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Endocrinology > Reproductive Treatments > Flashcards

Reproductive Treatments Flashcards

1
Q

is primary hypogonadism easy or difficult to treat?

A

difficult

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2
Q

how to treat secondary hypogonadism in males?

A

treat with gonadotrophins (ie LH and FSH) to induce spermatogenesis

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3
Q

how does LH work to induce sperm?

A

LH > stimulates Leydig cells > ^ intra testicular testosterone

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4
Q

how does FSH work to induce sperm?

A

FSH > stimulates seminiferous tubule development + spermatogenesis

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5
Q

when treating secondary hypogonadism, how much does LH increase testosterone?

A

to much higher levels than in circulation (x100)

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6
Q

give an example of a cause of acquired hypogonadism

A

opioid abuse

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7
Q

should testosterone be given to men desiring fertility?

A

no, avoid

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8
Q

why should giving testosterone be avoided in men that desire fertility?

A

treatment will lower LH / FSH further and further reduce spermatogenesis

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9
Q

what is the preferred reproductive treatment for men with secondary hypogonadism desiring fertility?

A

Give hCG injections (which act on LH-receptors)

If no response after 6 months, then add FSH injections

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10
Q

what is Kallmann syndrome?

A

Congenital Hypogonadotrophic Hypogonadism

due to deficiency of gonadotropin-releasing hormone

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11
Q

Kallmann syndrome presents as?

A

anosmia

lack of/delayed puberty

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12
Q

have people with congenital hypogonadotrophic hypogonadism had mini-puberty?

A

no

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13
Q

why is FSH important during mini puberty?

A

for growing the pool of immature spermatogonia and germ cells

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14
Q

reproductive treatment for congenital hypogonadotrophic hypogonadism?

A

2-4 months pretreatment with FSH before hCG treatment

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15
Q

what gives the indication a better prognosis in those with congenital hypogonadotrophic hypogonadism?

A

Pretreatment Testicular size (Seminiferous tubules)

ie testicular volume >6ml

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16
Q

symptoms for loss of testosterone

A

loss of early morning erections
decreased libido
decreased energy

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17
Q

how to confirm low testosterone?

A

At least 2 low measurements of serum testosterone before 11am

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18
Q

testosterone replacement

A 
Daily Gel eg Tostran. Care not to contaminate partner.
3 weekly intramuscular injection (eg Sustanon)
3 monthly intramuscular injection (eg Nebido)
Less Common (Implants, oral preparations)
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19
Q

what are the risks that come with testosterone replacement?

A

increased haematocrit > risk of hyperviscosity + stroke

increased PSA

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20
Q

aim of ovulation induction?

A

to develop one ovarian follicle

to increase FSH by a small amount

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21
Q

what can happen if >1 follicle develops?

A

this risks multiple pregnancy (ie Twin / Triplet)

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22
Q

what does PCOS stand for?

A

polycystics ovarian syndrome

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23
Q

PCOS usually presents as?

A

amenorrhoea (missed periods) or irregular periods, weight gain, fatigue, hirsutism, acne, mood changes, sleep problems, infertility, depression

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24
Q

how to restore ovulation?

A

Lifestyle / Weight Loss / Metformin
Letrozole (Aromatase inhibitor)
Clomiphene (Oestradiol receptor antagonist)
FSH stimulation

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25
Q

oestradiol causes negative feedback to?

A

hypothalamus

pituitary

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26
Q

how does letrozole work?

A

inhibits aromatase > prevents conversion of testosterone to oestradiol > decreases -ve feedback > increases LH/FSH > stimulates follicle growth

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27
Q

how does clomiphene work?

A

oestradiol receptor antagonist > decreases ve feedback > increases LH/FSH > stimulates follicle growth

28
Q

outline the steps to in vitro fertilisation

A

FSH stimulation > oocyte retrieval > fertilisation in vitro > embryo incubation > embryo transfer

29
Q

how to prevent premature ovulation in IVF?

A

prevent premature LH surge either GnRH antagonist/agonist protocol

30
Q

how can both a GnRH agonist or a GnRH antagonist be used to block an LH surge?

A

depends on if GnRH given is pulsatile (causing LH peaks) or non-pulsatile (initial flare then inhibited)

31
Q

how to mature eggs in IVF?

A

exposure to LH via hCG

32
Q

exposure to hCG has the side effect of?

A

excessive ovarian stimulation > ovarian hyper-stimulation syndrome

33
Q

ovarian hyper-stimulation syndrome can lead to?

