Week 1 Powerpoint


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Week 1 Powerpoint

  1. 1. Group 4 Kristen Dominik, Kelly Lawn, Kelly Magoffin, Leigh Smyczek, Jennifer Townsell
  2. 2. <ul><li>KR has been trying unsuccessfully for 1.5 years to become pregnant. </li></ul><ul><li>She has a very irregular menstral cycle. </li></ul><ul><li>She’s been using an ovulation monitor for 6 months with no positive readings. </li></ul><ul><li>She is feeling depressed. </li></ul>KR’s Questions : Should I meet with a fertility specialist? What are the advantages? What tests will be run? Metformin helped my friend conceive, what should I know about that? 35 year old woman (gravida 0, para 0)
  3. 3. <ul><li>Saliva Test </li></ul><ul><li>1. Place a drop of saliva on the surface of the lens </li></ul><ul><li>2. Allow the sample to dry for at least five minutes and replace the lens into the body of the microscope. </li></ul><ul><li>3. Look into the lens and push the light button to observe the test results. (focus on image) </li></ul><ul><li>4. If you see a &quot;ferning&quot; or crystal pattern in your saliva, you know you are fertile - the perfect time to conceive! </li></ul><ul><li>Urine Test (Clearblue monitors) </li></ul><ul><li>1. Assemble the test and hold in your urine stream for 5-7 seconds. </li></ul><ul><li>2. The test ready symbol will start flashing after 20-40 seconds to show the test is working. </li></ul><ul><li>3. The display will show your result within 3 minutes. </li></ul><ul><li>4. If the Luteinizing Hormone (LH) Surge symbol is displayed, then you have detected your LH surge! </li></ul><ul><li>5. You should ovulate within the next 24-36 hours. </li></ul>
  4. 4. <ul><li>For a 28 day cycle, you should test on day 9 of your cycle, ovulation should occur between days 10 and 17. </li></ul><ul><li>If your cycle is 21 days or less (irregular period), you should start testing on day 5 of your cycle. If your cycle is longer than 40 days, you should start testing 17 days before you expect your next period. </li></ul>
  5. 5. <ul><li>Can Result From… </li></ul><ul><ul><li>Improper use of test </li></ul></ul><ul><ul><li>Irregular periods </li></ul></ul><ul><ul><li>Improper timing of sexual activity in conjunction with LH surge </li></ul></ul><ul><ul><li>Women over 35 ovulate less, but still have menstrual periods (anovulation) </li></ul></ul><ul><ul><li>Infertility </li></ul></ul>
  6. 6. Most women will seek the help of a specialist after unsuccessfully trying to become pregnant for one year. However, women over the age of 35, those having irregular periods, or with medical problems should visit sooner.  KR should see a fertility specialist <ul><li>Advantages : </li></ul><ul><li>Fertility specialists have extensive training in obstetrics, gynecology, endocrinology and infertility. </li></ul><ul><li>Tests can be run for female infertility as well as semen analysis. It is important to test both partners as male factors account for 50% of all infertility cases. </li></ul><ul><li>The specialist will perform advanced tests to determine the fertility of the patient. </li></ul>
  7. 7. <ul><li>First Visit : The fertility specialist will measure the patient’s follicle stimulating hormone (FSH) and luteinizing hormone (LH) to determine baseline levels. This is done on the third day of the patient’s cycle. </li></ul><ul><li>Second Visit : The second visit occurs on the day of the LH surge, which is before ovulation in most cases. The reproductive specialist will likely perform the following tests.. </li></ul><ul><ul><ul><li>Cervical Mucus Test – this is a post-coital test to determine the sperm’s ability to penetrate and survive in the cervical mucus. </li></ul></ul></ul><ul><ul><ul><li>Ultrasound Test – used to assess the thickness of the lining of the uterus (endometrium), monitor follicle development, and check the condition of the uterus and ovaries. </li></ul></ul></ul>
  8. 8. <ul><li>Hormone Testing – evaluates levels of hormones contributing to the reproductive process such as LH, FSH, estradiol, progesterone, prolactin and more. </li></ul><ul><li>Hysterosalpingogram (HSG) – an x-ray of the uterus and fallopian tubes to identify any blockages. </li></ul><ul><li>Hysteroscopy – used to examine the inside of the uterus and is helpful in diagnosing abnormal uterine conditions such as internal fibroids, scarring, polyps, and congenital malformations. </li></ul><ul><li>Laparoscopy - outpatient procedure to view the fallopian tubes, ovary and uterus which can diagnose causes of infertility such as endometriosis or tubal blockage. </li></ul><ul><li>Endometrial Biopsy - removing a small amount of tissue from the endometrium prior to menstruation to determine if there is a hormonal imbalance. </li></ul>Upon normal results from the previous tests, the fertility specialist may pursue the following..
