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50 Cards in this Set
- Front
- Back
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Infertility - Definition
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The inability to conceive after 1 year of unprotected intercourse
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Infertility - The probability of achieving pregnancy in 1 cycle is ___ %
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20%
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Infertility - ___% of all couples with normal fertility will achieve pregnancy in 12 months
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85%
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Infertility - Female fertility should be examined prior to male (True/False)
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False.
Male fertility is non invasive and should be checked first. |
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Infertility - General factors causing infertility (4)
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WARS:
- Weight (overweight BMI >29 or very underweight) - Alcohol use - Recreational drug use - Smoking (active and 2nd hand) - male and female |
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Infertility - Female causes (3)
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- Increasing age
- Ovulatory dysfunction (PCOS, Anovulation, Luteal phase defect, hyperprolactemia) - Anatomical factors (tubal dysfunction, cervical factors) |
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Infertility - Fertility declines after age ___, marked decline after age ___.
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30
40 |
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Infertility - Increasing age - What causes infertility in this case? (3)
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FOI:
- Fewer and lower quality eggs remain - Ovulation becomes more irregular - Increased exposure to disease development (eg. PID, endometriosis) |
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Infertility - Anovulation results from disruption of the hypothalmic-pituitary-ovarian axis (True/False)
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True
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Infertility - Hypothalmic-pituitary-ovarian axis can be thrown off by what causes? (4)
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CEASED:
Chemotherapy Excessive exercise Anorexia/bulimia Stress Endocrine diseases such as DM, Thyroid dysfunction Direct injury(neoplasm) |
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Infertility - The most common cause of anovulation is PCOS (True/False)
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True.
Affects 6-7% of women of reproductive age. |
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Infertility - PCOS - Pathophysiology?
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Inappropriate gonadotropin secretion - hypersecretion of LH and insulin stimulate production of androgens.
Insulin sensitivity in ovaries(causing hyperandrogenism). Insulin resistance in other tissues. |
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Infertility - PCOS is defined by 3 characteristics
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Hyperandrogenism
Oligomenorrhea or amenorrhea Polycystic ovaries |
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Infertility - PCOS signs and symptoms (4)
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HOMI:
- Hyperandrogenism (hirsutism, acne, male pattern baldness, ancanthosis nigricans) - Obesity - Menstrual cycle anomalies - Infertility |
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Infertility - PCOS - 1st line Pharmacotherapy to treat infertility aspect
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Clomiphene citrate
Metformin |
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Infertility - PCOS - To treat hirsutism, can give ___
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Spironolactone
Metformin |
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Infertility - PCOS - To treat abnormal menstruation, can give ___
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OCPs
Insulin sensitizer |
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Infertility - PCOS - Clomiphene citrate(Clomid) - MOA
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Unknown exactly however stimulates release of FSH and LH, causing development and maturation of ovarian follicle
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Infertility - PCOS - How is Clomiphene is taken?
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In monthly courses. No more than 6 courses is recommended.
50mg x 5 days starting on day 5 of menstrual cycle(either spontaneous or progestin induced). If no ovulation, subsequent cycles increase to 100mg. |
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Infertility - PCOS - Clomiphene - If anovulatory for 3 cycles using clomiphene then one should stop taking it (True/False)
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True
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Infertility - PCOS - Clomiphene - Ovulation is expected ___ days after last dose
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5-10 days
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Infertility - PCOS - Clomiphene - When and how frequent should intercourse occur?
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EOD starting 4-5 days(or sooner) after last clomiphene dose
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Infertility - PCOS - Clomiphene - If sole reason for infertility is irregular ovulation, then efficacy of clomiphene is ___%.
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50-80% ovulation.
40% will become pregnant. |
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Infertility - PCOS - Clomiphene - Adverse effects:
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MH OVA:
- Multiple gestations - Hot flashes - Ovarian hyperstimulation syndrome - Vision disturbances - Abdominal discomfort |
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Infertility - PCOS - Clomiphene - Ovarian hyperstimulation syndrome symptoms:
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DAN's VW:
- Diarrhea - Abdominal pain and distention - Nausea - Vomiting - Weight gain |
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Infertility - PCOS - Metformin MOA
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Decreases liver glucose output
Improves peripheral insulin sensitivity |
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Infertility - PCOS - Metformin is just as good as clomid for efficacy (True/False)
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False.
