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Y2 BRS Endocrinology > Reproductive Treatments > Flashcards

Reproductive Treatments Flashcards

1
Q

What is done for testosterone replacement if not desiring fertility?

A

Treat Symptoms- loss of early morning erections, libido, decreased energy, shaving

Investigate the cause of low testosterone.

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2
Q

What are the testosterone replacement options?

A
  • Daily Gel (eg Tostran). Care not to contaminate partner.
  • 3 weekly intramuscular injection (eg Sustanon)
  • 3 monthly intramuscular injection (eg Nebido)
  • Less Common (Implants, oral preparations)
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3
Q

What safety monitoring is required in testosterone replacement?

A

• Increased Haematocrit (risk of hyperviscosity and
stroke)
• Prostate (Prostate Specific Antigen (PSA) levels)

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4
Q

How is secondary hypogonadism treated?

A

Treat with Gonadotrophins (ie LH and FSH) to induce Spermatogenesis

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5
Q

What does LH do for secondary hypogonadism treatment?

A

Stimulates Leydig cells to increases intratesticular testosterone, to much higher levels than in circulation (x100).

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6
Q

What does FSH do for secondary hypogonadism treatment?

A

Stimulates seminiferous tubule development and spermatogenesis.

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7
Q

What does be avoided to give to men describing fertility?

A

Testosterone

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8
Q

What is the treatment for a low sperm count?

A

Sperm induction:

Give hCG injections (which act on LH-receptors)
If no response after 6 months, then add FSH injections

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9
Q

What are the key features of PCOS - polycystic ovary syndrome?

A
  1. Hyperandrogenism - clinical (acne/hirsutism) or biochemical
  2. Irregular periods
  3. PCO morphology on ultrasound
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10
Q

What are the key features of hypothalamic amenorrhea?

A
  1. Low body weight
  2. Excessive exercise
  3. Stress
  4. Genetic susceptibility
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11
Q

What are the aims of ovulation induction?

A
  • To develop one ovarian follicle

- To cause small increase in FSH

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12
Q

What are the risks if >1 follicle develop in ovulation induction?

A

Risks multiple pregnancy -> risks for mother and baby during pregnancy

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13
Q

How would you restore fertility in anovulatory PCOS?

A
  1. Lifestyle / Weight Loss / Metformin
  2. Letrozole (Aromatase inhibitor)
  3. Clomiphene (Oestradiol receptor modulator)
  4. FSH stimulation
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14
Q

How does Letrozole work?

A
  1. Aromatase inhibitor = low oestradiol
  2. Decreased negative feedback hypothalamus and pituitary gland
  3. Increased LH and FSH
  4. Increased FSH stimulate follicle growth in ovaries
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15
Q

How does Clomiphene work?

A

Oestradiol receptor modulator

  1. Decreased negative feedback hypothalamus and pituitary gland
  2. Increased LH and FSH
  3. Increased FSH stimulate follicle growth in ovaries
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16
Q

What are the stages in IVF - in vitro fertilisation?

A
  1. Oocyte retrieval
  2. Fertilisation in vitro
  3. Embryo incubation
  4. Embryo transfer
17
Q

What may be done instead of IVF if a male factor is involved?

A

Intra-cytoplasmic sperm injection

18
Q

What is the first thing to do in IVF?

A

FSH stimulation - supraovulation

19
Q

How is premature ovulation prevented in IVF?

A

Prevent LH surge:

  1. GnRH antagonist protocol (short protocol)
  2. GnRH agonist protocol (long protocol)
20
Q

In preventing premature ovulation in IVF, which protocol is long?

A

GnRH angonist

21
Q

In preventing premature ovulation in IVF, which protocol is short?

A

GnRH antagonist

22
Q

Why does a continuous high dose of GnRH inhibit LH surge?

A

As it results in non-pulsatile GnRH -> LH inhibition (after initial flare)

23
Q

How are eggs matured in IVF?

A

LH exposure

24
Q

What are barrier methods of contraception?

A

-Male / female condom / diaphragm or cap with spermicide

25
Q

What are hormonal methods of contraception?

A
  • Combined Oral Contraceptive Pill (OCP)
  • Progestogen-only Pill (POP)
  • Long Acting Reversible Contraception (LARC)
  • Emergency Contraception
26
Q

What are permanent methods of contraception?

A
  • Vasectomy

- Female sterilisation

27
Q

What are the advantages of condoms?

A
  • Protect against STI’s
  • Easy to obtain – free from clinics / No need to see a healthcare professional
  • No contra-indications as with some hormonal methods
28
Q

What are the disadvantages of condoms?

A
  • Can interrupt sex
  • Can reduce sensation
  • Can interfere with erections
  • Some skill to use eg correct fit.
  • Two are not better than one
29
Q

How does the OCP (oral contraceptive pill) affect the HPA axis?

A
  1. Oestrogen + progesterone -> Negative feedback on hypothalamus and pituitary gland -> decreased LH and FSH -> anovulation
  2. Thickening of cervical mucus
  3. Thinning of endometrial lining to reduce implantation
30
Q

What are the advantages of the combined OCP?

A
  • Easy to take – one pill a day (any time of day)
  • Effective
  • Doesn’t interrupt sex
  • Can take several packets back to back and avoid withdrawal bleeds
  • Reduce endometrial and ovarian cancer
  • Weight Neutral in 80% (10% gain, 10% lose)
31
Q

What are the disadvantages of the combined OCP?

A
  • It can be difficult to remember
  • No protection against STIs
  • P450 Enzyme Inducers may reduce efficacy
  • Not the best choice during breast feeding
32
Q

What are the side effects of the combined OCP?

A 
Possible side effects :
• Spotting (bleeding in between periods)
• Nausea
• Sore breasts
• Changes in mood or libido 
• Feeling more hungry

Extremely rare side effects:
• Blood clots in the legs or lungs (2 in 10,000)

33
Q

What are the non-contraceptive uses of the combined OCP?

A

• Helps make periods lighter and less painful
(eg endometriosis or period pain or menorrhagia)
• Withdrawal bleeds will usually be very regular
• PCOS: help reduce LH and hyperandrogenism

34
Q

What is suitable if women can’t take oestrogen?

A

POP - progesterone only pill (mini-pill)

35
Q

What are the advantages of the POP?

A
  • Works as OCP but less reliably inhibits ovulation
  • Often suitable if can’t take oestrogen
  • Easy to take – one pill a day, every day with no break
  • It doesn’t interrupt sex
  • Can help heavy or painful periods
  • Periods may stop (temporarily)
  • Can be used when breastfeeding
36
Q

What are the disadvantages of the POP?

A
  • Can be difficult to remember
  • No protection against STIs
  • Shorter acting – needs to be taken at the same time each day
37
Q

What are the possible side effects of the POP?

A
  • Irregular bleeding
  • Headaches
  • Sore breasts
  • Changes in mood
  • Changes in sex drive

Y2 BRS Endocrinology (9 decks)

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