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BRS Year 2 > Reproductive Treatments > Flashcards

Reproductive Treatments Flashcards

1
Q

How easy is primary hypogonadism in males treated?

A

Hard to treat via hormones

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2
Q

How is secondary hypogonadism in males treated? How does this help? (requiring fertility)

A

Gonadotrophins (LH/FSH)

Stimulates spermatogenesis

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3
Q

What hormone stimulates testosterone via what cells?

A

LH stimulates it via leydig cells

Increases intratesticular testosterone to much higher levels

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4
Q

What hormone stimulates spermatogenesis in what structure?

A

FSH in seminiferous tubules

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5
Q

What injections for male infertility target LH receptors?

A

hCG injections (act on LH receptors)

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6
Q

Does Congenital Secondary Hypogonadism have better, same or worse prognosis than Acquired Secondary Hypogonadism in males and why?

A

Worse- he has not gone through mini puberty

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7
Q

When is testosterone replacement given?

A

If not desiring fertility

Testosterone lowes FSH/LH so reduces spermatogenesis

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8
Q

What testosterone replacements are available?

A

Daily gel- tostran
3 weekly IM injections
3 monthly IM injection
Less common: implants, oral preparations

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9
Q

What do we have to monitor when giving testosterone replacement?

A 
Observe haematocrit (risk of hyperviscosity and stroke- stimulates erythropoiesis)
Prostate (PSA levels)
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10
Q

How is fertility mainly improved for patients with PCOS?

A

Try to stimulate ovulation (ovulation induction) via development of one ovarian follicle (avoids multiple pregnancy as this has risks for mother and baby)
We aim to cause a small increase in FSH

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11
Q

How is ovulation induction encouraged?

A
  1. Lifestyle / Weight Loss / Metformin
  2. Letrozole (Aromatase inhibitor)
  3. Clomiphene (Oestradiol receptor antagonist)
  4. FSH stimulation (injection)
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12
Q

How does letrozole/ aromatase inhibitor/ oestradiol receptor antagonist work?

A

Reduces negative feedback from oestradiol
Aromatase inhibitor prevents conversion from testosterone to oestradiol
This increases FSH and stimulates follicle growth

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13
Q

How does IVF work?

A

High dose of FSH to stimulate eggs
Prevent premature ovulation via GnRH agonist/antagonist
Give LH to allow egg maturation
Retrieve oocyte from ovary
Fertilisation in vitro or intracytoplasmic injection of sperm
Embryo incubation
Embryo transfer

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14
Q

When is intracytoplasmic injection of sperm (ICSI) used and what is it?

A

When theres a problem with the sperm, inject one sperm into an egg

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15
Q

What do we do to premature ovulation in IVF?

A

Prevent it by giving medicine to prevent premature LH surge

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16
Q

How is premature LH surge prevented in IVF?

A

Via GnRH antagonist (short protocol) or GnRH agonist (long protocol) - if given GnRH in a non pulsatile way LH is inhibited

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17
Q

How are eggs matured in IVF and where?

A

By giving LH (activates the oocyte maturation promoting factor, MPF and oocyte chromosome segregation) then hCG (promotes VEGF and neovascularization)

They should still be in the ovary

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18
Q

What happens in egg maturation?

A

Egg goes from metaphase 1 to metaphase 2 - goes from diploid to haploid

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19
Q

How does Ovarian hyperstimulation syndrome occur?

A

Due to long lasting hCG during IVF

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20
Q

How does Ovarian hyperstimulation syndrome present?

A

Pleural effusion
Ascites
Renal failure
Ovarian torsion

Cause: increased renin and VEGF (vascular endothelial growth factor) so more fluid moving into interstitial space

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21
Q

What are methods of contraception?

A

Barrier: male / female condom/ diaphragm or cap with spermicide
Combined Oral Contraceptive Pill (OCP)
Progestogen-only Pill (POP)
Long Acting Reversible Contraception (LARC)
Emergency Contraception

Permanent methods:
Vasectomy
Female sterilisation (hysterectomy)

22
Q

What are positives of the oral contraceptive pill (OCP)?

A 
Easy to take 
 Effective
 Doesn’t interrupt sex
 Can take several packets back to back and avoid withdrawal bleeds
 Reduce endometrial and ovarian cancer
23
Q

What are negatives of the OCP?

A

It can be difficult to remember
No protection against STIs
P450 Enzyme Inducers may reduce efficacy (OCP metabolised by p450)
Not the best choice during breast feeding

24
Q

What are side effects of the OCP?

A 
Spotting (bleeding in between periods)
 Nausea
 Sore breasts
 Changes in mood or libido 
 Feeling more hungry
25
Q

What are non contraceptive uses of the OCP?

A

Lighter/less painful periods

PCOS (reduces LH and hyperandrogenism)

26
Q

What is the progesterone only pill (mini pill)?

