Reproductive Treatments Flashcards
What are the indicators that spermatogenesis induction is needed?
Primary and secondary hypogonadism
Is primary or secondary hypogonadism in males harder to treat?
Primary hypogonadism
How is secondary hypogonadism treated to improve fertility in males?
Gonadotrophins to induce spermatogenesis
How does LH induce spermatogenesis?
Stimulates Leydig cells to increase intratesticular testosterone levels
How does FSH induce spermatogenesis?
Stimulates seminiferous tubule development and spermatogenesis
What treatment is given for sperm induction?
hCG injections, if no response after six months then give FSH injections
What treatment should be avoided in men seeking fertility?
Testosterone treatment as this will decrease FSH and LH further and further decrease spermatogenesis
How do hCG injections act to increase spermatogenesis?
Act on LH receptors
What is Kallman syndrome?
A congenital secondary hypogonadism resulting in absence of mini-puberty
What treatment should be given to a patient with Kallman syndrome to increase fertility?
2-4 months of pre-treatment of FSH before administering hCG treatment
What are the symptoms associated with testosterone deficiency?
Loss of early morning erections, low libido, decreased energy
What diagnostic tests should be undertaken to confirm testosterone deficiency?
2 low measurements of serum testosterone before 11am
What treatment should be given to treat testosterone deficiency in someone not desiring fertility?
Daily gel e.g Tostran, 3 weekly intramuscular injections
What are the aims of ovulation induction?
To develop one ovarian follicle and increase FSH by a small amount
What are the risks of more than one ovarian follicle being developed in ovulation induction?
Multiple pregnancies which can cause risks for both mother and baby during pregnancy
What four treatments are given to restore ovulation in a patient with PCOS?
1.lifestyle changes/ metformin to reduce body weight
2. Letrozole - aromatase inhibitor
3. Clomiphene - oestradiol receptor antagonist
4. FSH stimulation
Outline the mechanism of action of letrozole
Inhibits aromatase in the ovaries therefore reducing negative feedback causing the hypothalamus to make more GnRH increasing LH and FSH levels
Outline the mechanism of action of Clomiphene
Blocks oestradiol receptors in the hypothalamus and pituitary resulting in an increase in gonadotrophins
What are the 4 stages of IVF treatment?
Oocyte retrieval, fertilisation in vitro, embryo incubation, embryo transfer
What happens pre-oocyte retrieval in IVF treatment?
FSH stimulation induces growth of multiple follicles, GnRH antagonist to prevent premature ovulation, trigger injection of hCG to mature eggs for collection
What are the 2 major issues that need to be overcome in IVF treatment for it to be successful?
Premature ovulation due to LH surge. Ovarian hyper-stimulation syndrome
How does long acting GnRH agonist reduce LH?
Ig GnRH is given in a continuous high dose GnRH is no longer pulsatile therefore GnRH receptors will be desensitised causing LH inhibition
what causes ovarian hyper-stimulation syndrome?
LH must be given to achieve egg maturation, sometimes there is an excessive response to gonadotrophions (GnRH). This overstimulates the ovaries
What happens to the ovaries in response to excessive gonadotrophins?
Overstimulated ovaries enlarge and release chemicals into the bloodstream
