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Exam 2
Lecture 3 Part 1
67
Anatomy
2nd Grade
02/07/2013

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Term
infertility is not concieving for how long if no contraceptives?
what about if prior oral contraceptives?
Definition
1 year;
15 months
Term
what is primary infertility?
Definition
not concieving any children
Term
what is secondary infertility?
Definition
have had 1 child but cant convcienve now
Term
_% of US women have some sort of infertility?
Definition
10
Term
30-35% of infertility is related to _ abnormailites
Definition
endocrine
Term
contraception rates decrease for 2 age groups
Definition
35-39
40-45
Term
how much do male partners contribute to infertility?
Definition
half
Term
estrogen needs to be suffieicnet in what phase?
Definition
follicular
Term
has infertility increase or decreased?
Definition
increased
Term
contributing factors to increased infertility-4
Definition
older age
contraceptives
sexual practices
increase in therapeutic abortions
Term
infertility occus when you block dopamaine or serotonin?
Definition
dopamine
Term
most common cause of anovulation and menstrual problwem with women of normal hormone levels?
Definition
hypothalmic dysfunction
Term
what causes hypothalmic disorders
Definition
eating disorder/weight loss>15%
stress
exercise
Term
hyperanadrogenicity is oftentime diagnosed as what?
these people have chronic increase in what hormone?
Definition
PCOS
LH- whcih stimulate follicla aproduction of androgen
Term
what is PCOS often associated with?
Definition
metabolic syndrome obesity, insulin resitance
Term
whcih endocrine disorder decreases GnRH
Definition
hyperprolactinemia
Term
which endocrine disorder leads to hyperprolacitnemia
Definition
hypothyroidism
Term
why is a dopamine blocker not good?
Definition
blocks the inhibiton of prolactin
Term
most evals of infertility dont occur until _ months of trying?
unless what?
Definition
12;
>35 yo
Term
during the medical/surgical etc history eval what kind of disorder are you looking for?
Definition
e ndocrine
Term
during the female eval what 2 disease do you screen for
Definition
gonorrhea
clamydia
Term
what is a hysterosalpinogogram?
Definition
fluro and radioscopic visual of the upper gential tract of female
Term
pateint counseling for Basal temperature:
what day do you take first measurement, an what time of day?
Definition
1st day of menstrual cycle- in morning befoer get out of bed
Term
normallt your temperature is lwoer before_ and then hgiher after.
this is also called?
Definition
ovulation
buphasic
Term
what temp indicated ovulation is about to happen?
what temp says it already occured?
Definition
.1 decrease
.4-.6 increase
Term
the littple spike of temp before it lowers for ovulation is a spike in what hormone?
what about the huge spike after ovulation?
Definition
estogren
progestroen
Term
when do you being testing for ovulation kits?
Definition
3-4 days before ovulatoin- day 10 of menstruaiotn cycle
Term
once ovulation kit is positive- how long do you ahve to have sex?
Definition
24 hours
Term
male infertility can be due to-
Definition
hyperproloactinemia, DM, nutrition defic, low count/ immotile sperm
Term
what drugs cna impair spermatogeniss?
Definition
cocaine, majuirnaa, cafeeine, alcohol, nicotine
Term
for semen analysis- how long do you ahve to abstain from ejaculation ebfore hand?
then abnormla results should be confirmed with _ other times
Definition
2-3 days
2-3 times
Term
what are the nonpharm options for infertility?
Definition
intruterine insemination- IUI
assisted reproductive therapy ART
Term
what are the 3 forms of assisted reproductive therapy?
Definition
in vitro fertilization/embryo trnasfer
gamete tranfer
zygote trnasfer
Term
non pharm therapy-
Definition
reduce BMI <30
females no NSAIDS or ASA around ovulation
meds that cause hyperprolactin, impair sperm
Term
what do NSAIDS or ASA do to ovulation?
Definition
prevent release of oocyte
Term
why do you not want to use vaginal lubricants?
Definition
impair sperm
Term
when is intruterine insemination perfeormed? -2
Definition
on the day after urinary surge of LH
or
36 hours after injection of hCG
Term
what is ART?
Definition
direct retrival of oocytes and mainuplating sperm to get preggo
Term
is ART common?
whaht is the most ocmmon form of ART?
Definition
no
in vitro fertilization/ test tube babies
Term
in which nonpharm procudure is more than 1 embroy trnasfered to uturus?
why?
Definition
ART
increase lieklihood of preggo
Term
who created invitro fertilization?
Definition
robert edwards
Term
what is the estrogen recptor antagonist?
Definition
clomiphene citrate
Term
Effect of clomiphene -3
Definition
blocks feedback inhibiton of hpyothalmus
reiases FSH and LH
raised HPG function
Term
what are some pharmacologic therapies?
Definition
gonadotropins
orals contraceptives/estrogen
GnRH blockers, agonists
Term
this is the treatment for infertility in anovulatory women
Definition
clomiphene
Term
what do the effects of clomiphene lead to? -2
Definition
enlarges ovaries
drug induced ovulation for ppl with PCOS or amenorrhea
Term
primary site of action for clomiphene
secodnary site fo action?
Definition
estrognen recptors in the ovaries
direct effect on ovaries
Term
Clomiphene
-absorption:
distribution:
t 1/2:
Definition
good oral
broad
5-7 days
Term
which med is metabolized by CYP 2D6
Definition
clomiphene
Term
clomiphene essntial puts women in-
so this means?
Definition
menopause
same ADEs
Term
clomiphene common ADEs-4
Definition
hot flash (vasomototr flush), abdomnial disocmfort, visual blurring, reversible ovary enlarge/cysts
Term
infrequent effects of clomiphene-3
Definition
n/v, uterine bleeding
Term
whcih med enhances the chance of triplets, twins?
why?
Definition
clomipehene
creates mutliple ovulation
Term
more people ovulate than actually get preggo once on clomipehen- why? -3
Definition
antiestrogen effect on uterus
ednometiral thinning and produciton of thick cervicla mucus
Term
when do you start clomiphene?
Definition
on cycle day 2-5 (use for 5 days)
Term
what counts as clomiphene thera[y failure
Definition
no preggo within 6 months
Term
t med is first line for PCOS?
Definition
clomipehene
Term
what med is first line for women with nromal GnRH
Definition
clomipehene
Term
what med is first line for ovulation induction with timed intercourse/IUI
Definition
clomipehene
Term
what med is the aromatase inhibitor
Definition
letrazole/ Femara
Term
MOA of letrazole
what surge does this lead to?
Definition
inhbitis conversion of testosterone to esttradiol;
LH and FSH
Term
side effects of letrazole-3
Definition
hot flashes, headahce, breast tender
Term
letrazole therapy is started what day
Definition
3rd day of cycle
Term
when do you letrazole
Definition
clomiphene fail, but before gonadotropins
Term
clomipehene vs letrazole
whihc has less anti-estrogen effects
which has longer half life
which has higher conception rate in first cycle?
Definition
lestrogen
clomipehen
letrazole
Term
clomiphene and lestrogen
when is ovulation expected?
when should intercourse be?
Definition
5-10 days after last dose
every other day for 1 week beginnging 4-5 days after last dose
Term
clomipehen and lestrogen
what should you report to doctor-4
monitor ovulation with? -2
Definition
vomiting, nasuea, pain, bloating
kits or ultrasound
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