B6 Endo/GU Pharmacology Final Exam
Definition & General Causes of Infertility - fail conceive after specif time w/ reg interc
w/o contrac (ie. 12 mts
... [Show More] if <35y/o & 6mts if >35 or PCOS)
- 1/3 causes each fem orig, male orig, unk/combo of both partners
- conceiv prob decr 3-5%/yr after 30-32, faster after 37-40y/o by dim oocyte qual+quant
Pathophysiology, Sx, Labs, Causes, Solution for WHO Group I Infertility - - Pathophys =
hypogonadotr hypogon by hypoth-pit fail
- Sx/labs = amen, low FSH/LH, low estrad, +/- elev prolactin
- Causes = eating disords, wt/exerc extremes, hyperprol
- Soln = correct cause (ie. gain wt, thyr med, dopa ag); reg Gn & ind ovul
Pathophysiology, Sx, Labs, Causes, Solution for WHO Group II Infertility - - Pathophys
= normogonadotr anov by hypoth-pit-ovar fail **MOST COMMON**
- Sx/labs = nl FSH, nl-elev LH, nl estrad, elev PRL, galactorr
- Causes = PCOS, ovul-rel dysfunc, hyperPRL
- Soln = meds ind ovul, Gn to reg ovul, decr PRL by Dopa ag
Pathophysiology, Sx, Labs, Causes, Solution for WHO Group III Infertility - - Pathophys
= hypergonadotr hypogon by ovar fail
- Sx/labs = elev FSH, low estrad
- Causes = adv age
- Soln = oocyte don, IVF
Other causes of Infertility - ut/outfl tract abnorms, tub dis by PID
- Treat w/ meds/IVF
Pathophysiology, Sx, Labs, Causes, Solution for Male Factor Infertility - - Pathophys =
anat vars, chrom abnorms, erec/ejac dysf
- Sx/labs = abnl FSH/LH, testost, semen analysis
- Causes = inf, inj, tox expos, syst dis, sperm ABs, hypogon, testic dis, sperm transp
defs
- Soln = IVF, intraut insem, don sperm
**MOST COMMON CAUSE is cryptorch**
Overview of Repro Endocrinology - hypoth secr GnRH stim ant pit gonadotropins
LH+FSH stim ovars+testes
- -reg by inhibin (-FSH) & elev estrog/progest/testost (-GnRH+LH/FSH)
- +reg by activin (+FSH) & estrog (+LH/FSH mid-cyc)
Role of Gonadotropins in Menstrual Cycle - - Follic ph (prolif ph) = low estrog/inhib -->
elev LH/FSH stim follic dev for dom foll form; high sust estrog, mid-cyc LH/FSH surge
for ovul
- Luteal ph (secr ph) = corp lut secr estrog+progest, endom prep for implant by progest
incr blood supp spir arts
**ovar dysf accounts for most infert cases**
B6 Endo/GU Pharmacology Final Exam
Gonadotropin Function in Women - - FSH = germ c mat by dir stim follic gr+mat, enh
granul c LH responsiveness; steroidogen by follic ph estrog prod in foll
- LH = steroidogen by ovar estrog & lut ph estrog+progest for follic w breakd for ovul &
subseq resuming oocyte meiosis
- hCG = LH analog for steroidogen, plac estrog+progest dur preg
Gonadotropin Function in Men - - FSH = testost bind in Sertoli c mediating cell
mat+spermatid diff (spermatogen)
- LH = steroidogen by test Leydig c prod testost
Role of Gonadotropins in Fertility & Pregnancy - - LH surge = impend ovul prediction det
by ur ovul pred kits --> should engage in interc if LH elev
- implant --> emb hCG prod working @ LH-R, meas in preg tests prev CL loss --> CL
maint cont prod progest+estrad until placenta takes over
Description & Treatment of PCOS - most comm anov infert cause w/ menstr irreg, infert,
obes, hyperandrog, insul resis
- Treat = wt red, low-d OCP/progestin decr LH+androg synth, Spirono for acne+hirsut
b/c anti-androg, Clomiphene if desire preg, MEtformin if diab/metab synd feats or ocul
issues, Aromatase inhibs off-lab for ovul
Non-pharmacologic therapy for Infertility - - smok cess
- wt modul BMI<30 (ideal 18-30)
- red excess caffeine
- EtOH cess
- folic ac suppl decr NTD w/ 400mcg/d, 5mg/d for high risk NTD incl obes, DM, epilep,
hemat disords, prev NTD kids
- approp coitus freq Q1-2d around expec ovul
Description of Ovulation Induction (OI) for Infertility Management - used in anov pts to
achieve preg w/ interc/IUI (just trying to control time of ovul)
- most for PCOS, hyperPLN, hypogonatr hypogon (uncomm)
Description of Controlled Ovarian Stimulation (COS) for Infertility Management - pts
already having ovul cyc w/ unexpl infert, struc abnorms+dis
- ova coll+fert ex vivo then reimplant (IVF)
Pharmacological Management of Infertility - incl ovul induction & controlled ovar stim
**mult pregs can occur**
Drug Classes & Examples for Infertility Treatment - - SERMs = Clomiphene
- Arom inhibs = Letrozole, Anastrozole
- Gonadotropins = FSH, hMG (hum menop gonadotr), hCG
- Dopa ags = Bromocriptine, Cabergoline
- GnRH ags = Leuprolide, Goserelin
- GnRH antags = Cetrorelix, Ganirelix [Show Less]