Pharmacology, preventing or causing pregnancy Flashcards Preview

Module 6: Repro/Endocrine > Pharmacology, preventing or causing pregnancy > Flashcards

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What is the most effective form of contraception (besides abstinence)?



What is the mechanism of action of an IUD?

- Causes sterile inflammation in the uterus

- Sperm is destroyed by PMNs

- Thickens cervical mucous

- Inhibits ovulation

- Thins endometrial lining, decreasing menstrual volume


What are the benefits and side effects of IUDs?

- Ease of use
- No systemic exposure to hormones
- Lower menstrual blood loss
- May decrease endometrial cancer risk
- May be used during breast feeding

Side Effects:
- Need to check string
- Increased risk of acne
- Changes in menstrual flow
- Risk of uterine perforation
- Risk of pelvic infection


What is the MoA for Depo Provera?

- Inhibits ovulation

- thickens cervical mucus

- Thins endometrial lining


What are the benefits and side effects of Depo Provera?

- Easy use (injection every 3 months)
- Decreases anemia
- Decreases PID
- Decreases ectopic pregnancy
- May decreased endometrial cancer
- Can be used during breast feeding

Side Effects:
Irregular menstrual bleeding
- Amenorrhea
- Acne
- Mood changes
- Headache
- Possible weight gain


What is the MoA of Oral Contraceptives?

- Inhibits mid-cycle LH surge (preventing ovulation)

- Thickens cervical mucous

- Disrupts tubal and uterine motility

- Alters glycogen production in endometrium


What are the benefits and side effects of oral contraceptives?

- Decreased menstual blood loss
- Decreased PMS
- Decreased acne
- Decreased ectopic pregnancy
- Decreased symptomatic functional cysts
- Decreased PID

Side Effects:
- Increased cervical dysplasia
- Increased risk of thromboembolism
- Breast tenderness, nausea, fluid retention (all increase with increased estradiol)


What is the MoA of vaginal contraception (the ring)?

- Circular silastic capsule releases:
15 ug ethinyl estradiol daily
120 ug etonogestrel daily

- Kept in place for 3 weeks, 1 week off

- Inhibits ovulation

- Thickens cervical mucus

- May alter endometrial glycogen


What are the benefits and side effects of vaginal contraception (the ring)?

- Ease of use
- Lower hormonal exposure
- Less impact on liver
- Improved menstrual cycle control
- May help with ovarian/endometrial cancer prevention

Side Effects:
- Vaginitis
- Break-through bleeding
- Nausea
- Breast tenderness
- Possible increased cervical dysplasia or thromboembolism


What is the MoA of emergency contraception?

It is, essentially, a massive load of estrogen on the system

- Alterations in tubal transport

- Interference with corpus luteum function

- Direct interference with fertilization

- Disrupts implantation


What are the side effects of emergency contraception?

- Nausea/vomiting

- Breast tenderness

- Headache

- Dizziness

- Not effective for established pregnancies


What are the factors that determine what treatment is required for infertility?

Treatment depends on Infertility Diagnosis:

- Unexplained infertility
- Anovulation/PCOS
- Tubal Factor
- Endometriosis
- Recurrent Pregnancy Loss
- Male Factor


What is fecundability?

Probability that a cycle will result in pregnancy


What is fecundity?

Probability that cycle will result in a live birth


What is the recommendation for all couples - regardless of diagnosis of infertility?

Maintain good health in both partners
- BMI in normal range
- Avoid tobacco, heavy alcohol, other substances
- Limit caffeine consumption

Maximize Intercourse Timing
- Intercourse every other day around time of ovulation


What does a diagnosis of unexplained infertility require?

- Evidence of ovulation

- Normal ovarian reserve and uterine cavity

- Patent fallopian tubes

- Normal semen parameters


What are the treatment options for unexplained infertility?

- Natural cycle timed intercourse

- Natural cycle Intrauterine insemination

- Clomiphene citrate (CC) alone

- CC and IUI

- Injectable gonadotropins and IUI

- In Vitro Fertilization


What is the standard recommendation for unexplained infertility?

3-6 months of CC/IUI, then proceed with IVF


What is required for the diagnosis of  Anovulatory/PCOS WHO Group I?  What is the infertility treatment?

Hypogonadotropic Hypogonadal Anovulation - Inadequate central gonadotropin function

- Often requires gonadotropin injections


What is requried for the diagnosis of Anovulatory/PCOS WHO Group III?  What is the treatment?

Hypergonadotropic Anovulation - Classically premature ovarian insufficiency

- Requires donor oocyte IVF


What is required for the diagnosis of Anovulatory/PCOS WHO Group II?  What is the treatment?

Eugonadotropic, Euestrogenic Anovulation - Classical PCOS

Required for diagnosis:
- Oligomenorrhea (fewer than 9 cycles/year)
- Ultrasound evidence of PCO
- Clinical or laboratory evidence of high androgens

- Weight loss in obese patients
- Metformin (thiazolidinedione)
Can increase ovulation in some women with PCOS by correcting androgen levels in ovary


What can be used to treat tubal factor infertility?

Tubal anastomosis
- Other surgery to open blocked tubes in controversial

- initially developed for tubal factor infertility


What is the treatment for endometriosis infertility?

Surgical excision of minimal/mild endometriosis appears to improve pregnancy rates (moderate/severe benefits unclear)



What are treatments of male factor infertility?

- Vasectomy reversal if no other infertility factors
--> second option is surgical sperm retrieval for IVF/ICSI

- Consider IVF/ICSI