Reproductive Treatments Flashcards
How is primary hypogonadism in males treated?
Hard to treat via hormones
How is secondary hypogonadism in males treated? How does this help?
Gonadotrophins (LH/FSH)
Stimulates spermatogenesis
What hormone stimulates testosterone via what cells?
LH stimulates it via leydig cells
What hormone stimulates spermatogenesis in what structure?
FSH in seminiferous tubules
What injections for male infertility target LH receptors?
hCG injections
Does Congenital Secondary Hypogonadism have better, same or worse prognosis than Acquired Secondary Hypogonadism in males and why?
Worse- he has not gone through mini puberty
When is testosterone replacement given?
If not desiring fertility
What testosterone replacements are available?
Daily gel- tostran
3 weekly injection
3 monthly injection
What do we have to monitor when giving testosterone replacement?
Observe haematocrit (risk of hyperviscosity and stroke) Prostate (PSA levels)
How is fertility mainly improved for patients with PCOS?
Try to stimulate ovulation (ovulation induction) via development of one ovarian follicle (avoids multiple pregnancy)
How is ovulation induction encouraged?
- Lifestyle / Weight Loss / Metformin
- Letrozole (Aromatase inhibitor)
- Clomiphene (Oestradiol receptor antagonist)
- FSH stimulation (injection)
How does letrozole/ aromatase inhibitor/ oestradiol receptor antagonist work?
Reduces negative feedback from oestradiol
How does IVF work?
High dose of FSH to stimulate eggs
Prevent premature ovulation via GnRH agonist/antagonist
Give LH to allow egg maturation
Retrieve eggs from ovary
Fertilisation in vitro or intracytoplasmic injection of sperm
Embryo incubation
Embryo transfer
When is intracytoplasmic injection of sperm (ICSI) used and what is it?
When theres a problem with the sperm, inject one sperm into an egg
What do we do to ovulation in IVF?
Prevent it by giving medicine to prevent premature LH surge
How is premature LH surge prevented in IVF?
Via GnRH antagonist or GnRH agonist- if given GnRH in a non pulsatile way LH is inhibited
How are eggs matured in IVF and where?
By giving LH then hCG-they should still be in the ovary
What happens in egg maturation?
Egg goes from metaphase 1 to metaphase 2 to allow it to halve its DNA content
How does Ovarian hyper stimulation syndrome occour?
Due to long lasting hCG during IVF
How does Ovarian hyper stimulation syndrome present?
Pleural effusion
Ascites
Renal failure
Ovarian torsion
What are methods of contraception?
Barrier: male / female condom/ diaphragm or cap with spermicide
Combined Oral Contraceptive Pill (OCP)
Progestogen-only Pill (POP)
Long Acting Reversible Contraception (LARC)
Emergency Contraception
Vasectomy
Female sterilisation
What are positives of the OCP?
Easy to take Effective Doesn’t interrupt sex Can take several packets back to back and avoid withdrawal bleeds Reduce endometrial and ovarian cancer
What are negatives of the OCP?
It can be difficult to remember
No protection against STIs
P450 Enzyme Inducers may reduce efficacy
Not the best choice during breast feeding
What are side effects of the OCP?
Spotting (bleeding in between periods) Nausea Sore breasts Changes in mood or libido Feeling more hungry
What are non contraceptive uses of the OCP?
Lighter/less painful periods
PCOS (reduces LH and hyperandrogenism)
What is the progesterone only pill (mini pill)?
Works as OCP but less reliably inhibits ovulation
Often suitable if cant take oestrogen
Can be used when breastfeeding
What are negatives of the mini pill?
Can be difficult to remember
No protection against STIs
Shorter acting – needs to be taken at the same time each day
What are the common long acting reversible contraceptives (LARCs)?
IUD (copper coil)- decreases sperm survival
Intra uterine systems- secretes progesterone
Progestogen-only injectable contraceptives or subdermal implants
What are the emergency contraceptives?
IUD
Emergency contraceptive pill (ellaOne in 5 days, Levonelle in 3 days- less effective)
What are side effects of emergency contraception?
Headache, abdominal pain, nausea
What should we consider when chosing contraception?
Risk of venous thromboembolism
Other conditions
Need for prevention of STIs
Concurrent medication
What are risks of HRT?
Venous thrombo embolism- use transdermal oestrogens if this is the case
Hormone sensitive cancers (mainly endometrial but also breast and ovarian, especially if use is long term)
Cardiovascular disease
Small risk of stroke
What must we give with oestrogen? Why?
Progesterone- to prevent endometrial cancer (presents with post menopausal bleeding)
What are benefits of HRT?
Relief of symptoms
Less osteoporosis related fractures
How is gender different to sex?
Gender- what you identify as
Sex- biological
What is gender dysphoria
When gender non conforming causes depression
What are treatments for supporting transgender males/females?
Men- Testosterone injections or gels, progesterone to surpress menstrual bleeding
Women- high dose oestrogen, reduce testosterone via GnRH agonists (desensitisation of HPG axis)
What are treatments for supporting transgender males/females and gender non binary individuals?
Men- Testosterone injections or gels, progesterone to surpress menstrual bleeding
Women- high dose oestrogen, reduce testosterone via GnRH agonists (desensitisation of HPG axis)
