Fertility II

Question 1

What are the therapeutic uses of gonadtropins in fertility?

Answer 1

They can be used to treat infertility in anovulatory women or women with hypogonadism.Women who have not been able to become pregnant with clomiphene (Clomid, Serophene) may be encouraged to try gonadotropins as a next step.

Question 2

What is Menotropin?

Answer 2

Menotropin preparations are mixed solutions of FSH and LH isolated from urine that are designed for use in selected women where they stimulate the ovaries to mature follicles, thus making them more fertile. They can also be used inhypogonadalmen to stimulate sperm production.

Question 3

How are menotropins given?

Answer 3

They are administered by typically daily injection, intramuscularly or subcutaneously, for about ten days under close supervision to adjust dose and duration of therapy.

Question 4

Are Menotropins 1:1 in FSH:LH ratios?

Answer 4

While earlier menotropin medications contained FSH and LH at a 1:1 ratio, the recognition that it is FSH that is critical for follicle stimulation has led to development of newer preparations that contain a much higher FSH/LH ratio, Fertinex being an example.[4]

Question 5

T or F. Progesterone inhibits uterine contraction

Answer 5

T.

Question 6

What are the pharmacokinetic advantages of synthetic estrogens like ethinyl estradiol and mestranol?

Answer 6

These have ethinyl groups (triple bonds) which greatly decrease hepatic metabolism compared to native estrogens which have very poor bioavailability

Question 7

Why would clomiphene and fulvestrant be useful for infertility in anovulatory women?

Answer 7

These are pure antiestrogens, aka they inhibit estrogen action in all tissue so they prevent feedback inhibition of natural estrogens and stimulate release of GnRH which stimulates LH/FSH release leading to ovulation

Question 8

The risk for CV events in women taking estrogen is especially high in what population?

Answer 8

smokers

Question 9

What are the most effective contraceptives?

Answer 9

IUDs, progestin implants, and sterilization

Question 10

What are the most popular contraceptives?

Answer 10

hormonal contraceptives

Question 11

What are the least effective contraceptives?

Answer 11

Barrier and fertility-based methods (calendar)

Question 12

Why would combo estrogen/progestin be a good contraceptive?

Answer 12

feedback inhibition on the pituitary inhibits gonadotropin release. While there are many different formulations, the estrogen in these pills is typically ethinyl estradiol or mestranol and the progesterone is typically noerthindrone, norgestrel, or levonorgestrel

Question 13

How are most oral contraceptives packaged?

Answer 13

21/7 cycle (21 active/7 placebo). Some have less placebo days- these preps may decrease menstrual symptoms (HA, bloating, menstrual pain)

Question 14

What are some contraindications to combo oral contraceptives?

Answer 14

TE diseasecerbral vascular diseaseMI or CADcongenital hyperlipidemiaKnown or suspected breast cancerEndometrial cancer

Question 15

What is a ‘minipill’?

Answer 15

Low dose of only progestin. Blocks ovulation in only 60-80% of cycles and the presence of progestin impairs pserm transport by thickening the cervical mucus, decreases motility of ova in the fallopian tubes, and impairs the endometrium

Question 16

T or F. Minipills have a slightly higher failure rate than combo pills

Answer 16

T.

Question 17

What are some non-contraceptive benefits of birth control?

Answer 17

-reduced dysfunctional uterine bleeding and dysmenorrhea-Menstrual regularity-increased hemoglobincombo pills raise SHBG and thus decrease free androgens, resultsing in less hirsutism and acne-Tx of PCOS

Question 18

How are minipills taken?

Answer 18

Taken daily and continuous, no placebos. Pills should be taken at the same time each day.

Question 19

Minipills are best for women who are _____

Answer 19

breast feeding or 35+ and smokeProgestin is responsible for the acne and weight gain seen

Question 20

How are transdermal patches given?

Answer 20

New patch each week for 3 weeks, then patch-free for one weekNote that transdermal patches deliver both ethinyl estradiol and progestin

Question 21

What are some of the AEs of transdermal patch contraceptives?

Answer 21

-the patch is less effective in women 90+ kg becuase of adipose tissue-breakthrough bleeding is more common in the first 2 cycles-skin irriation may be a problem

Question 22

How are vaginal contraceptive rings given?

Answer 22

Inserted intravaginally by the pt. and left in palce for 3 weeks and take out for 1 week. During those three weeks the ring should not be removed for more than 3 hrs and is not effective until in palce for 7+ daysNOTE: This delivers both ethinyl estradiol and progestin

Question 23

T or F. There is a rapid return to fertility after removal of a vaginal contraceptive ring

Question 24

What hormones do injectable contraceptives give?

Answer 24

progesterone only- usually medroxyprogesterone. Injected every 3 monthsDiscontinue after 2 yrs unless no alternative

Question 25

AEs of injectable contraceptives?

Answer 25

Amenorrhea common, irregular bleeding can occurweight gain, HA, and decreased bone densitydelayed return to fertility (6-12 months)

Question 26

Implants hormonal contraceptives give what hormone?

Answer 26

progesterone only, usually etonogestrel given as a signle rod implanted under the skin in the upper armSame AEs as all progestins

Question 27

How long are implanted hormonal contraceptives effective for?

Answer 27

3 yrs

Question 28

What are the types of IUD?

Answer 28

Copper containing (copper is spermacidal) and progestin releasing (levonorgestrel)

Question 29

T or F. Fertility is quickly restored after using an IUD

Answer 29

T. There is a high initial cost, but very low overall cost

Question 30

What are the AEs of an IUD?

Answer 30

less blood loss; FDA approved for dysmenorrheacooper may cause crampingprogestin may cause irregular bleeding (6-12 mo)

Question 31

What is the most common spermicide?

Answer 31

Nonoxynol-9, a surfactant available in foams, gels, creams, suppositories. NOTE: These are only effective for about 1 hr so reapplication is necessary and they MUST be in contact with the cervix to work

Question 32

What are the potential AEs of spermacides?

Answer 32

less effective than others, irriations of vaginal mucosa, toxic shock syndrome

Question 33

What is a 'sponge'?

Answer 33

barrier form of protection containing nonoxynol-9 that is moistned in water and palced over the cervix. This is immediately effective and is effective for up to 24 hrs but must remain in place 6 hrs after intercourse (inferior to diaphragms)

Question 34

Emergency contraception is most effective if taken within ____ hrs of intercourse

Answer 34

72- Use progetins to delay ovulation

Question 35

What do PlanB and Preven consist of?

Answer 35

two doses of levonorgestrel seperated by 12 hrs (first dose should be within 72 hrs of intercourse)

Question 36

What type of delivery of androgens is most effective/

Answer 36

IM

Question 37

What are the AEs of testosterone abuse?

Answer 37

lower testosterone levelsdecreased libidodecreased spermatogenesishepatotoxicity

Question 38

What is Oxandrolone (Oxandrin)?

Answer 38

an anabolic steroid that has less conversion to estrogens and less inhibition of testosterone synthesis

Question 39

What is Cyproterone acetate?

Answer 39

Competes with DHT for androgen receptor binding, preventing translocation into the nucleus for tx of acne, baldness, hirsutism, virilizing syndrome, and inhibitng libidio in sexually deviant men

Question 40

Why is nicalutamide better than flutamide?

Answer 40

lower hepatic toxicity and once a day administration

Question 41

Notes about Finasteride

Answer 41

Should not be touched by pregnant women, absorbed through skin and can cause birth defect in male fetus. Men taking this should not donate blood