Reproductive Treatments

Question 1

What are the indicators that spermatogenesis induction is needed?

Answer 1

Primary and secondary hypogonadism

Question 2

Is primary or secondary hypogonadism in males harder to treat?

Answer 2

Primary hypogonadism

Question 3

How is secondary hypogonadism treated to improve fertility in males?

Answer 3

Gonadotrophins to induce spermatogenesis

Question 4

How does LH induce spermatogenesis?

Answer 4

Stimulates Leydig cells to increase intratesticular testosterone levels

Question 5

How does FSH induce spermatogenesis?

Answer 5

Stimulates seminiferous tubule development and spermatogenesis

Question 6

What treatment is given for sperm induction?

Answer 6

hCG injections, if no response after six months then give FSH injections

Question 7

What treatment should be avoided in men seeking fertility?

Answer 7

Testosterone treatment as this will decrease FSH and LH further and further decrease spermatogenesis

Question 8

How do hCG injections act to increase spermatogenesis?

Answer 8

Act on LH receptors

Question 9

What is Kallman syndrome?

Answer 9

A congenital secondary hypogonadism resulting in absence of mini-puberty

Question 10

What treatment should be given to a patient with Kallman syndrome to increase fertility?

Answer 10

2-4 months of pre-treatment of FSH before administering hCG treatment

Question 11

What are the symptoms associated with testosterone deficiency?

Answer 11

Loss of early morning erections, low libido, decreased energy

Question 12

What diagnostic tests should be undertaken to confirm testosterone deficiency?

Answer 12

2 low measurements of serum testosterone before 11am

Question 13

What treatment should be given to treat testosterone deficiency in someone not desiring fertility?

Answer 13

Daily gel e.g Tostran, 3 weekly intramuscular injections

Question 14

What are the aims of ovulation induction?

Answer 14

To develop one ovarian follicle and increase FSH by a small amount

Question 15

What are the risks of more than one ovarian follicle being developed in ovulation induction?

Answer 15

Multiple pregnancies which can cause risks for both mother and baby during pregnancy

Question 16

What four treatments are given to restore ovulation in a patient with PCOS?

Answer 16

1.lifestyle changes/ metformin to reduce body weight
2. Letrozole - aromatase inhibitor
3. Clomiphene - oestradiol receptor antagonist
4. FSH stimulation

Question 17

Outline the mechanism of action of letrozole

Answer 17

Inhibits aromatase in the ovaries therefore reducing negative feedback causing the hypothalamus to make more GnRH increasing LH and FSH levels

Question 18

Outline the mechanism of action of Clomiphene

Answer 18

Blocks oestradiol receptors in the hypothalamus and pituitary resulting in an increase in gonadotrophins

Question 19

What are the 4 stages of IVF treatment?

Answer 19

Oocyte retrieval, fertilisation in vitro, embryo incubation, embryo transfer

Question 20

What happens pre-oocyte retrieval in IVF treatment?

Answer 20

FSH stimulation induces growth of multiple follicles, GnRH antagonist to prevent premature ovulation, trigger injection of hCG to mature eggs for collection

Question 21

What are the 2 major issues that need to be overcome in IVF treatment for it to be successful?

Answer 21

Premature ovulation due to LH surge. Ovarian hyper-stimulation syndrome

Question 22

How does long acting GnRH agonist reduce LH?

Answer 22

Ig GnRH is given in a continuous high dose GnRH is no longer pulsatile therefore GnRH receptors will be desensitised causing LH inhibition

Question 23

what causes ovarian hyper-stimulation syndrome?

Answer 23

LH must be given to achieve egg maturation, sometimes there is an excessive response to gonadotrophions (GnRH). This overstimulates the ovaries

Question 24

What happens to the ovaries in response to excessive gonadotrophins?

Answer 24

Overstimulated ovaries enlarge and release chemicals into the bloodstream

Question 25

What are the complications associated with ovarian hyper-stimulation syndrome?

Answer 25

hCG has long lasting effects, chemicals make blood vessels leaky, abdominal swelling, less blood in blood vessels leading to renal failure. Ovaries become so big they twist on themselves

Question 26

List some examples of temporary methods of contraception

Answer 26

Barrier (male/female condom), combined oral contraceptive pill, progesterone-only pill, long acting reversible contraception

Question 27

List some examples of permanent methods of contraception

Answer 27

Vasectomy, female sterilisation

Question 28

How do the OCP and POP cause anovulation?

Answer 28

Cause negative feedback on hypothalamus and pituitary

Question 29

How does the progesterone only pill act as a contraceptive?

Answer 29

Causes thickening of cervical mucus and thinning of endometrial lining reduce ovum implantation

Question 30

What enzymes can reduce the efficacy of the OCP and POP?

Answer 30

P450

Question 31

Aswell as a form of contraception, the OCP can also be used to treat what condition?

Answer 31

PCOS by helping reduce LH and hyperandrogenism

Question 32

What is the main downside of POP in comparison to OCP?

Answer 32

Shorter acting- needs to be taken at the same time each day

Question 33

Outline the side effects of the OCP

Answer 33

Spotting, nausea, sore breasts, changes in mood or libido, feeling more hungry, VTE (blood clots in the legs or lungs, 2 in 10,000)

Question 34

Outline the side effects of POP

Answer 34

Irregular bleeding, headaches, sore breasts, changes in mood, changes in sex drive