Reproductive Treatments

Question 1

how is male hypogonadism confirmed?

Answer 1

2x low fasting serum testosterone in morning

Question 2

Symptoms of hypogonadism

Answer 2

Loss of morning erections,low energy,low libido

Question 3

Common treatment for male hypogonadism

Answer 3

daily gel, 3 weekly intramuscular injection, 3 monthly intramuscular injection

watch haemaocrit as risk of hyper viscosity,watch PSA,don’t contaminate partner with gel

(Secondary)

Question 4

what is needed to induce spermatogenesis?

Answer 4

gonadotrophins FSH and LH

Question 5

LH FSH function in males

Answer 5

LH stimulates Leydig cells → increase in intratesticular testosterone

FSH stimulates seminiferous tubule development + spermatogenesis

Question 6

treatment for male cause infertility?

Answer 6

hCG injections for 6 months, then +FSH injections if no effect
hCG mimicks LH so activates leydig cells thus producing testosterone

Question 7

what does hCG do?

Answer 7

Acts on LH

Question 8

would you ever give testosterone in hypogonadism

Answer 8

no, could further reduce FSH and LH → spermatogenesis worse. issue is in pituitary

Question 9

causes of hypothalamic amenorrhea?

Answer 9

low body weight, excessive exercise, stress, genetic susceptibility

Question 10

what is the aim of ovulation induction?

Answer 10

Develop 1 ovarian follicle
Via small FSH increase
If more than 1 then risk of multiple pregnancy

Question 11

treatments to restore ovulation in PCOS?

Answer 11

lifestyle/5% weight loss

metformin

• letrozolearomatase inhibitor → more oestrogen less androgens
• clomipheneoestradiol receptor modulation

FSH stimulation

Question 12

treatments to restore ovulation in hypothalamic amenorrhea?

Answer 12

lifestyle / weight gain / reduce exercise

pulsatile GnRH pump

FSH stimulation

letrozole

clomiphene

Question 13

steps of IVF treatment?

Answer 13

oocyte retrieval → fertilisation in vitro/intracytoplasmic injection if sperm count is low → embryo incubation → embryo transfer

Question 14

action of oestrogen and progesterone in HPG axis?

Answer 14

negative feedback on pituitary and hypothalamus

Question 15

how does contraceptive pill work?

Answer 15

increase oestrogen and progesterone

anovulation, thickening of cervical mucus, thining of endometrial lining = less implantation

Question 16

permanent methods of contraception?

Answer 16

Vasectomy and female sterilization

Question 17

plus sides for contraceptive pills and dis

Answer 17

effective, weight neutral in most, reduce ovarian and endometrial cancer, withdrawal bleeds can be avoided

no STI protection, side effects including spotting, nausea, sore breasts, changes in mood (& blood clots in lungs and legs). P450 enzyme inducers can reduce efficacy

Question 18

what are the non contraceptive uses?

Answer 18

making periods lighter and less painful, for menorrhagia (heavy periods), dysmenorrhea (painful periods) can help with PCOS symptoms as reduces LH and hyperandrogenism via increasing SHBG

Question 19

Alternative for contraceptive pill

Answer 19

Progesterone only

often if oestrogen can’t be taken, less reliable ovulation inhibition, shorter acting (same time take each day)
Can be used when breast feeding

Question 20

examples of long-acting reversible contraceptives?

Answer 20

coils (intrauterine devices → mechanically prevent implantation, intrauterine systems → secrete progesterone, thin womb lining and thicken mucus)
IUD-mechanically prevents implantation,lasts 5-10 yrs,can cause heavy periods and can come out during first 3 months with periods
IUS-secreted progesterone to thin lining of the womb and thicken cervical mucus (can reduce heavy bleeding),lasts 5 years
progesterone only injectable contraceptives/subdermal implants (long lasting)

Question 21

examples of emergency contraceptives?

Answer 21

copper intrauterine device (up to 5 days after unprotection)

morning after pills

ulipristal acetate (stops progesterone working normally, prevents ovulation, up to 5 days after)

levonorgestrel (synthetic progesterone preventing ovulation, up to 3 days after)

Question 22

side effects and contraindications of emergency cont

Answer 22

vomiting (take another if within a few hours), nausea, headache, abdominal pain

liver P450 enzyme inducer meds make less effective (drug metaboliser)

avoid OCP if migraine w aura, smoking 15+ a day and 35+, stroke or cvd history, current breast cancer

also other stuff like endometriosis, premenstrual syndrome, menorrhagia, fibroids, hirsutism

Question 23

HRT

Answer 23

menopause hormone treatment
Reduces risk of osteoporosis,relieves low oestrogen symptoms eg flushing sweats disturbed sleep decreased libido low mood

Risk of venous thromboembolism
Higher risk for breast cancer and ovarian
Transdermal oestrogen are safer for VTE than oral,avoid oral in BMI > 30kg/m^2

Question 24

all women with an endometrium must be prescribed what?

Answer 24

Progestagens
As oestrogen alone causes endometrial hyperplasia

Question 25

postmenopausal bleeding could indicate what when on HRT

Answer 25

endometrial cancer

Question 26

other risks of HRT?

Answer 26

cardiovascular disease (esp if started later eg 10 years after menopause, better in younger women soon after menopausal ), stroke (slightly higher for oral and for combined)

Risk of breast cancer related to long duration of treatment (continuous treatment worse than sequential)

Ovarian cancer risk after LT use

Question 27

hormone treatment for transgender men?

Answer 27

testosterone + progesterone if needed to suppress menstrual bleeding

Question 28

hormone treatment for transgender women?

Answer 28

reduce testosterone e.g. with GnRH agonists, anti-androgen medications

high dose oestrogen (similar side effect profile to OCP)