Reproductive treatments Flashcards

1
Q

How do LH and FSH stimulate spermatogenesis?

A

LH stimulates Leydig cells to increase intratesticular testosterone FSH stimulates seminiferous tubule development and spermatogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the treatment for secondary hypogonadism in men requiring fertility?

A

Give hCG injections which act on LH receptors If no response after 6 months, add LH injections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what treatment should you give to a man with kallmann syndrome (congenital hypogonadotrophic hypogonadism)? What pretreatment testicular size has a better outcome?

A

FSH for 2-4 months then hCG treatment >6ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does someone qualify for testosterone replacement?

A

at least 2 low measurements of serum testosterone before 11am

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what forms of testosterone replacement are there?

A

daily gel eg. tostran 3 weekly IM injection (sustanon) 3 monthly IM injection (nedbido) implants, oral preparations (less common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what precautions should be taken with tostran (daily testosterone gel)

A

be careful not to contaminate partner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the safety cautions of taking testosterone?

A

Increased haematocrit (risk of hyperviscosity and stroke) Prostate specific antigen levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do we only want to develop one follicle during ovarian induction in PCOS?

A

if >1 follicle develops, this risks multiple pregnancy with more risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you restore ovulation in anovulatory PCOS?

A
  1. Lifestyle/weight loss/metformin 2. Letrozole (aromatase inhibitor) reduces oestradiol to reduce negative feedback 3. Clomiphene - oestradiol receptor antagonist 4. FSH stimulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does letrazole, an aromatase inhibitor, affect the gonadohypothalamopituitary axis?

A

Inhibits conversion of testosterone to oestradiol Oestradiol normally has a negative feedback effect on the hypothalamus and anterior pituitary By reducing oestradiol we are reducing negative feedback, therefore increasing release of GnRH and LH and FSH FSH stimulates follicle growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how does clomiphene (an oestradiol receptor antagonist) affect the gonado-hypothalamo-pituitary axis?

A

Works as an antagonist of the oestradiol receptors, reducing negative feedback of oestradiol (blinds the receptors to oestradiol), resulting in increased GnRH and FSH/LH, increased FSH stimulates follicle growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 4 stages of IVF treatment?

A
  1. FSH injection and oocyte retrieval
  2. Fertilisation in vitro
  3. Embryo incubation
  4. Embryo transfer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What two types of in vitro fertilisation are there?

A

Intra-cytoplasmic sperm injection (if problem with sperm)

In vitro fertilisation (standard)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two types of treatment that are used to prevent LH surge and premature ovulation?

A
  1. GnRH antagonist given on day 6 of IVF (or day 5 of FSH treatment)
  2. GnRH agonist given 8 days before FSH treatment and maintained for duration of treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can both a GnRH agonist and antagonist be used to block an LH surge?

A

GnRH is pulsatile

If you give a non-pulsatile GnRH agonist continuous high dose, there will be an initial flare and then LH inhibition due to desensitization of LH receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are the eggs carefully matured?

A

By hCG exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the symptoms of ovarian hyper-stimulation syndrome and what is it caused by?

A
  • pleural effusion
  • ascites
  • renal failure
  • ovarian torsion

hCG injection - hCG is very long lasting and can cause this side effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how does hCG work to cause egg maturation?

Why do we use it instead of LH?

A

acts on LH receptors

It is more effective and more likely to result in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the barrier methods of contraception?

A

male/female condom/ diaphragm or cap with spermicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the hormonal methods of contraception?

A

combined oral contraceptive pill

progestogen-only pill

long acting reversible contraception (LARC)

emergency contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the permanent methods of contraception?

A

Vasectomy

Female sterilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does the oral contraceptive pill work?

A

oestrogen provides negative feedback to hypothalamopituitary axis, decreasing GnRH and LH/FSH, resulting in anovulation

progesterone thins endometrial lining and thickens cervical mucus to reduce implantation and prevent sperm entering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the benefits of the combined oral contraceptive pill?

A

One pill a day

effective

doesn’t interrupt sex

reduce endometrial and ovarian cancer

can take several packets back to back and avoid withdrawal bleeds

weight neutral in 80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are the downsides of the combined oral contraceptive pill?

A
  • No protection against STIs
  • Difficult to remember
  • P450 enzyme inducers eg. antibiotics, may reduce efficacy
  • Not great during breastfeeding
  • side effects such as spotting, nausea, sore breasts, changes in mood and libido, feeling hungry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are three combined oral contraceptive pill non-contraceptive uses?

A
  1. Helps make periods lighter and less painful
  2. Withdrawal bleeds will usually be regular
  3. PCOS: help reduce LH and hyperandrogenism
26
Q

what are the benefits of the progesterone only pill or ‘mini pill’?

A
  • suitable if can’t take oestrogen
  • easy to take
  • doesn’t interrupt sex
  • can help heavy or painful periods
  • periods may stop
  • can be used when breastfeeding
27
Q

progesterone only pill negatives?

A
  • less reliably inhibits ovulation than OCP
  • No protection against STIs
  • can be difficult to remember
  • shorter acting so needs to be taken at the same time every day
  • side effects: irregular bleeding, headaches, sore breasts, changes in mood, changes in sex drive
28
Q

Give 3 examples of long acting reversible contraceptives

A
  1. Intra-uterine device (IUD) ie. copper coil
  2. Intra-uterine systems which secretes progesterone eg. mirena coil
  3. Progesterone only injectable contraceptives or subdermal implants.
29
Q

How long does the copper coil last for?

