Flashcards in Infertility Treatments Deck (29)
What does fecundability mean?
Probability that a cycle/month will result in pregnancy
What does fecundity mean?
Probably of live birth in a cycle/month
What is the best time to have intercourse in terms of when you ovulate if you want to get pregnant?
2 days BEFORE you ovulate
#1 cause of male infertility?
Why can giving testosterone to a man with low testosterone backfire?
The concentration of testosterone in the testicle is 100x greater than peripheral testosterone. When you give exogenous testosterone, it can 1) feedback on the hypothalamus to shut up LH release and 2) be converted to estradiol peripherally which will shut off GnRH production and further reduce the man's ability to make endogenous testosterone.
What do we look at when we do a semen analysis?
Total motile count=Volume*concentration*%motile
should be >20 million
In a man with prior vasectomy, what are his options for reversal?
1. Vasectomy reversal (ha, no shit)
2. Surgical sperm retrieval: MESA, TESE which are then used during IVF or ICSI cycles
MESA: Microsurgical Epididymal Sperm Aspiration
TESE: Testicular Sperm Extraction
ICSI: Intracytoplasmic Sperm Injection (single sperm injected into a single oocyte that they got from IVF)
What classifies someone as having oligospermia
Mild: 10-20 million
Moderate: 5-10 million
Severe: less than 5 million
What are examples of ART: Assisted Reproductive Technology
2. Intra-cytoplasmic Sperm Injection (ICSI)
these are methods that combine sperm and egg OUTSIDE the body.
What is IUI: Intrauterine Insemination ?
Motile Sperm is taken from the male (or donor).
The woman's time of ovulation is identified by blood tests and then the concentrated and washed sperm is injected into her uterus 36-40 hours after ovulation is triggered or started naturally.
What is COH: Controlled Ovarian Hyperstimulation?
COH: Inducing the ovulation of many follicles
What is Clomiphene Citrate used for and how does it work?
It is a SERM so it competes with endogenous estrogen receptors, reducing estrogen feedback inhibition causing increased GnRH and therefore increased LH/FSH release. This stimulates ovulation.
What is Letrozole? How does it work?
It is an aromatase inhibitor that inhibits the conversion of androgens to estrogen. Again, this blocks the negative feedback of estrogen so your body is more likely to ovulate (more FSH/LH)
Why would you use metformin to treat infertility??? So confussseeedddddd
Yes this is an anti-hyperglycemic, as you know
It is used in patients with PCOS who are typically obese (but not always). This can help correct androgen levels, and also help with weight loss and decrease BP and cholesterol
Can you just use recombinant FSH and LH to help women ovulate?
Yes. Yes you can.
What's the different between IVF and ICSI
In IVF you just take an egg from the female and place bunch of sperm around it and let them at it.
In ICSI, if the male doesn't have that many motile sperm, you can identify the motile ones and then directly inject it into the cytoplasm of the egg.
Whats the difference between WHO Group I, II and III anovulation?
WHO Group I: not enough gonadotropins so tx by giving them
WHO Group II: Normal estrogen levels, but anovulation is present, classically a case of PCOS
WHO Group III: hypergonadotropic (at menopausal ranges) so tx with IVF
What is tubal factor infertility?
If there is damage to the tubes from ectopic pregnancies, the best treatment course is IVF, because opening up a closed tube won't really fix the problem (it will just scar and close up again)
Why do you not want to get endometriosis other than the fact that getting endometriosis is bad.
I'm tired. I'm sorry.
Infertility is greater in these pts. IVF is only half as successful as in tubal factor pts possibly due to scarring or an oocyte problem.
Treat these pts with excision of mild endometriosis but for moderate/severe pts surgery has unclear benefits
Leiomyomas can cause infertility if they are located ____________
Submucosal or intracavitary (decreased pregnancy rate by 30-50%). Treat with resection.
Intramural ones will be removed if >4cm
Pedunculated ones are usually only treated if symptomatic
What's a disease that causes really bad uterine scar tissue usually after a D&C that can cause infertility?
What are the 3 reasons for undisputed pregnancy loss?
3. Immunologic (antiphospholipid syndrome)
What are the most common genetic abnormalities that lead to miscarriage? How do you treat?
Trisomies (specifically 16)
Tx: genetic counseling, identifying normal eggs and using those
What is an anatomic reason for pregnancy loss?
What can you give to patients that have immunologic reasons for pregnancy loss such as Lupus or antiphospholipid syndrome?
1. Aspirin and Heparin (together)
3. IVIG or prednisone (immunosuppressive therapy--does not improve pregnancy)
Thyroid function (low or high) can effect pregnancy loss. How should you treat it if she's hypo and what level should TSH be at?
Levothyroixine (if hypo). Keep TSH below 2.5uU/mL prior to and during pregnancy
DM is associated with pregnancy loss (And caudal regression remember??). How do you treat?!
Manage glucose. Just put this in so you associate DM with pregnancy loss.
Hyerpolactinemia can cause pregnancy loss too. How do you treat?
Bromocriptine or cabergoline.
Again just remember hyperprolactinemia is associated with pregnancy loss because of the excess prolactin increasing GnRH and messing up HPO axis