therapeutics exam 2 infertility

clomiphene citrate

• increases FSH and LH

• used for inducing ovulation

• administer for 5 days

• start 2nd to 5th day of menses

• start with 50mg

• 1st line for PCOS

• AE

  • hot flashes

  • abdominal pain

aromatase inhibitors (letrozole and anastrozole)

• comparable to clomiphene with effectiveness

• 1st line for PCOS

Exogenous Gonadotropins

• stimulate ovarian growth and maturation

• AE

  • Ovarian cysts/pain

  • ovarian hyperstimulation syndrom

  • multiple gestations

• Progesterone needed for luteal support or induce menses

GnRH agonist leuprolide

• suppress natueral cycle

• lower doses may encourage FSH and LH

  • 40-50 mcg

• high dose

  • 10-20 units

GnRH antagonist cetrorelix and ganirelix

• suppress FSH and LH

• less side effects

chronic gonadotropin (ovidrel, pregnyl, novarel)

• similar to LH, triggers ovulation

• tiggers ovulation 36 hrs after injection

• hCG can be positive in the blood for days after injection

ovarian hyperstumulation

• risk greatest with use of exogenous gonadopropins and high dose of hCG

• mild symptoms

• must have a lot of fluids

symptoms of OHSS

• weigh wain >2.25 kg within 24 hrs

• abdominal/pelvic pain

• N/V/D

• dyspnea, dizziness

• oliguria

metformin

• can be combined with CC

• 500 mg initially then 1000 bid

progesterone oral capsules

• 100-200 daily to TID orally or vaginally

• avaoid in peanut allergy

• when used vaginally avaoid other vaginal preparation for 6 hrs before or after

aspirin

may reduce uterine clotting which may reduce OHSS risk