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P&T Block 5 Renal > L74 > Flashcards

Flashcards in L74 Deck (21)

Def of infertility

1 year with unprotected intercourse


Normal: talk through the hormonal axis to getting a dominant follicle

1. GnRH from hypothalamus -> ant pit released FH
2. FH acts at ovary to move multiple follicles into development
3. Surge in E form these = -FB onto ant pit = ↓FSH
4. Dominant follicle chosen = E spike = +FB = ↑LH to stimulate OVULATION


Normal: describe the hormones involved after ovulation

CL makes P = -FB on ant pit + hypothalamus
No pregnancy = progresterone drops = period


Hormones you want to check if a woman is ovulation

Day 3 FSH - elevated concerned for early menopause
Day 21 progesterone- ovulate around day 14, should be elevated at 21
Prolactin - ↑ed means you won't ovulate


How does body temp predict fertility

Progesterone ↑body temp
You can have sex during this period aka you've already ovulated


What is the fertility window?

3-5 days before ovulation - sperm can remain in repro tract
24 hrs after ovulation


Meds to make a woman ovulate

Clomiphene citrate
Menopausal gonadotropin - make you think you're menopausal = overproduced FSH


Mechanism of clomiphene citrate

Lose the -FB to hypothalamus from the ↑P from dominant follicle
↑FSH to overstim ovaries
Give d5-10


What is a hysterosalpingogram? Who do you do it for?

Check uterus and tubes for scarring
+ Contrast, take XR
Do it after menstruation before ovulation (not to disrupt an existing pregnancy)


What is a sonohytserogram? What is the main cons?

US after injecting saline into the tubes
Good for tubes, bad for uterus eval


What does PID put you at risk for?

Tubal infertility


How would you use laperoscopy to eval patency of tubes?

Camera in
Retrograde fill tubes with dye
Should spill into abdomen if patent


What is a hysteroscopy?

Camera in through cervix
Doesn't help you eval the tubes


Treat tubal cause of infertility if both tubes effected

Take eggs out - fertilize out of body - implant into uterus


Why is there a delay in male fertility?

Takes 3 months to produce viable sperm
Overturn sperm every 3 months anyways


Describe the -FB in male fertility

1. Hypothalamus - GnRH
2. Anti pit - LH + FSH
3. Make sperm via leydig (LH) and sertoli cells (FSH)
4. Testosterone shuts off the hypothalamus one the sperm are make


What is the male workup for fertility?

Sperm analysis - count, motility, morphology


Where does fertilization happen?

In the tubes - why most common site of ectopic


Treat male infertility

↑# via multiple ejaculation + cryopreseration
Steroids if Abs vs sperm
Treat ED
Surg if obstruction
+Hormones if defiicient


How test cervical mucus problem?

After sex - see how long takes sperm to get through


What is the risk of clomiphene?

Multiple kids in a pregnancy - twins, triples