Infertility

Question 1

drugs used in female infertility

Answer 1

1) Clomiphene
2) Gonadotrophins and analogues

Question 2

Adm of Clomiphene

Answer 2

oral

Question 3

MoA of Clomiphene

Answer 3

Estrogen receptor antagonist -> induces ovulation

Question 4

Gonadotrophins?

Answer 4

FSH, LH and HCG (human chorionic gonadotropin)

*hCG –> hormone produced by the placenta during pregnancy

Question 5

AE of Clomiphene

Answer 5

1) Ovarian hyper-stimulation syndrome (OHSS)
2) Twins are common; multiple pregnancy is unusual
3) Ovarian cysts
4) Hot flushes
5) Headaches
6) Blurred vision
7) Prolonged use may increase ovarian and endometrial cancer risk

Question 6

Complications of Gonadotrophin treatment

Answer 6

• Multi-fetal gestation
• OHSS

Question 7

Ovarian hyperstimulation syndrome causes?

Answer 7

• Increased vascular permeability
• Rapid accumulation of fluid
• May lead to hypovolemia, electrolyte disturbances,
  acute respiratory distress syndrome, thromboembolism, hepatic dysfunction

Question 8

MoA of Gonadotrophins

Answer 8

Stimulate ovulation

Question 9

CU of Clomiphene

Answer 9

1) Anovulatory infertility (egg not released from the ovaries during the menstural cycle)
2) Ovulation induction

Question 10

Causes of Anovulation

Answer 10

1) Hypopituitarism
2) Following failure of treatment w/ Clomiphene

Question 11

Synthetic GnRH is termed ——–

Answer 11

gonadorelin

Question 12

GnRH analogous

Answer 12

Buserelin,
leuprorelin (leuprolide),
goserelin and
nafarelin

-relin

Question 13

Adm of GnRH analogs (leuprolide , busrelin, nafarelin, goserelin)

Answer 13

Given by SC infusion in pulses to mimic physiological secretion of GnRH
–> Stimulate gonadotrophin release and induce ovulation

Question 14

Specialist use in infertility treatment regimens to suppress the pituitary before administration of GnRH analogs. why is that?

Answer 14

GnRH analogs act as GnRH agonists so, Continuous use stimulates gonadotrophin release transiently, Then paradoxically inhibits gonadotrophin release (so now acting as an antagonist)
- Downregulation (desensitisation) of GnRH receptors in the pituitary -> (↓ FSH,LH -> ↓ ER in Females and ↓ testosterone in Males)
- Inhibits spermatogenesis and ovulation

Question 15

CU of GnRH agonists

Answer 15

Used for gonadal suppression in various sex hormone dependent conditions
1) Breast cancer,
2) endometriosis,
3) Large uterine fibroids (tumours in the uterus)

Question 16

AE of GnRH Agonsits

Answer 16

1) Flushing
2) Vaginal dryness
3) Bone loss
4) hypo-oestrogenism (lower than normal levels of ER)

Question 17

Drugs used to treat male infertility

Answer 17

1) GnRH therapy
2) Clomiphene
3) hCG: ICSH analogue
4) Human Menopausal gonadotrophin (hMG) : ICSH+ FSH

Question 18

MoA of GnRH therapy in infertile males

Answer 18

Increases secretion of ICSH/FSH from anterior pituitary

Question 19

MoA of Clomiphene in the treatment of male infertility

Answer 19

Blocks negative feedback inhibition of oestrogen
on anterior pituitary: increases ICSH/FSH release

Question 20

MoA of hCG in male infertility treatment

Answer 20

ICSH analogue –> Increases testosterone levels (spermatogenesis)

Question 21

MoA of hMG in the treatment of Male infertility

Answer 21

Combination of ICSH/FSH: increase testosterone levels and spermatogenesis