Pharmacotherapy of Infertility Flashcards
Clear Blue Fertility Monitor detects?
LH and estrogen hormones
Clear Blue Fertility Monitor general
99% accurate
Should be off oral contraceptives for 2 cycles
Use first urine sample of the morning!
Fertility scope is what kind of test and what does it monitor?
Saliva based
Estrogen levels
Fertility Scope General
Requires visual interpretation
98% accurate
OK in women with irregular periods
Fertility Scope can be affected by
Eating Drinking Brushing teeth Smoking within 2-3 hr Any residue of food or alcohol
First Response Fertility is what kind of test and what does it monitor?
Urine
FSH on day 3 of menses
First Response cannot be used if
Taken oral contraceptive or hormonal medication within 60 days
First Response Daily Ovulation Test is what kind of test and what does it monitor?
Urine
LH surge
First Response Daily Ovulation Test General
Do not open the foil pouch until containing strips until DAY 5 of period
Must be used within 30 days after opening
Test around the same time every day
OvWatch is what kind of test and what does it monitor?
Wrist-mounted
Transdermal Chloride
OvWatch general
Cl surge = fertile window
Notifies 4 days before ovulation (high probability of pregnancy)
EXPENSIVE
No OCs
Begin wearing within 3 days start of menses
Treatment of Infertility
Ovulation induction or controlled ovarian hyperstimulation
Goals of treatment
Achieve pregnancy
Birth of a healthy infant
Minimize the stress, physical discomfort, financial cost and risk
Non-Steroidial Estrogen Receptor Blocker Example
Clomiphene
Clomiphene MOA
Inhibit estrogen binding and prevents normal feedback inhibition, increasing LH and FSH
Clomiphene Side Effects
Hot flashes, ab discomfort, multiple prego, n/v/d
Clominphene place in therapy
First line for ovulation induction with timed intercourse, PCOS and women with normal GnRH production
Counseling Points for Clominphene
Patient should have a blood check of progesterone around day 21 to detect if an increase has occured
Aromatase Inhibitor
Letrozole
Letrozole MOA
Inhibits conversion of testosterone to estrogen increase release of FSH and LH
Letrozole place in therapy
Ovulation stimulation
Clomiphene failure
Monitoring with Clomiphene and Letrozole
Via Ovulation prediction kits of ultrasounds
hMG
Repronex
Menopur
75 IU FSH and LH
HP-FSH
Bravelle
75 IU FSH
Follitropin-alpha and beta
Lutropin alpha
Gonal F and Follistim AQ both are 75 IU FSH
Luveris is 75 IU LH
hCG Brand Names
Pregnyl
Novarel
Ovidrel
- Usually an additive therapy
hCG MOA
Supplement LH to mimic LH surge
hCG Side Effects
Headache, irritability, restlessness, fatigue, edema
hCG Place in Therapy
Female: ovulation induction and correct lack of LH surge
Male: Spermatogenesis if with hypogonadotropic hypogonadism
Lupron
leuprolide
GnRH Agonists
Injection
Zoladex
Goserelin
GnRH Agonists
Implant
Synarel
Nafarelin
GnRH Agonists
Nasal Spray
Lutrepulse
Gonadorelin acetate
GnRH Agonists
Pump
GnRH Agonists MOA
Stimulate gonadotropin release form pituitary
Few weeks later, shuts it down
GnRH Agonists Side Effects
Vaginal bleeding
Breast tenderness
Hot flashes, headaches, vaginal dryness
GnRH Agonists Place in Therapy
Anovulation due to GnRH deficiency
PCOS
Increase Sperm Count
Antagon
Cetrotide
Ganirelix
Cetrorelix
GnRH Antagonists
GnRH Antagonists MOA
Decrease FSH and LH via competition for receptors
Antagon should be used with
hCG
GnRH Antagonists Place in Therapy
Suppress premature LH surge and premature ovulation
OCs as hormonal supplements
Before fertility treatment to induce withdrawal bleeding
Reduces androgenicity and ovarian cysts
Estrogen use
Increase volume and thin cervical mucus and facilitate growth of endometrium
Progesterone use
Maintain endometrium
Dosing not user friendly
When would you use a dopamine agonists?
Hyperprolactinemia
Drugs for ovulation induction/
Clomiphene
+/- gonadotropins
Drugs for controlled ovarian hyperstimulation
Gonadotropins
+/- GnRH agonists OR antagonists
hCG