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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
What are hormonal methods of contraception?
- Combined Oral Contraceptive Pill (OCP) - Progestogen-only Pill (POP) - Long Acting Reversible Contraception (LARC) - Emergency Contraception
26
What are permanent methods of contraception?
- Vasectomy | - Female sterilisation
27
What are the advantages of condoms?
* 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
What are the disadvantages of condoms?
* Can interrupt sex * Can reduce sensation * Can interfere with erections * Some skill to use eg correct fit. * Two are not better than one
29
How does the OCP (oral contraceptive pill) affect the HPA axis?
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
What are the advantages of the combined OCP?
* 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
What are the disadvantages of the combined OCP?
* It can be difficult to remember * No protection against STIs * P450 Enzyme Inducers may reduce efficacy * Not the best choice during breast feeding
32
What are the side effects of the combined OCP?
``` 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
What are the non-contraceptive uses of the combined OCP?
• 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
What is suitable if women can't take oestrogen?
POP - progesterone only pill (mini-pill)
35
What are the advantages of the POP?
* 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
What are the disadvantages of the POP?
* Can be difficult to remember * No protection against STIs * Shorter acting – needs to be taken at the same time each day
37
What are the possible side effects of the POP?
* Irregular bleeding * Headaches * Sore breasts * Changes in mood * Changes in sex drive

Y2 BRS Endocrinology (9 decks)

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