Reproductive treatments Flashcards
How would you treat a male with low testosterone (hypogonadism) not desiring fertility?
(first you need to confirm at least 2 low fasting measurements of serum testosterone in morning and investigate the cause of low testosterone)
Testosterone Replacement:
- Daily Gel: Care not to contaminate partner
- 3 weekly intramuscular injection
- 3 monthly intramuscular injection
- Less Common (Implants, oral preparations)
Safety Monitoring:
Increased Haematocrit (risk of hyperviscosity and stroke)
Prostate (Prostate Specific Antigen (PSA) levels)
Treats:
- Loss of early morning erections
- Low libido
- Decreased energy
- Reduced shaving frequency
DOES NOT TREAT INFERTILITY (testosterone reduces LH/FSH levels- worsens spermatogenesis)
How would you treat a male with low testosterone (hypogonadism) who is desiring fertility?
(Secondary Hypogonadism-
deficiency of gonadotrophins (LH/FSH) ie hypogonadotrophic hypogonadism:)
Gonadotrophins (ie LH and FSH) needed to induce spermatogenesis (LH stimulates Leydig cells to increase intratesticular testosterone levels much higher than in circulation & FSH stimulates seminiferous tubule development and spermatogenesis.)
treatment for inducing spermatogenesis:
1. hCG injections (which act on LH-receptors and induce spermatogenesis)
2. If no response after 6 months, then add FSH injections.
How would you treat Polycystic Ovary Syndrome?
Restore Ovulation :
Lifestyle / Weight Loss 5%
Metformin
Letrozole- first line in PCOS (Aromatase inhibitor)
Clomiphene (Oestradiol receptor modulator)
FSH stimulation
How would you treat Hypothalamic Amenorrhoea?
Restore Ovulation :
Lifestyle / Weight gain / reduce exercise
Pulsatile GnRH pump
FSH stimulation
Letrozole (Aromatase inhibitor)
Clomiphene (Oestradiol receptor modulator)
What are some risks with ovulation induction?
Ovulation induction methods aim to cause small increase in FSH & develop one ovarian follicle
- If >1 follicle develops, this risks multiple pregnancy (ie Twin / Triplet)
- Multiple pregnancy has risks for mother and baby during pregnancy
What does IVF treat? What is the process of IVF?
“Infertility”
1. Oocyte retrieval
2. Fertilisation in vitro (Intra-cytoplasmic sperm injection if needed)
3. Embryo incubation
4. Embryo transfer
What are the different contraception methods?
Methods:
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
What are the pros and cons of barrier contraception (condoms)?
Positives:
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
Negatives
Can interrupt sex
Can reduce sensation
Can interfere with erections
Some skill to use eg correct fit.
Two are not better than one
What are the pros and cons of Combined Oral Contraceptive Pill?
Positives:
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 Ca
Weight Neutral in 80%
(10% gain, 10% lose)
Has some non- contraceptive uses
Negatives:
It can be difficult to remember
No protection against STIs
P450 Enzyme Inducers may reduce efficacy
Not the best choice during breast feeding
Possible side effects:
- Spotting (bleeding in between periods)
- Nausea
- Sore breasts
- Changes in mood or libido
- Feeling more hungry (try different OCPs to see which suits best)
Extremely rare side effects:
- Blood clots in the legs or lungs (2 in 10,000)
What are the non-contraceptive uses of Combined Oral Contraceptive Pills?
- Helps make periods lighter and less painful
- Endometriosis / Fibroids
- Dysmenorrhoea (painful periods)
- Menorrhagia (heavy periods) - Regular Withdrawal Bleeds / or no Bleeds
- PCOS: OCP can helps reduce LH and hyperandrogenism (acne / hirsutism)
What are the pros and cons of the Progesterone Only Pill (POP) or Mini Pill?
Positives:
Works as OCP but less reliably inhibits ovulation
Often suitable if they can’ttake oestrogen
Easy to take – one pill per day with no break
It doesn’t interrupt sex
Can help heavy or painful periods
Periods may stop (temporarily)
Can be usedwhen breastfeeding
Negatives:
Can be difficult to remember
No protection against STIs
Shorter acting – needs to be taken at the same time each day
Possible side effects:
- Irregular bleeding
- Headaches
- Sore breasts
- Changes in mood
- Changes in sex drive
What are the 2 different types of Long-Acting Reversible Contraceptives you can take?
- Coils:
Suitable for most women
Prevent implantation of conceptus – important for some religions
Rarely can cause Ectopic Pregnancy
Can be used as emergency contraception - Progesterone-only injectable contraceptives/ subdermal implants:
Long-lasting so may not be best option if desiring fertility soon.
What are the 2 types of coils you can use? what are the pros and cons for each?
Intra-Uterine Device (IUD) ie Copper Coil-
Pros:
mechanically prevent implantation, decrease sperm / egg survival
Most effective emergency contraception
can be fitted up to 5 days after unprotected sex- can be used as emergency contraception (<1% chance of pregnancy)
Lasts 5-10yrs
Cons:
Can cause heavy periods, and 5% can come out especially during first 3months with periods.
Intra-Uterine Systems (IUS)which secretes progesterone (eg Mirena Coil) to thin lining of the womb and thicken cervical mucus
Pros:
can be used to help with heavy bleeding)
Lasts 5yrs.
What are the pros and cons of using emergency contraceptive pills “morning after pill”
- Ulipristal acetate 30mg (ellaOne)
Ulipristal acetate stops progesterone working normally and prevents ovulation
Must be taken within 5 days of unprotected intercourse (earlier has better efficacy).
1-2% can get pregnant if ovulation has already occurred. - Levonorgestrel 1.5mg (Levonelle)
less effective (esp if incr BMI >27 kg/m2)
Synthetic Progesterone prevents ovulation (don’t cause abortion)
Must be taken within 3 days of unprotected intercourse. 1-3% failure rate
Side effects of the pills: (headache, abdominal pain, nausea)
Liver P450 Enzyme inducer medications make it less effective.
If vomit within 2-3hrs of taking it, need to take another.
In which cases would you not consider using OCP?
OCP’s risk venous thromboembolism: avoid if:
Migraine with aura (risk of stroke)
Smoking (>15/day) at age >35yrs
Stroke or CVD history
Current Breast cancer
