Reproductive treatments Flashcards
Diagnosing male hypogonadism
Measure testosterone twice, in the morning on an empty stomach
What are the four types of testosterone replacement?
Daily gel (avoid contaminating female partner .: no sharing of towels)
3 weekly intramuscular injection,
3 monthly intramuscular injection,
implants
What are two molecules that need to be measured for safety during testosterone replacement?
Haematocrit increase (stroke, hyperviscosity) // Prostate Specific Antigen levels (BPH)
Why is LH and FSH needed for male fertility?
Spermatogenesis - LH stimulates Leydig cells to increase intratesticular testosterone levels,
FSH stimulates seminiferous tubule development & spermatogenesis
What injections should be given if a man wishes fertility?
hCG injections for 6 months, then FSH injections
Testosterone can suppress LH/FSH and decrease fertility
What are the two most common causes of irregular periods?
PCOS and Hypothalamic Amenorrhea (acquired hypogonadotrophic hypogonadism - exercise, low bmi)
What are the different causes of PCOS and hypothalamic amenorrhea ?
PCOS - Hyperandrogenism and PCO morphology on ultrasound //
Hypothalamic Amenorrhea - low BMI, stress, exercise excess
How many follicles do you aim to develop in ovarian induction and why?
1 - multiple ovulated could lead to multiple pregnancies, posing risk to mother and baby. Therefore only aim for a small increase in FSH
What 5 treatments would you give in PCOS to restore ovulation?
Lifestyle/Weight Loss, Metformin,
Letrozole (aromatase inhibitor, decrease oestrogen and increases FSH), Clomiphene (oestradiol receptor),
FSH stimulation
What 5 treatments would you give for hypothalamic amenorrhea to restore ovulation?
Same as PCOS BUT: weight gain instead of weight loss // pulsatile GnRH pump instead of metformin
Why would you not prefer to give letrozole or clomiphene for hypothalamic amenorrhea?
These reduce oestradiol levels which are already low in hypothalamic amenorrhea
What is the percentage chance of conception if a couple has regular sex for one year without contraception?
85% (14% of couples are infertile)
What is the four step process in IVF?
Oocyte retrieval,
fertilisation in vitro,
embryo incubation,
embryo transfer
What are the two different processes for fertilisation in IVF?
In vitro fertilisation (on agar plate) or Intra-cytoplasmic sperm injection (directly inject sperm into egg nucleus - usually done if there is a problem with sperm fertility)
What are the other advantages/disadvantages of condoms?
Easy to obtain // Reduce sensation, User-dependent
How does the oral contraceptive pill cause changes in the body?
Oestrogen and progesterone cause negative feedback, inhibiting release of LH and FSH
What are the three effects of the COC pill in the body?
Anovulation,
thickening of cervical mucus, thinning of endometrial lining (reduces implantation)
What are the advantages/disadvantages of the combined pill?
Once a day, effective // have to remember, upregulates p450 so other meds less effective
What are the side effects of the COC pill?
Nausea, mood changes, blood clots (rare)
What are three non-contraceptive uses of the COC pill?
Makes periods lighter and less painful - Dysmenorrhoea, Menorrhagia (Endometriosis/Fibroids) //Withdrawal Bleeds //
PCOS (reduce LH and hyperandrogenism)
What are the contraindications for COC pill?
Risk of VTE: Migraine, Smoking, CVD, Breast Cancer
What is the POP pill and when is it used?
Progesterone only pill, used when you cannot take oestrogen (ie if there is an increased clot risk) & breastfeeding
What are the two disadvantages of the POP pill?
Less reliably inhibits ovulation // Shorter acting - needs to be taken at the same time every day
What are two examples of LARCs?
Long Acting Reversible Contraception - Coils, Progesterone-only injectable contraceptives