A 
pleural effusion
shortness of breath
ascites
kidney failure
ovarian torsion
34
Q

list permanent methods of contraception

A

vasectomy

female sterilisation

35
Q

list non-permanent methods of contraception

A 
barrier (male/female condom/diaphragm)
combined oral contraceptive pill
progestogen only pill
long acting reversible contraception
emergency contraception
36
Q

positives to barrier conception (condoms)

A

Easy to obtain – free from clinics
No need to see a healthcare professional
Protect against STI’s
No contra-indications as with some hormonal methods

37
Q

negatives to barrier conception (condoms)

A

Can interrupt sex
Can reduce sensation
Can interfere with erections
Some skill to use properly eg ensure no air, not too large or small

38
Q

what effect does the oral contraceptive pill have on the HPG axis?

A

oestrogen + progesterone -vely feedback to hypothalamus and pituitary > decreased LH/FSH
thickening of cervical mucus
thinning of endometrial lining to reduce implantation

39
Q

positives to the combined oral contraceptive pill

A 
Easy to take (one pill any time of day)
Effective
Doesn’t interrupt sex
Can take several packets back to back and avoid withdrawal bleeds
Reduce endometrial and ovarian cancer
Weight Neutral in 80%
40
Q

negatives to the combined oral contraceptive pill

A

It can be difficult to remember
No protection against STIs
P450 Enzyme Inducers may reduce efficacy
Not the best choice during breast feeding

41
Q

possible side effects to the combined oral contraceptive pill

A 
Spotting (bleeding in between periods)
 Nausea
 Sore breasts
 Changes in mood or libido 
 Feeling more hungry
42
Q

extremely rare side effects to combined oral contraceptive pill

A

Blood clots in the legs or lungs

43
Q

non-contraceptive uses of the combined oral contraceptive pill

A

Helps make periods lighter and less painful
Withdrawal bleeds will usually be very regular
PCOS: help reduce LH and hyperandrogenism

44
Q

positives to the progesterone only pill

A

Works as OCP but less reliably inhibits ovulation, often suitable if can’ttake oestrogen, easy to take – one pill a day, every day with no break, doesn’t interrupt sex, helps heavy or painful periods, periods may stop (temporarily), can be usedwhen breastfeeding

45
Q

negatives to the progesterone only pill

A

Can be difficult to remember
No protection against STIs
Shorter acting – needs to be taken at the same time each day

46
Q

possible side effects to the progesterone only pill

A 
Irregular bleeding
 Headaches
 Sore breasts
 Changes in mood
 Changes in sex drive
47
Q

list examples of long acting reversible contraceptives

A

intra uterine device (IUD)
intra uterine systems (IUS)
Progestogen-only injectable contraceptives or subdermal implants

48
Q

list examples of emergency contraception

A

IUD
Emergency contraceptive pill, ulipristal acetate 30mg (ellaOne)
Emergency contraceptive pill, levonorgestrel 1.5mg (Levonelle)

49
Q

side effects of the emergency contraceptive pill

A

headache, abdominal pain, nausea

50
Q

avoid OCP if you have these comorbidities:

A 
Migraine with aura (risk of stroke)
Smoking (>15/day) + age >35yrs
Stroke or CVD history
Current Breast cancer
Liver Cirrhosis
Diabetes with retinopathy/nephropathy/neuropathy
51
Q

oral contraceptive pill has risk of?

A

risk of venous thromboembolism

52
Q

conditions that may benefit from OCP

A

menorrhagia
endometriosis
fibroids

53
Q

what concurrent medication needs to be considered when choosing contraception?

A 
P450 liver enzyme-inducing drugs (eg anti-epileptics,some antibiotics)
Teratogenic drugs (eg lithium or warfarin)
54
Q

list types of contraception by increasing efficacy (in brackets are user dependent)

A

none > withdrawal > fertility awareness > [diaphragm > male condoms > vaginal ring > POP > OCP > female condoms] > depot progesterone > IUD > IUS > implant

55
Q

peri-menopausal

A

Within 12 months of last menstrual period

56
Q

post-menopausal

A

After 12 months of last menstrual period

57
Q

risks of HRT

A

venous thrombo-embolism
hormone sensitive cancers
concern for increased risk of cardiovascular disease
risk of stroke

58
Q

which are safer for VTE: oral or transdermal oestrogens?

A

transdermal

59
Q

avoid oral oestrogens in what population?

A

BMI > 30 kg/m2

60
Q

what cancers are women at a higher risk of on HRT?

A

breast
ovarian
endometrial

61
Q

when giving HRT, ‘………’ must be prescribed to all women with an endometrium

A

progestogens

62
Q

benefits of HRT

A

Relief of symptoms of low oestrogen

Less osteoporosis related fractures

63
Q

hormone treatment for transgender / gender non binary pre-pubertal young people

A

GnRH agonist for pubertal suppression and then sex steroids

64
Q

masculinising hormones for transgender men

A

testosterone

65
Q

side effects of masculinising hormones for transgender men

A

Polycythaemia
lower HDL
Obstructive Sleep Apnoea

66
Q

feminising hormones for transgender women

A

estrogen

reduce testosterone

Endocrinology (15 decks)

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