reversal if no other infertility factors
• -> second option is surgical sperm retrieval for IVF/ICSI

Oligospermia:
- Consider IVF/ICSI