Repro Endocrinology and Infertility Flashcards
(42 cards)
define infertility
> 1 yr of unprotected sex without conception
* 6 months if >35 yrs old
fecundability definition and average rate
probability of achieving pregnancy in a single menstrual cycle (about 20-25% in young couples)
definition of fecundity
probability of achieving a live birth after attempting conception for a single menstrual cycle (accounts for miscarriage)
miscarriage rate for young women and women > 40 yrs old
12% in young women; 26% in >40 yrs old
OB/GYN definition of menstrual cycle
24-36 days give or take
how do you calculate ovulation from menstrual cycle?
take cycle length and subtract 14
describe basal body temp around ovulation…what hormone causes this effect in BBT (basal body temp)? how does this BBT relate to fertility?
temp increases AFTER ovulation due to progesterone; most infertile after ovulation because high BBT
when a woman tests positive for an ovulation test, it is a signal that she will be ovulating in __-__ hrs
24-36
ovulation tests are detecting what hormone?
LH
which two pt groups have a higher baseline LH and are more at risk for a false-positive on an ovulation test?
1) . PCOS
2) . premature menopause pts
follicle is a cyst that contains a ___
egg
what are two disorders that can stop ovulation?
thyroid disorders and hyperprolactinemia
estrogen has _________ feedback on pit/hypothalamus at the beginning of menses; at midcycle, estrogen begins _________ feedback
negative; positive (stimulates LH and FSH for LH surge)
to evaluate FSH, LH, and estradiol levels for ovulation, blood is drawn between days __-__
2-4
how do SERMs work? example of SERM
binds to estrogen receptor and acts as agonist or antagonist in tissues (mostly antagonist to give false sense of low estrogen levels = inc in LH/FSH)
*clomid/clomiphene
to diagnosis someone with PCOS, you need 2 out of the following 3 criteria PLUS what else
1).oligoovulation/anovulation
2). evidence of elevated androgens (hirsutism)
3). polycystic ovaries
PLUS- rule out other possible conditions
how does letrozole work?
it blocks aromatase (prevents conversion of androgens to estrogen), so estrogen levels dec and brain stimulates more release of LH/FSH
letrozole works good for fertility in _____ pts
PCOS
what are two drugs that require the HPO axis to be intact?
aromatase inhibitors and SERMS
what medications are used to induce ovulation in women without an intact HPO axis?
gonadotropins LH and FSH injected
what often happens with fertility when using gonadotropin therapy for ovulation?
multiple births
what does ovarian drilling do?
helps pts, specifically PCOS pts, who cant ovulate on medications by destroying androgen producing tissue
how much sperm defines fertility? what % of them have forward motility?
15-20 million/ml; 1/3
three causes of abnormal sperm
1) . genetic- klinefelters, CFTR mutation, and microdeletion of Y chromosome
2) . hormonal- Hypo/pit dysfunction
3) . environmental toxins- smoking, radiation, heat, varicocele
