Reproductive Treatments

Question 1

What are the symptoms for low testosterone?

Answer 1

-Loss of early morning erections
-Lower libido
-Decreased energy
-Lower frequency of shaving

Question 2

How do we diagnose low T?

Answer 2

At least 2 low measurements of serum T before 11am (when its meant to be high)

Question 3

What different types of T replacement treatments are there?

Answer 3

-Daily gel (e.g Tostran)
-3 weekly intramuscular injections (e.g Nebido)
-implants/ oral route

Question 4

What do we need to monitor for safety?

Answer 4

-Increased haematocrit
-Prostate

Question 5

What’s the difference between primary and secondary hypogonadism

Answer 5

Primary- Issue with the sex organ (balls)
Secondary- Issue is somewhere else affecting the balls

Question 6

Whats the difference in how you treat primary and secondary hypogonadism?

Answer 6

Primary- Hard to treat
Secondary- (deficiency in gonadotrophins) so treat with gonadotrophins to induce spermatogenesis i.e LH and FSH.

Question 7

What does LH and FSH do to the testes?

Answer 7

LH- stimulates Leydig cells to increase intratesticular T to much higher levels in circulation

FSH- Stimulates seminiferous tubule development and spermatogenesis.

Question 8

For secondary hypogonadism what medications do we give in men desiring fertility?

Answer 8

-hCG injections, if no response after 6 months add FSH injections.

Question 9

What is hypothalamic amenorrhoea?

Answer 9

When you have insufficient energy for fertility from decrease in hypothalamus function

Question 10

What are some causes of hypothalamic amenorrhoea?

Answer 10

-Low body weight
-Excessive exercise
-Stress
-Genetic susceptibility

Question 11

What is the aim of ovulation induction?

Answer 11

To develop 1 ovarian follicle

Question 12

What are the different methods to restore ovulation?

Answer 12

-Lifestyle/weight loss/ metformin
-FSH stimulation by injection
-Letrozole
-Clomiphene

Question 13

What is letrozole and clomiphene and how do they work?

Answer 13

Letrozole- Is an aromatase inhibitor. Inhibits aromatase which converts T into E2. Decreased E2 has negative feedback on hypothalamus therefore increasing FSH and stimulating follicle growth.

Clomiphene- Is an oestradiol receptor modulator. Is an E2 antagonist working in the same way as letrozole to decrease E2.

Question 14

What is premature ovulation and how do we prevent it?

Answer 14

Release of egg from follicle before we collect eggs for IVF,
We give a hormone that suppresses LH surge.

Question 15

What are the two ways of suppressing the LH surge?

Answer 15

-GnRH antagonist protocol (short protocol)
-GnRH agonist protocol (long protocol)

Question 16

Explain how the GnRH antagonist and agonist protocols work?

Answer 16

GnRH antagonist protocol:
- Start FSH from day 2 of menstrual cycle
- At day 6 we start GnRH antagonist- will prevent LH surge

GnRH agonist protocol:
- Start GnRH agonist from day 21 of previous cycle (day -7 of current cycle)
- Start FSH like usual on day 2

Question 17

How can both a GnRH agonist and antagonist be used to block an LH surge?

Answer 17

• GnRH needs to be given in pulsatile manner to stimulate LH
• If we give non-pulsatile continuous GnRH, we get desensitisation of GnRH receptor- causing initial flare of LH, but then LH inhibition.

Question 18

How do we mature the egg after preventing premature ovulation?

Answer 18

• We give LH exposure to induce oocyte maturation
• When eggs are immature, they’re at metaphase 1 and are diploid
• After being exposed to LH, they go into metaphase 2 and become haploid (can now be fertilised by sperm)

Question 19

Which hormones do we give commonly to induce oocyte maturation?

Answer 19

-hCG: acts on LH receptors but is much longer acting than LH

-GnRH agonist is second most common