A

Works as OCP but less reliably inhibits ovulation
Often suitable if cant take oestrogen
Can be used when breastfeeding

27
Q

What are negatives of the mini pill?

A

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

28
Q

What are the common long acting reversible contraceptives (LARCs)?

A

IUD (copper coil)- decreases sperm survival and prevents implantation
Intra-uterine systems- secretes progesterone which thins lining of sperm and thickens cervical lining
Progestogen-only injectable contraceptives or subdermal implants

29
Q

What are the emergency contraceptives?

A

IUD
Emergency contraceptive pill : Ulipristat acetate 30mg (ellaOne) within 5 days, Levenorgestrel 1.5mg (Levonelle) within 3 days- less effective

30
Q

What are side effects of emergency contraception?

A

Headache, abdominal pain, nausea
Liver p450 enzyme inducer medication makes it less effective
If vomit in 2-3 hours of taking need to take another

31
Q

What should we consider when chosing contraception?

A

Risk of venous thromboembolism
Other conditions
Need for prevention of STIs
Concurrent medication e.g. P450 liver enzyme inducing medication

32
Q

What are risks of HRT?

A
  1. Venous thrombo embolism- use transdermal oestrogens if this is the case (oral oestrogens go past first pass metabolism in liver so can increase clotting factors along with SHBG, triglycerides and CRP)
  2. Hormone sensitive cancers: Slight increase in risk for breast cancer only on combined HRT (assess risk before prescription), small increase in ovarian cancer risk after long term use, highest risk is endometrial cancer
  3. Cardiovascular disease: no inc. risk if started before 60yrs, inc. risk if started 10 years post menopause
  4. Small risk of stroke: risk is higher when taking oral over transdermal oestrogens and higher when taking combined over oestrogen only.
33
Q

What must we give to women with an endometrium on HRT? Why?

A

Progesterone- to prevent endometrial cancer (sometimes presents with post menopausal bleeding)

Oestrogen thickens endometrium (risk of cancer) so progesterone thins it

Assess HRT safety/ efficacy at 3 months then annually

34
Q

What are benefits of HRT?

A

Relief of symptoms of low oestrogen

Less osteoporosis related fractures (decreased by 1/3)- oestrogen promotes activity of osteoblasts

35
Q

How is gender different to sex?

A

Gender- what you identify as, its a social construct

Sex- biological

36
Q

What is gender dysphoria?

A

When gender non conforming causes distress

37
Q

What are treatments for supporting transgender males/females?

A

Trans Men- Testosterone injections or gels, progesterone to suppress menstrual bleeding
Trans Women- high dose oestrogen, reduce testosterone via GnRH agonists (desensitisation of HPG axis- make GnRH non-pulsatile) and anti androgen medication

38
Q

If there is no response to hCG injections for sperm induction after 6 months what should be given?

A

Add FSH injections

39
Q

What are positives of condoms?

A

Protect against STI’s
Easy to obtain- free from clinics
Non contraindications as not hormonal

40
Q

What are negatives of condoms?

A 
Can interrupt sex
Can reduce sensation
Can interfere with erection
Some skill to use
Two aren't better than one
41
Q

How does the OCP work?

A

Causes anovulation
Thickens cervical mucus
Thickens endometrial lining to reduce implantation

42
Q

With what conditions should you avoid OCP?

A 
Migraine with aura
Smoking
Stroke or CVD
Current breast cancer
Liver cirrhosis
Diabetes with complications
43
Q

What is cisgender?

A

Same sex and gender

44
Q

What is gender non-conforming?

A

Gender that doesn’t match assigned sex

45
Q

What is the effect of taking masculinising hormones for transgender men?

A 
Balding
Deeper voice/ acne/ increased coarser facial and body hair
Change in distribution of body fat
Enlargement if clitorus
Menstrual cycle stops
Increased muscle mass and strength
46
Q

What is the effect of feminising hormones for transgender women?

A

Height, voice and adams apple will not change
Consider sperm banking before taking therapy

1-3 months: decrease in sexual desire/ function / baldness slows or may reverse
3-6 months: softer skin/ change in body fat distribution/ decrease in testicular size/ breast development/ tenderness
6-12 months: hair may become softer and finer

47
Q

What are 2 causes of irregular periods?

A

PCOS

Hypothalamic amenorrhea

48
Q

What are causes of hypothalamic amenorrhea?

A

Stress
Excess exercise
Low body weight
Genetic susceptibility

49
Q

How does the OCP work?

A

Increases progesterone which neg. feedbacks on hypothalamus to decrease GnRH which decreases LH and FSH- no LH surge so follicle is lost and ovulation prevented.
Progesterone also thickens cervical mucus- hard for sperm penetration

Increases Estrogen which neg. feedbacks to ant. pituitary to dec. FSH secretion

50
Q

What is a possible sign of endometrial cancer?

A

Post menopausal bleeding

BRS Year 2 (110 decks)

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