What are the downsides?

A

5-10 years

heavy periods, can come out during the first 3 months along with periods

30
Q

what are the benefits of coils?

A
  • can be used for women with or without previous children
  • Prevent implantation of conceptus - important for some religions
  • can be used as emergency contraception
31
Q

Precautions/ things to bear in mind regarding intra-uterine coils?

A

must exclude STIs and cervical screening must be up to date before insertion

rarely can cause ectopic pregnancy

32
Q

What are the three types of emergency contraception? How long can they be used after unprotected sex?

A
  1. Copper intra-uterine device <5 days after
  2. Emergency contraceptive pills:
  • ulipristal acetate 30mg (ellaOne) <5 days
  • levonorgestrel 1.5mg (Levonelle) <3 days
33
Q

how does ulipristal acetate (ellaOne) work?

A

stops progesterone working normally and prevents ovulation

34
Q

how does levonorgestrel work? who is it less effective in?

A

synthetic progesterone prevents ovulation

must be taken within 3 days of unprotected intercourse

women with BMI greater than 27kg/m2

35
Q

what are the side effects of emergency contraceptive pills?

A

headache, abdominal pain, nausea

liver P450 enzyme inducer medications make it less effective

If vomit within 2-3hr of taking it, may need to take another

36
Q

what is one of the major risks of the OCP?

A

risk of venous thromboembolism (VTE)/CVD/stroke

37
Q

in what circumstances should you avoid the OCP?

A

migraine with aura (risk of stroke)

smoking >15/day and age >35 years

stroke or CVD history

current breast cancer

liver cirrhosis

diabetes with retinopathy/nephropathy/neuropathy

38
Q

what other conditions may benefit from OCP?

A

menorrhagia

endometriosis

fibroids

39
Q

what are medications that can effect choice of contraception?

A

P450 liver enzyme inducing drugs eg. anti-epileptics, some antibiotics

teratogenic durgs eg. lithium or warfarin

40
Q

Which are the three most effective types of contraception?

A

Implant, IUS and IUD

41
Q

what does peri-menopausal mean?

A

within 12 months of last menstrual period

42
Q

what does post menopausal mean?

A

after 12 months of last menstrual period

43
Q

which is safer for venous thrombo-embolism, transdermal or oral oestrogens and why?

A

Oral oestrogens undergo first pass metabolism in the liver and increase SHBG, triglycerides, CRP

so transdermal is safer

44
Q

at what BMI should people avoid oral oestrogens?

A

>30

45
Q

what is the other risks besides VTE when having hormone replacement therapy?

A

breast cancer (hormone sensitive cancers)

only risk is in women with combined HRT (oestrogen and progesterone)

ovarian cancer - small increase in risk after long term use

cardiovascular risk if starting 10 years after menopause

small increased risk of stroke –> oral >transdermal oestrogens, combined >oestrogen only

46
Q

what must you do to prevent endometrial cancer in women when giving oestrogen?

A

also prescribe progestogens

47
Q

When should you assess hormone replacement therapy’s safety?

A
  • after 3 months
  • then annually
48
Q

post-menopausal bleeding can indicate what?

A

endometrial cancer

49
Q

name the benefits of HRT?

A

relief of sympyoms of low oestrogen:

  • flushing
  • disturbed sleep
  • decreased libido
  • low mood
  • less osteoporosis related fractures (decreased by 33%)
50
Q

cisgender means?

A

same sex and gender

51
Q

gender non-conforming

A

gender does not match assigned sex

52
Q

gender dysphoria

A

when gender not matching assigned sex leads to depression

53
Q

non-binary

A

gender does not match to traditional gender understanding

eg. agender, bigender, pangender, gender fluid

54
Q

transgender

A

transitioning or planning to transition physical appearance from one to another

55
Q

transgender males

transgender women

A

female sex at birth, but male gender

male sex at birth, but female gender

56
Q

What treatment is given to prepubertal young people who want gender reassignment surgery?

A

GnRH agonist for pubertal suppression and then sex steroids

gender reassignment surgery after 1-2 years of hormonal treatment

57
Q

which sex steroid hormones are given to transgender men?

what are the side effects?

A

testosterone injection or gel, progesterone to suppress menstrual bleeding if needed

  • polycythaemia
  • lower HDL
  • obstructive sleep apnoea
58
Q

what happens as a result of giving testosterone to transgender men, and in what period?

A
  • balding
  • deeper voice/acne/increased and coarser facial and body hair
  • change in distribution of body fat
  • enlargement of clitoris
  • menstrual cycle stops
  • increased muscle mass and strength

1-6 months

59
Q

what are the feminizing hormones for transgender women?

A
  1. oestrogen - 4-5mg per day –> aim for estradiol levels of 734pmol/L
  2. GnRH agnosists to induce desensitization of HPG axis, and anti-androgen medications eg. cyproterone acetate, spironolactone - has a negative effect on androgen receptor
60
Q

What are the effects of giving feminising hormones for transgender women?

A
  • 1-3 months decrease in sexual desire/function, baldness slows/may reverse
  • 3-6 months softer skin and change in body fat distribution, change in testicular size, breast development and tenderness
  • 6-12 months hair becomes softer and finer