T2 L9 PT. 2 (SINGLETON) (INFERTILITY)

What is fecundity?

capacity to have a live birth

What is fecundability?

Probability of achieving a pregnancy in a single menstrual cycle with adequate sperm exposure and no contraception that results in a live birth

What is fertility?

The ability to have a clinical pregnancy

What is sterility?

Permanent state of infertility

Describe the way male infertility is worked up

Abstain from ejaculation for 2-5 days prior to sample collection

- Evaluated for conc., motility, morphology

First line treatment for male infertility?

IUI or artificial insemination

Second-line treatment: IVF

Hypogonadism's role in male infertility?

Oligospermia, azoospermia

Decreased testosterone and increased TSH

Role of SERMs in ovulation induction?

Enhances normal follicular maturation process and ovulation (DW likes this one)

Role of aromatase inhibitors in ovulation induction?

Block conversion of androgens into estrogen, creating a hypoestrogenic state to promote the release of additional LH and FSH (DW likes this one)

Role of gonadotropins in ovulation induction?

Recruitment and development of multiple follicles (DW likes this one)

Role of GnRH agonists in ovulation induction?

Allow optimal duration of gonadotropic administration (DW likes this one)

Role of GnRH antagonists in ovulation induction?

Immediately suppress gonadotropic release (no premature LH surge) (DW likes this one)

Role of human chorionic gonadotropin in ovulation induction?

Simulation of a natural LH surge to trigger ovulation (DW likes this one)

SERMs cause a __________ surge

gonadotropin

Clomiphene class?

SERM

Side effects associated with Clomid?

Hot flashes, abdominal/pelvic discomfort, ovarian enlargement, headaches, mood swings, nausea, visual disturbances, multiple births

Aromatase inhibitor of choice for ovulation induction?

Letrozole

T/F: Gonadotropins when combined with HCG offer a greater chance of producing a mature egg and getting pregnant.

True

Side effects associated with gonadotropins?

Menopausal side effects

Breast pain

Abdominal pain

Ovarian hyperstimulation syndrome

Hot flashes

What is ovarian hyperstimulation syndrome (OHSS)?

Iatrogenic complication of ovarian stimulation where ovaries become swollen and painful. Varying degrees of severity and can cause significant morbidity and mortality.

How can we avoid OHSS if dosing gonadotropins?

Withhold hCG shot; lower-doses or withholding gonadotropins

What drug can be used for the avoidance of OHSS?

Dopamine agonists - cabergoline

When do we give hCG shot?

When we know eggs are mature

Action of GnRH antagonists?

Maximize follicular maturation by ensuring there is no LH surge

Dopamine agonists used in hyperprolactinemia

Bromocriptine

Cabergoline