Term
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Definition
| failure to achieve pregnancy during one year of frequent, unprotected sex |
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Term
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Definition
| incapable of producing offspring |
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Term
| definition of oligomenorrhea |
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Definition
interval between vaginal bleeding >/= 35 days
patient typically ovulates, but less often
weak predictor of infertility |
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Term
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Definition
interval between vaginal bleeding > 6 months
patient may only rarely ovulate
strong predictor of infertility |
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Term
| the burden of infertility upon patient well-being |
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Definition
emotional (depression, relationships), financial, and the susceptibility to questionable or fraudulent therapies
infertility often co-exists with secondary depression (15-54%)
infertility places extreme pressure on interpersonal relationships
often leads to marital difficulties and/or sexual dysfunction
financial burden of infertility treatments can be immense
women with infertility may be more susceptible to claims of questionable or fraudulent therapies |
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Term
| signs and symptoms of clinical disease to screen for patients who require immediate physician attention to address "fertility issues" |
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Definition
WOMEN:
menstrual cycle:
regularity
catamenial symptoms
abdominal or vaginal pain
overweight, obesity, and physical inactivity are associated with decreased rates of conception
excessive caffeine may decrease fertility
MEN:
signs or symptoms of hypogonadism
lifestyle modifications that can increase testosterone levels, sprem count, and/or sperm motility:
avoid tobacco and marijuana
some pesticides are associated with low sperm count (especially with commercial use)
increasing weight bearing exercise can increase testosterone levels |
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Term
| visual saliva fertility detection method |
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Definition
increased estradiol levels lead to increased NaCl concentration in saliva 3-4 days before ovulation and 2 days after ovulation
salt crystalizes into "fern pattern"
"traditional" method for detecting ovulation
15-20% of women do not "fern" during ovulation
must wait 2 hours after eating, drinking, or smoking
commercial visual saliva kits may offer no real advantage over less expensive visual methods |
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Term
| urine LH fertility detection method |
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Definition
detects LH surge 14-48 hours prior to ovulation
cost ~ $50 for 2 kits
test strip kits and midstream kits:
both are reliable
patient preference
MORE ACCURATE THAN SALIVA METHOD; USUALLY USED FIRST LINE |
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Term
| transdermal ovulation prediction |
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Definition
sensor worn on wrist detects increasing chloride ion levels in the sweat prior to ovulation
user begins device at night on 1st, 2nd, or 3rd day of menstrual cycle
MAY PROVIDE THE EARLIEST METHOD OF DETECTING OVULATION
very expensive: ~ $200 per 3 months of use
may be ineffective if too much or too little sweat
too much sweat or exposure to water may damage device |
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Term
| basal body temperature charting fertility detection method |
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Definition
increase from 97F to 98F or higher
rise in temperature occurs 2 days after LH surge |
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Term
| mid-luteal progesterone level fertility detection method |
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Definition
| evaluates corpus luteal production of progesterone |
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Term
| methods used in OTC sperm analysis kits and counseling for patients on their use |
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Definition
visual analysis of sperm count and motility
not the easiest thing for a novice to perform accurately
RECOMMEND PROFESSIONAL ANALYSIS |
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Term
| WHO classifications of anovulation (based on laboratory findings and/or clinical presentation; average incidence of the 3 sub-groups) |
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Definition
WHO 1:
decreased FSH AND E2 levels
~5% of patients
hypothalamic/pituitary failure
WHO 2:
normal FSH AND E2 levels
~80-85% of patients
hypothalamic/pituitary dysfunction (PCOS)
WHO 3: increased FSH and decreased E2
~10% of patients
ovarian failure (menopause) |
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Term
| step-wise treatment algorithm for WHO 2 patients: traditional |
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Definition
1. Clomiphene Citrate (CC)
2. Gonadotropins (FSH) +/- Clomiphene Citrate
3. in vitro fertilization (IVF) +/- Comiphene Citrate +/- FSH |
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Term
| step-wise treatment algorithms for WHO 2 patients: optional revised version |
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Definition
1. Clomiphene Citrate
2. consider metformin for signs/symptoms of PCOS
3. gonadotropins (FSH) +/- Clomiphene Citrate
4. in vitro fertilization +/- Clomiphene Citrate +/- FSH |
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Term
clomiphene citrate:
singletone live birth rate
multiple live birth rate
average time to pregnancy |
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Definition
cumulative singleton live birth rate: 37%
multiple live birth rate: 2%
average time to pregnancy 11.4 months |
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Term
gonadotropins (FSH)
singleton live birth rate
average time to pregnancy |
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Definition
cumulative singleton live birth rate: 43%
average time to pregnancy: 11.4 months |
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Term
in vitro fertilization
singletone live birth rate |
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Definition
cumulative singleton live birth rate: 28%
MULTIPLE LIVE BIRTH RATE HIGHEST WITH IVF STRATEGIES USING MULTIPLE PRE-EMBRYOS |
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Term
combination clomiphene citrate and FSH
singletone live birth rate
multiple live birth rate
average time to pregnancy |
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Definition
cumulative singleton live birth rate: 71%
multiple live birth rate: 7%
average time to pregnancy: 11.4 months |
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Term
combination IVF, clomiphene citrate, and FSH
singleton live birth rate |
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Definition
| cumulative singleton live birth rate: 77% |
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Term
clomiphene citration
typical timing and duration of doses
methods used for determining success
when to consider treatment failure |
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Definition
typical timing and duration of doses:
initiate on days 3-4 post spontaneous or MPA-induced withdrawal bleed
typically dose for 5 days
increase dose each cycle if ovulation does not occur
methods used for determining success:
CC has antiestrogenic effects on the hypothalmus which stimulates FSH and LH = follicular rupture
serum LH levels
when to consider treatment failure:
treatment duration ~1 year
predictors of failure with CC treatment alone:
obesity
amenorrhea prior to treatment
increased ovarian volume
hyperadrogenemia
older age (?)
