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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