reproductive treeatments Flashcards
how can we treat symptoms of hypogonadism for those not desiring fertility in men
testosterone replacement : daily gel - tostran (don't contaminate partner) 3 weekly intramuscular- sustanon 3 monthly inramusc injection - nebido implants /oral preparations
how can we monitor testosterone replacement
increased haematocrit - hyper viscosity and stroke
prostate - psa levels
how can we treat infertility for those trying
primary - difficult to treat
secondary - treat with gonadotropins to induce spermatogenesis
why does lh replacement cause
hcg
stimulates leydig cells to increase intratesticular testosterone to higher levels
what does fsh replacement cause
stimulates seminiferous tubule development and spermatogenesis
how to treat infertility in those with pcos
restore ovulation - weightless/lifestyle/metformin letrozole - aromatase inhib clomiphene - oestradiol receptor modulator fsh stimulation
how does letrozole work
it acts on aromatase which usually converts testosterone to oestradiol
lower levels of e2 means decreased levels of neg feedback to hypothalamus and pituitary gland
increased fsh and lh
how does clomiphene work
antagonist of estradiol dreceptors
less neg feeback
increased fish and lh
what is another way to treat female infertility if meds are insufficient
ivf
how does ivf work
oocyte retrieval from ovary
fertilise in vitro or use intracytoplasmic sperm injection
embryo incubation 3-5 days
choose strongest embryo and transfer into uterus
what do you do at each stage go ivf
fsh stimulation
prevent premature ovulation - prevent lh surge
then for maturation give lh
how do we prevent premature lh surge
short -
give fsh day 2 and start giving gnrh antagonist at day 6
long protocol-
give gnrh agonist 7 days before lh
what does continuous dose of gnrh cause
desensitises of gnrh receptor
initial flare then lh inhibition
what are some forms of contraception
barrier - condoms diaphragm ocp pop larc emergency contraception permanent - vasectomy
pros of condoms
prevents stis
easy to obtain
no contra indications
cons of condoms
can interrupt sex
reduces sensation
needs skill
how does oral contraceptive pill work
prog and oest have negative feedback effects on hypothalamus and pituitary
decreases lh and fsh
what else does progesterone in pill cause
thickening of cervical mucus
thinning of endometrial lining
pros of ocp
easy to take - 1 pill day effective doesn't interfere with sex weight neutral in 80% reduces endometrial and ovarian cancer
cons of ocp
difficult to remember no protection against stis p450 enzyme inducer can reduce efficiacy possible side effects - spotting nausea sore breasts feeling hungry
what are some non contraceptive uses if ocp
makes periods lighter and less painful
withdrawal bleeds are regular
pcos - helps reduce lh and hyperandrogenism
pros of POP
suitable of can't take oestrogen easy to take doesn't interrupt sex helps heavy painful periods can be used when breastfeeding
cons of POP
difficult to remember no protection against sti
shorter acting
some side effects - bleeding, headaches,sore throat, changes in mood and sex drive
what are some examples of long acting reversible contraceptives
coils
intrauterine device i.e copper coil
intrauterine system which secretes prog
progesterone only injectable cont or subdermal injection
why are coils suitable
prevents inplantation
rarely cause ectopic pregnancy
what is emergency contraceptive
copper coil inserted unto 5 days after
pills:
ulipristal acetate 30mg - stops progesterone and prevents ov
levonorgestrel - synthetic progesterone
side effects of emergency pill
headaches
naasea
p450 enzyme can effect
how to choose contraceptive
look at comorbidities
other conditins
need still prevention?
other meds they are on
when should you avoid ocp
if have migraine withaura smoker strok/cvd breast cancer liver cirrhosis
what are the risks with hormone replacement therapy
venous thrombosis embolism
oral increases shbg,crp,triglycerides
transthermal is safer
hormone sensitive cancers e.g endometrial cancer
must prescribe progesterone in all women with endometrium!
concern about cvd risk
risk of stroke - small
benefits of hrt
relieve symptoms of low oestrogen
less osteoporosis related fractures
what is gender
social construct
what is sex
biologically defined according to genitalia
how to treat transgender
gnrh agonist for suppression and then sex steroids for men - testosterone progesterone to stop menstrual bleeding for women - oestrogen reduce testosterone (andogren blocker)