(all similar to PCOS) |
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Term
gonadotropins: FSH
typical timing and duration of doses
methods used for determining success |
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Definition
typical timing and duration of doses:
low-dose, step-up protocol:
patient specific dosing beginning on DAY 6-7 OF CYCLE
dose increased if no response on ultrasonography or in serum estradiol
methods used for determining success:
ultrasounds every 2-3 days to visualize follicle development
human chorionic gonadotropin (hCG) given once one follicle is mature to induce ovulation
monitor serum estradiol (E2) levels to determine adequate response |
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Term
| counseling points on clomiphene citrate |
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Definition
side effects:
headaches
hot flashes
breast tenderness
bloating
N/V
ocular effects |
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Term
| counseling points on FSH therapy |
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Definition
| contraception should be instituted in patients when >/= 3 dominant follicles develop to avoid multiple live births |
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Term
| differentiate between available gonadotropin products (source, administration, and FSH and LH content) |
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Definition
urine sources:
typically IM adminstration
chorionic gonadotropin
mimics action of LH
from urine of pregnant women
menotropin (eqaal ratio of FSH and LH)
from urine of postmenopausal woemn
recombinant preparations (rFSH):
typically sub-Q adminstration
more pure and with less variability than urine sources
more expensive, but most widely used due to predictability
follitropin alpha and follitropin beta equally efficatious |
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Term
| signs and symptoms of PCOS |
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Definition
cause is largely unknown
increased insulin levels decrease hepatic production of sex hormone binding globulin, resulting in higher concentration of free androgens in the blood
irregular menses
masculinization
relative functional hyperandrogenism
estrogen levels may not be decreased, but estrogen effects are decreased
obesity (cause vs. effect?)
fat represents a site of intense sex hormone metabolism resulting from steroidogenic enzymes, such as aromatase
infertility and 1st trimester spontaneous abortion are common with PCOS |
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Term
| patients at risk for PCOS |
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Definition
risk factors: genetics, obesity, diabetes
PCOS is more prevalent in African American women |
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Term
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Definition
weight loss to near ideal body weight is the most effective therapy
caloric restriction
folic acid 1 mg per day
physical exercise: weight bearing and aerobic
metformin: first line drug therapy
metformin therapy has shown to improve both fertility and 1st trimester spontaneous abortion
normal menses resumes in 55-90% of women
no teratogenicity has been noted with use of metformin in pregnancy
use metformin regardless of diabetes co-incidence
indicated if patient has history of spontaneous abortion despite weight loss
addition of clomiphene citrate |
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Term
| signs and symptoms of endometriosis |
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Definition
pelvic pain
dysmenorrhea
pain with intercourse
increase in menstruation
inferility |
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Term
| definition of endometriosis |
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Definition
| growth of estrogen-dependent endometrial tissue outside the uterus |
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Term
| common sites of endometriosis |
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Definition
ovaries
fallopian tubes
outer surface of uterus
uterine ligaments |
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Term
| drug therapies that treat the symptoms of endometriosis |
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Definition
NSAIDs
oral contraceptives - continuous
GnRH antagonists
gonadotropin inhibitor: danazol
MOA: blocks ovarian stimulating hormones to prevent menstruation
ADRs: acne, facial hair |
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Term
| only effective therapy for treating endometriosis-induced inferility |
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Definition
surgery
NO DRUG THERAPY WILL TREAT ENDOMETRIOSIS-INDUCED INFERILITY |
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Term
| what herbs are promoted to treat "female reproductive complaints"? |
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Definition
red clover blossom
licorice
chastetree berry
black cohosh
dong quai
wild yam
false unicorn root |
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