Infertility

Question 1

____ is a couple’s failure to achieve pregnancy after 1 year of regular, unprotected intercourse (woman <35 y/o, 6 mo. if >35 y/o)

Answer 1

infertility

Question 2

infertility occurs in ~___% of couples

Answer 2

15%

Question 3

What factors can contribute to infertility?

Answer 3

Factors:
male
ovarian
cervical 
uterine
tubal 
peritoneal 
unexplained

Question 4

What are preconception core interventions?

Answer 4

Add folic acid
Control DM and PKU levels 
no alcohol/drugs/smoking
optimize BMI
change meds that hurt fetus 
avoid teratogens

Question 5

How is a Semen analysis performed?

What information does it give you?

Answer 5

Abstinence for 2-7 days

Eval specimen w/in 1 hr

Provides information on semen volume and sperm concentration/motility/morphology

Question 6

___% of male factor infertility can be overcome effectively w/ Rx

Answer 6

<10%

Question 7

____ is a term for a minimal number of sperm

Answer 7

Oligospermia

Question 8

___ is a term for non-motile sperm

Answer 8

Asthenospermia

Question 9

What medication is most likely to lead to pregnancy in a woman w/ PCOS?

What is the 2nd line medication?

Answer 9

Clomiphene citrate

Metformin (used alone or in combo with CC)

Question 10

How would you work up a woman for infertility?

Answer 10

Basically the same way you would for secondary or primary amenhorrhea… not going to belabor this with more f***ing cards (lol lauren)

Question 11

Other than Clomiphene citrate and Metformin, what other medications can you use to tx a anovulatory woman?

Answer 11

Aromatase Inhibitors
Exogenous Gonadotropins (FSH +/- LH)
Dopamine Agonists

Question 12

Clomiphene citrate requires a functioning ____ to work and will cause ___% of women to ovulate and ___% of women will become pregnant

Answer 12

H-P-O axis

80%
40%

Question 13

Main ADR of Clomiphene citrate …

Answer 13

Vasomotor: HOT FLASHES

Question 14

Clomiphene citrate will not work in women with ____

Answer 14

primary ovarian failure

Question 15

___ is indicated in anovulatory women w/ normal levels of Gn and Estrogen —> PCOS most common dx.
It is used off-label but suggested first-line for ovulation induction in PCOS with BMI>30 by some

Answer 15

Letrozole

Question 16

Letrozole interferes with the conversion of ____ to estrogens, causing a reduction in circulating Estrogen and stimulating a compensatory rise in ____, which can induce ovulation

Answer 16

Androgens

Gn secretion

Question 17

____ are used as Injections to promote ovarian follicle development by increasing the stimulation of ovarian FSH receptors above that of endogenous FSH secretion. the negative feedback to H-P-O axis is disrupted

Answer 17

Exogenous Gonadotropins: FSH +/- LH

Question 18

the use of Exogenous Gonadotropins: FSH +/- LH causes;

Rate of ovulation = __-___%
Pregnancy rate = __-__% per cycle

Answer 18

70-90%

15-25

Question 19

what is a common complication of Exogenous Gonadotropins: FSH +/- LH

Answer 19

Multifetal gestation

Question 20

___ are used for hyperprolactinemic anovulation

Answer 20

Dopamine Agonists

Question 21

_____ occurs in up to 30% of infertile couples after thorough evaluation

Answer 21

Unexplained infertility