reproductive treeatments

Question 1

how can we treat symptoms of hypogonadism for those not desiring fertility in men

Answer 1

testosterone replacement :
daily gel - tostran (don't contaminate partner)
3 weekly intramuscular- sustanon
3 monthly inramusc injection - nebido
implants /oral preparations

Question 2

how can we monitor testosterone replacement

Answer 2

increased haematocrit - hyper viscosity and stroke

prostate - psa levels

Question 3

how can we treat infertility for those trying

Answer 3

primary - difficult to treat

secondary - treat with gonadotropins to induce spermatogenesis

Question 4

why does lh replacement cause

hcg

Answer 4

stimulates leydig cells to increase intratesticular testosterone to higher levels

Question 5

what does fsh replacement cause

Answer 5

stimulates seminiferous tubule development and spermatogenesis

Question 6

how to treat infertility in those with pcos

Answer 6

restore ovulation - 
weightless/lifestyle/metformin
letrozole - aromatase inhib
clomiphene - oestradiol receptor modulator
fsh stimulation

Question 7

how does letrozole work

Answer 7

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

Question 8

how does clomiphene work

Answer 8

antagonist of estradiol dreceptors
less neg feeback
increased fish and lh

Question 9

what is another way to treat female infertility if meds are insufficient

Answer 9

ivf

Question 10

how does ivf work

Answer 10

oocyte retrieval from ovary
fertilise in vitro or use intracytoplasmic sperm injection
embryo incubation 3-5 days
choose strongest embryo and transfer into uterus

Question 11

what do you do at each stage go ivf

Answer 11

fsh stimulation
prevent premature ovulation - prevent lh surge
then for maturation give lh

Question 12

how do we prevent premature lh surge

Answer 12

short -
give fsh day 2 and start giving gnrh antagonist at day 6
long protocol-
give gnrh agonist 7 days before lh

Question 13

what does continuous dose of gnrh cause

Answer 13

desensitises of gnrh receptor

initial flare then lh inhibition

Question 14

what are some forms of contraception

Answer 14

barrier - condoms diaphragm 
ocp
pop
larc
emergency contraception
permanent - vasectomy

Question 15

pros of condoms

Answer 15

prevents stis
easy to obtain
no contra indications

Question 16

cons of condoms

Answer 16

can interrupt sex
reduces sensation
needs skill

Question 17

how does oral contraceptive pill work

Answer 17

prog and oest have negative feedback effects on hypothalamus and pituitary
decreases lh and fsh

Question 18

what else does progesterone in pill cause

Answer 18

thickening of cervical mucus

thinning of endometrial lining

Question 19

pros of ocp

Answer 19

easy to take - 1 pill day
effective
doesn't interfere with sex
weight neutral in 80%
reduces endometrial and ovarian cancer

Question 20

cons of ocp

Answer 20

difficult to remember
no protection against stis
p450 enzyme inducer can reduce efficiacy
possible side effects - spotting
nausea
sore breasts 
feeling hungry

Question 21

what are some non contraceptive uses if ocp

Answer 21

makes periods lighter and less painful
withdrawal bleeds are regular
pcos - helps reduce lh and hyperandrogenism

Question 22

pros of POP

Answer 22

suitable of can't take oestrogen
easy to take
doesn't interrupt sex
helps heavy painful periods
can be used when breastfeeding

Question 23

cons of POP

Answer 23

difficult to remember no protection against sti
shorter acting
some side effects - bleeding, headaches,sore throat, changes in mood and sex drive

Question 24

what are some examples of long acting reversible contraceptives

Answer 24

coils
intrauterine device i.e copper coil
intrauterine system which secretes prog
progesterone only injectable cont or subdermal injection

Question 25

why are coils suitable

Answer 25

prevents inplantation

rarely cause ectopic pregnancy

Question 26

what is emergency contraceptive

Answer 26

copper coil inserted unto 5 days after
pills:
ulipristal acetate 30mg - stops progesterone and prevents ov
levonorgestrel - synthetic progesterone

Question 27

side effects of emergency pill

Answer 27

headaches
naasea
p450 enzyme can effect

Question 28

how to choose contraceptive

Answer 28

look at comorbidities
other conditins
need still prevention?
other meds they are on

Question 29

when should you avoid ocp

Answer 29

if have migraine withaura
smoker
strok/cvd
breast cancer 
liver cirrhosis

Question 30

what are the risks with hormone replacement therapy

Answer 30

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

Question 31

benefits of hrt

Answer 31

relieve symptoms of low oestrogen

less osteoporosis related fractures

Question 32

what is gender

Answer 32

social construct

Question 33

what is sex

Answer 33

biologically defined according to genitalia

Question 34

how to treat transgender

Answer 34

gnrh agonist for suppression and then sex steroids
for men - testosterone  
progesterone to stop menstrual bleeding
for women - oestrogen 
reduce testosterone (andogren blocker)