Reproductive Treatments Flashcards
how is male hypogonadism confirmed?
2x low fasting serum testosterone in morning
Symptoms of hypogonadism
Loss of morning erections,low energy,low libido
Common treatment for male hypogonadism
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)
what is needed to induce spermatogenesis?
gonadotrophins FSH and LH
LH FSH function in males
LH stimulates Leydig cells → increase in intratesticular testosterone
FSH stimulates seminiferous tubule development + spermatogenesis
treatment for male cause infertility?
hCG injections for 6 months, then +FSH injections if no effect
hCG mimicks LH so activates leydig cells thus producing testosterone
what does hCG do?
Acts on LH
would you ever give testosterone in hypogonadism
no, could further reduce FSH and LH → spermatogenesis worse. issue is in pituitary
causes of hypothalamic amenorrhea?
low body weight, excessive exercise, stress, genetic susceptibility
what is the aim of ovulation induction?
Develop 1 ovarian follicle
Via small FSH increase
If more than 1 then risk of multiple pregnancy
treatments to restore ovulation in PCOS?
lifestyle/5% weight loss
metformin
- letrozolearomatase inhibitor → more oestrogen less androgens
- clomipheneoestradiol receptor modulation
FSH stimulation
treatments to restore ovulation in hypothalamic amenorrhea?
lifestyle / weight gain / reduce exercise
pulsatile GnRH pump
FSH stimulation
letrozole
clomiphene
steps of IVF treatment?
oocyte retrieval → fertilisation in vitro/intracytoplasmic injection if sperm count is low → embryo incubation → embryo transfer
action of oestrogen and progesterone in HPG axis?
negative feedback on pituitary and hypothalamus
how does contraceptive pill work?
increase oestrogen and progesterone
anovulation, thickening of cervical mucus, thining of endometrial lining = less implantation
permanent methods of contraception?
Vasectomy and female sterilization
plus sides for contraceptive pills and dis
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
what are the non contraceptive uses?
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
Alternative for contraceptive pill
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
examples of long-acting reversible contraceptives?
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)
examples of emergency contraceptives?
copper intrauterine device (up to 5 days after unprotection)
morning after pills
ulipristal acetate (stops progesterone working normally by binding to prog receptors, prevents ovulation, up to 5 days after)
levonorgestrel (synthetic progesterone preventing ovulation, up to 3 days after)
side effects and contraindications of emergency cont
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
HRT
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
all women with an endometrium must be prescribed what?
Progestagens
As oestrogen alone causes endometrial hyperplasia
postmenopausal bleeding could indicate what when on HRT
endometrial cancer
other risks of HRT?
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
hormone treatment for transgender men?
testosterone + progesterone if needed to suppress menstrual bleeding
hormone treatment for transgender women?
reduce testosterone e.g. with GnRH agonists, anti-androgen medications
high dose oestrogen (similar side effect profile to OCP)
