EC/Infertility: Treatment

Question 1

Copper IUD: EC

Answer 1

Paragard
-Most effective (99.9
-Use within 5 days, lasts up to 10 years
-Must be placed in uterus by professional

Question 2

Ulipristal acetate: EC

Answer 2

Ella
-More effective than levonorgestrel
-Less effective if >195 lbs or BMI >30
-Use ASAP within 5 days
-Rx required
-Must be taken after every episode of unprotected sex
-Single 30 mg dose

*cousin to mifepristone (Mifeprex), also known as the “abortion pill” or RU-486

Question 3

Levonorgestrel: EC

Answer 3

Plan B One-Step (generics, Take Action, Aftera, My Way, React)
-Less effective if >165 lbs or BMI >25
-Use ASAP within 3 days (moderately effective within 5 days)
-OTC (no age restrictions)
-Must be taken after every episode of unprotected sex
-One 1.5 mg of levonorg

Main AE: nausea/vomiting
-Can rec OTC antiemetic if prone
-If vomits within 2 hr of dose, should re-take

Question 4

Infertility: OW

Answer 4

-Defined as not being able to get pregnant after one year or more of unprotected sex

-Clomiphene and letrozole used to induce ovulation (first line)

Question 5

Clomiphene

Answer 5

-A SERM
-Causes LH/FSH to surge
-Surge in LH = hot flashes
-Clotting risk

Question 6

Letrozole

Answer 6

-Impacts ovulation through estrogen negative feedback
(estrogen production is suppressed resulting in an initial FSH surge that leads to follicle development and ovulation)

Question 7

Gonadtropins

Answer 7

-Trigger ovulation by acting similar to FSH/LH
-Used after poor response to clomiphene or letrozole or to spur egg release after IVF or insemination

*only SC/IM (can be done by pt/partner)

Question 8

Leuprolide (Lupron)

Answer 8

-exogenous hCG or gonadotropin releasing hormone agonists (GnRHA), such as leuprolide (Lupron), can
be used to trigger ovulation

-are more commonly used to decrease hormone levels in breast or prostate cancer treatment

Question 9

Risk of Clomiphene/Gonadotropins

Answer 9

-can cause multiple eggs to be released,
which causes a risk of multiple births

Question 10

Gonadotropin Drug Names

Answer 10

Generic names include
-chorionic gonadotropin-recombinant
-follicle stimulating hormone-recombinant
-human chorionic gonadotropin-recombinant and menotropin

Brand names can include parts of the words reproduce, men(strual), follicle, gonadotropin, pregnancy and ovary
-Menopur, Follistim AQ, Gonal-f, Pregnyl, Novarel, Ovidrel