Treatment of female infertility Flashcards
What is recommended alcohol intake for women undergoing IVF/trying to get pregnant
no more than 3-4 units of alcohol per week
1-2 units 2 x per week
How long should folic acid be taken prior to pregnancy
before conception and up to 12 weeks of pregnancy to reduce chance of neural tube defect
0.4mg per day (women on antiepileptic should take 5mg per day)
Describe treatment of PCOS
- lifestyle factors, reduce BMI to less than 30
- Clomiphene citrate+/- metformin
- Laproscopic ovarian drilling, gonadotrophin therapy
- Assisted conception
How does clomiphene work
it is an anti oestrogen
blocks oestrogen feedback form ovaries to pituitary and hypothalamus thus ‘tricking’ pituitary into producing more FSH which may promote more sufficient follicle development
How is clomiphene taken
as a tablet initial dose of 50mg onc daily for 5 days from day 2 of menstrual cycle
what are side effects of clomiphene
blurred visions and headaches - stop immediately if develop
what is the biggest risk with climphene
10 percent multiple pregnancy rate - good practice to ultrasouns scan during the first month of use to make sure not too many dominant follicles develop
what is the max dose of clomiphene
150mg daily
what is the maximum number of cycles of clomiphene
6 months or six cycles due to possible risks of ovarian cancer with prolonged use
why is metformin used in PCOS
women with PCOS often have insulin resistance
advantageous as promoted mono ovulation so reduced the chance of multiple pregnancy we used alongside clomiphene
however, recent NICE metaanalysis found no differenct in live birth rates between clomiphene alone and clomiphene combined with metformin
What is laparoscopic ovarian drilling
ovaries are drilled using diathermy for a few seconds in multiple places
what is advantageous aout LOP
can do other procedures at same time eg remove endometriosis tissue, do Lap and dye
encourages mono ovulation so low risk of multiple pregnancy
effects can last for many years after treatment
the drilling is thought to disrupt ovarian stroma and appears to reset the miliu allowing folliculargenesis to commence but how it works exactly us unclear
When is gonadotrophin therapy used in PCOS
gonadotrophin injections daily can be used as second line treatment for PCOS instreas of lop
but high risk of multiple pregnancy - 20 percent
using low dose step up method in a low dose is used for 10 days and then ultrasound is used to see if a more than 10mm follicle has developed, same dose is continued for a few days and then a further can confirms presense of prevulatory follicle. trigger is given followed by timed intercourse - this reduces MP rates to around 10 percent
what assisted conception treatment do women with PCOS receive
IVF
how is group 3 anovulation treated
require donar gametes
adoption
accepting childlessness
what drugs can be given to treat hyperprolatinaemia
bromocriptine
how are group 1 ovulation disorders treated
address cause ie increase BMI, reduce exercise
pulsatile subcut GNRH via pump
also can induce ovulation with gonadotrphin injections daily for two weeks - should use menipur and has LH and FHS then give HCG and timed intercourse. monitor with ultrasound to reduce risk of multiple pregancy
how are women with tubal disease treated
IVF primarlity and remove hydrosalpinx if present and this will improve success (hydrosalpinx been shown to alf rates of IVF success
surgery to unblock tube may be beneficial in tubal cannulation
if only one tube blocked and no hydrosalpinx then can leave
what is ashermans syndrome
extensive uterine adhesions
causes usually retained placenta after delivery or endometrial curettage for a miscarriage
what is the namefor the process of removing fibroids
myomectomy
when should fibroids be removed
submucosal and distrupting uterine cavity
very large ones greater than 5cm
can do TCRF for smaller fibroids less than 3cm, but must do laparoscopy for women with bigger fibroids
in general population out with fertility NICE guidline only recommend removal if symptomatic and greater than 3cm
how is endometriosis treated
ablation of endometrial tissue and removal of cyst shown to improve natural pregnancy rate
unclear of cyst removal should be done prior to IVF
often best treatment is IVF
what is the risks of having an endometrioma during IVF
may make oocyte recovery difficult - rupture during this procedure may cause infection and pelvic absess
antibiotics should be given in this case
what protocol is beneficial for women with severe endometriosis for IVF
ultralong protocol
prolonged downregulation for 2-3 months
what is the treatment for unexplained infertility
no place for stimulation with clomiphene etc.
expectant management if no know pathology and under the age of 36 until 2 years of infertility. women over the age of 36 can be seen sooner for ivf treatment.
if ovarian reserve is extremely low may not be ale to offer any treatment without donor
why is IUI not preferred
not shown to have greater success than trying naturally
unless stimulated but this has high multiple pregnancy rate and often procedure is cancelled if there is more than two mature follicles seen on ultrasound
