Reproductive Treatments

Question 1

How is primary hypogonadism in males treated?

Answer 1

Hard to treat via hormones

Question 2

How is secondary hypogonadism in males treated? How does this help?

Answer 2

Gonadotrophins (LH/FSH)

Stimulates spermatogenesis

Question 3

What hormone stimulates testosterone via what cells?

Answer 3

LH stimulates it via leydig cells

Question 4

What hormone stimulates spermatogenesis in what structure?

Answer 4

FSH in seminiferous tubules

Question 5

What injections for male infertility target LH receptors?

Answer 5

hCG injections

Question 6

Does Congenital Secondary Hypogonadism have better, same or worse prognosis than Acquired Secondary Hypogonadism in males and why?

Answer 6

Worse- he has not gone through mini puberty

Question 7

When is testosterone replacement given?

Answer 7

If not desiring fertility

Question 8

What testosterone replacements are available?

Answer 8

Daily gel- tostran
3 weekly injection
3 monthly injection

Question 9

What do we have to monitor when giving testosterone replacement?

Answer 9

Observe haematocrit (risk of hyperviscosity and stroke)
Prostate (PSA levels)

Question 10

How is fertility mainly improved for patients with PCOS?

Answer 10

Try to stimulate ovulation (ovulation induction) via development of one ovarian follicle (avoids multiple pregnancy)

Question 11

How is ovulation induction encouraged?

Answer 11

1. Lifestyle / Weight Loss / Metformin
2. Letrozole (Aromatase inhibitor)
3. Clomiphene (Oestradiol receptor antagonist)
4. FSH stimulation (injection)

Question 12

How does letrozole/ aromatase inhibitor/ oestradiol receptor antagonist work?

Answer 12

Reduces negative feedback from oestradiol

Question 13

How does IVF work?

Answer 13

High dose of FSH to stimulate eggs
Prevent premature ovulation via GnRH agonist/antagonist
Give LH to allow egg maturation
Retrieve eggs from ovary
Fertilisation in vitro or intracytoplasmic injection of sperm
Embryo incubation
Embryo transfer

Question 14

When is intracytoplasmic injection of sperm (ICSI) used and what is it?

Answer 14

When theres a problem with the sperm, inject one sperm into an egg

Question 15

What do we do to ovulation in IVF?

Answer 15

Prevent it by giving medicine to prevent premature LH surge

Question 16

How is premature LH surge prevented in IVF?

Answer 16

Via GnRH antagonist or GnRH agonist- if given GnRH in a non pulsatile way LH is inhibited

Question 17

How are eggs matured in IVF and where?

Answer 17

By giving LH then hCG-they should still be in the ovary

Question 18

What happens in egg maturation?

Answer 18

Egg goes from metaphase 1 to metaphase 2 to allow it to halve its DNA content

Question 19

How does Ovarian hyper stimulation syndrome occour?

Answer 19

Due to long lasting hCG during IVF

Question 20

How does Ovarian hyper stimulation syndrome present?

Answer 20

Pleural effusion
Ascites
Renal failure
Ovarian torsion

Question 21

What are methods of contraception?

Answer 21

Barrier: male / female condom/ diaphragm or cap with spermicide
Combined Oral Contraceptive Pill (OCP)
Progestogen-only Pill (POP)
Long Acting Reversible Contraception (LARC)
Emergency Contraception
Vasectomy
Female sterilisation

Question 22

What are positives of the OCP?

Answer 22

Easy to take 
 Effective
 Doesn’t interrupt sex
 Can take several packets back to back and avoid withdrawal bleeds
 Reduce endometrial and ovarian cancer

Question 23

What are negatives of the OCP?

Answer 23

It can be difficult to remember
No protection against STIs
P450 Enzyme Inducers may reduce efficacy
Not the best choice during breast feeding

Question 24

What are side effects of the OCP?

Answer 24

Spotting (bleeding in between periods)
 Nausea
 Sore breasts
 Changes in mood or libido 
 Feeling more hungry

Question 25

What are non contraceptive uses of the OCP?

Answer 25

Lighter/less painful periods | PCOS (reduces LH and hyperandrogenism)

Question 26

What is the progesterone only pill (mini pill)?

Answer 26

Works as OCP but less reliably inhibits ovulation Often suitable if cant take oestrogen Can be used when breastfeeding

Question 27

What are negatives of the mini pill?

Answer 27

Can be difficult to remember No protection against STIs Shorter acting – needs to be taken at the same time each day

Question 28

What are the common long acting reversible contraceptives (LARCs)?

Answer 28

IUD (copper coil)- decreases sperm survival Intra uterine systems- secretes progesterone Progestogen-only injectable contraceptives or subdermal implants

Question 29

What are the emergency contraceptives?

Answer 29

IUD | Emergency contraceptive pill (ellaOne in 5 days, Levonelle in 3 days- less effective)

Question 30

What are side effects of emergency contraception?

Answer 30

Headache, abdominal pain, nausea

Question 31

What should we consider when chosing contraception?

Answer 31

Risk of venous thromboembolism Other conditions Need for prevention of STIs Concurrent medication

Question 32

What are risks of HRT?

Answer 32

Venous thrombo embolism- use transdermal oestrogens if this is the case Hormone sensitive cancers (mainly endometrial but also breast and ovarian, especially if use is long term) Cardiovascular disease Small risk of stroke

Question 33

What must we give with oestrogen? Why?

Answer 33

Progesterone- to prevent endometrial cancer (presents with post menopausal bleeding)

Question 34

What are benefits of HRT?

Answer 34

Relief of symptoms | Less osteoporosis related fractures

Question 35

How is gender different to sex?

Answer 35

Gender- what you identify as | Sex- biological

Question 36

What is gender dysphoria

Answer 36

When gender non conforming causes depression

Question 37

What are treatments for supporting transgender males/females?

Answer 37

Men- Testosterone injections or gels, progesterone to surpress menstrual bleeding Women- high dose oestrogen, reduce testosterone via GnRH agonists (desensitisation of HPG axis)

Question 38

What are treatments for supporting transgender males/females and gender non binary individuals?

Answer 38

Men- Testosterone injections or gels, progesterone to surpress menstrual bleeding Women- high dose oestrogen, reduce testosterone via GnRH agonists (desensitisation of HPG axis)