Not as good. |
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Infertility - PCOS - How does Metformin help?
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Improves menstrual cycle regulation and ovulation, and fertility
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Infertility - PCOS - Metformin dosing
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Start with 250mg - 500mg OD with food.
Increase as tolerated to 500-750mg TID with food. |
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Infertility - PCOS - Metformin is contraindicated in pregnancy (True/False)
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False.
Some studies show that taking metformin during pregnancy prevents spontaneous abortion (although more evidence needed) |
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Infertility - PCOS - Other agents used to treat infertility (3)
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GAG:
- GnRH agonists (eg. gonadorelin acetate) - Aromatase inhibitors (eg. letrozole, tamoxifen) - Gonadotropins(hMG, hCG, urofollitropin, follitropin alpha and beta) |
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Infertility - Luteal phase defect - Pathophysiology
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Insufficient progesterone levels do not allow for endometrium to implant --> failure to implant
Inability to prevent endometrium from breaking down (ie menstruation occurs)--> early miscarriage |
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Infertility - Luteal phase defect - Pharmcological treatment
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Progesterone.
Micronized progesterone capsules, gels, inserts. |
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Infertility - Luteal phase defect - Any kind of progesterone will help treat luteal phase defect (True/False)
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False.
Do NOT give synthetic MPA(Provera) as teratogenic (Category X). MPA= Medroxyprogesterone acetate |
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Infertility - Luteal phase defect - Progesterone dosing
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Prometrium 100mg pv od-bid immediately post ovulation x 10-14 days.
If successful can continue for 10-12 weeks. |
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Infertility - Hyperprolactinemia - MOA
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Elevated prolactin levels in blood cause inhibition of gonadotropin secretion and causes anovulation.
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Infertility - Hyperprolactinemia - Signs and Symptoms
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AAH DIG:
- Amenorrhea - Acne - Hisutism - Decreased libido - Infertility - Galactorrhea (spontaneous flow of milk from breast) |
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Infertility - Hyperprolactinemia - Possible causes
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- Drug induced (dopamine antagonists: antipsychotics, metoclopramide) (prolactin stimulators: methyldopa, TCAs, H2RAs like cimetidine, Protease Inhibitors), Verapamil
- Hyperthyoidism - Pituitary tumors - Nipple stimulation/Breastfeeding too early |
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Infertility - Hyperprolactinemia - Pharmacologic treatment
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Dopamine agonist
1st Line: Bromocriptine - AE: GI, N/V/D 2nd Line: Cabergoline |
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Infertility - Anatomical factors - PID pathophysiology
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A serious complication of some STIs (esp chlamydia).
Antibiotics do not reverse any damage done by STI. |
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Infertility - Anatomical factors - Guafenesin can be used to improve vaginal secretions to aid sperm delivery (True/False)
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True.
200mg TID and lots of water. |
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Infertility - Males to blame 40-50% of the time (True/False)
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True
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Infertility - Factors that cause low sperm count
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TOTO:
- Testicular trauma - Overheated scrotal area - Tight underwear - Obesity |
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Infertility - Replenishment of ejaculate volume is within 12 hours (True/False)
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False.
24-48 hours. |
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Infertility - Vaginal lubricants help the sperm move and improve fertility (True/False)
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False.
Avoid using vaginal lubricants as it impedes sperm. |
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Infertility - Factors that can affect spermatogenesis:
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CV HERD:
- Cigarette smoking - Venereal diseases - Heavy alcohol use - Excessive heat to scrotal area - Radiation - Drug induced |
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Infertility - Drugs that affect sperm production
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- Chemotherapeutic agents
- Recreational drugs - Anabolic steroids - Spironalactone - Sulfasalazine - Cimetidine - Nitrofurantoin |
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Infertility - Methods to check ovulation (2)
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- Basal body temperature charting
- Ovulation detection kits |
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Infertility - Basal body charting - How does it work?
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Basal body temperature rises 0.5 degrees fahrenheit or 0.28 degrees celcius.
Rise occurs over a period of 3 days and remains high until menstruation. Basal body temp taken within 5 minutes of waking. Doesn't work in some women, cannot interpret their BBT chart. |
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Infertility - Ovulation detection kit - How does it work?
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Detect the LH surge that precedes ovulation.
Need to have rough idea when ovulation occurs. Charting BBT or can subtract 14 days from expected menstruation. Comes in 5 or 7 day kits. |