  9. 9. <ul><li>Mechanism of Action </li></ul><ul><ul><li>Selective Estrogen Receptor Modulator (SERM) </li></ul></ul><ul><ul><ul><li>Inhibits normal negative feedback of circulating estradiol on the hypothalamus, preventing estrogen from lowering the output of gonadotropin releasing hormone (GnRH) </li></ul></ul></ul><ul><ul><li>Weak Estrogen Agonist </li></ul></ul><ul><li>Dosage </li></ul><ul><ul><li>Initially: 50mg by mouth everyday for 5 days, beginning on 3 rd , 4 th , or 5 th day of menstrual cycle </li></ul></ul><ul><ul><li>If ovulation does NOT occur: 100mg by mouth everyday for 5 days </li></ul></ul><ul><ul><ul><li>Start as early as 30 days after initial dosage </li></ul></ul></ul><ul><ul><li>Patient may receive up to 3 treatment cycles </li></ul></ul>Clomiphene is often a first line treatment to induce regular ovulation
  10. 10. <ul><ul><li>Provides an assessment of the patient’s ovarian reserve </li></ul></ul><ul><ul><li>Procedure: </li></ul></ul><ul><ul><ul><li>FSH and estradiol levels are measured on day 3 </li></ul></ul></ul><ul><ul><ul><li>Patient takes clomiphene 100mg on days 5-9 </li></ul></ul></ul><ul><ul><ul><li>FSH level is measured again on day 10 </li></ul></ul></ul><ul><ul><li>Considered abnormal if: </li></ul></ul><ul><ul><ul><li>either the day 3 or 10 FSH values are elevated or </li></ul></ul></ul><ul><ul><ul><li>day 3 estradiol is greater than 80 pg/ml </li></ul></ul></ul><ul><ul><li>If these results are abnormal, then the patient will have a decreased response to injectable FSH in assisted reproductive technology cycles </li></ul></ul><ul><ul><ul><li>These patients have low pregnancy success rates and have an increased chance of miscarriage </li></ul></ul></ul>
  11. 11. The use of injectable fertility drugs to stimulate ovulation will be considered after treatment with clomiphene has failed Gonadotropins  hormones produced by the brain to stimulate the ovaries to produce hormones and prepare eggs for release. -Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) <ul><li>Follicle Stimulating Hormone (FSH), such as Follistim, Fertinex, Bravelle, and Gonal-F </li></ul><ul><ul><li>Directly stimulates the recruitment and development of follicles </li></ul></ul><ul><li>Human Menopausal Gonadotropin (hMG), such as Pergonal, Repronex, and Metrodin. </li></ul><ul><ul><li>This drug combines both FSH and LH. </li></ul></ul><ul><li>Gonadotropin Releasing Hormone (GnRH), such as Factrel and Lutrepulse. </li></ul><ul><ul><li>Stimulates the release of FSH and LH from the pituitary gland. These hormones are rarely prescribed in the U.S. </li></ul></ul><ul><li>Gonadotropin Releasing Hormone Agonist (GnRH agonist), such as Lupron, Zoladex, and Synarel </li></ul><ul><ul><li>Inhibits premature LH surges in women undergoing controlled ovarian stimulation </li></ul></ul><ul><li>Gonadotropin Releasing Hormone Antagonist (GnRH antagonist), such as Antagon and Cetrotide </li></ul><ul><ul><li>Prevents premature ovulation </li></ul></ul><ul><li>Human Chorionic Gonadotropin (hCG), such as Pregnyl, Novarel, Ovidrel, and Profasi. </li></ul><ul><ul><li>This drug is usually used along with other fertility drugs to trigger the ovaries to release the mature egg or eggs. </li></ul></ul>
  12. 12. <ul><li>Metformin alone and later in combination with clomiphene citrate has been proposed as a sequential treatment program before the use of gonadotropin therapy for ovulation induction in infertile women with polycystic ovary syndrome (PCOS). </li></ul><ul><li>Current conservative practice: Discontinue metformin once pregnancy has been established. </li></ul><ul><li>Two retrospective analyses of metformin treatment continued through the first trimester suggested reduced rates of pregnancy loss, but data from a more recent prospective study did not support this effect. </li></ul><ul><ul><li>If the effect is on implantation, continuation of therapy into pregnancy would be advised; however, an effect on the developmental potential of the embryo would support the advice to withdraw treatment at establishment of pregnancy. </li></ul></ul><ul><li>Metformin is a Class-B drug. </li></ul><ul><li>Dose: 500mg TID or 850mg BID with meals </li></ul><ul><li>Side Effects: The most common are gastrointestinal side effects such as diarrhea, abdominal discomfort, nausea, and vomiting. These effects are dose-related. </li></ul><ul><li>Contraindications: Patients with renal, hepatic or cardiovascular problems, and sepsis. </li></ul>
  13. 13. <ul><li>Chronically abnormal ovarian function and hyperandrogenism </li></ul><ul><li>Affects 5–10% of women of reproductive age </li></ul><ul><li>Patient presents with: </li></ul><ul><ul><li>Infertility </li></ul></ul><ul><ul><li>Irregular menstrual cycles </li></ul></ul><ul><ul><li>Hirsutism </li></ul></ul><ul><li>Further testing to exclude endocrine disorders and The </li></ul><ul><li>Presence of polycystic ovaries, as shown by ultrasonography, (not included in the definition but this feature is mandatory in many centers). </li></ul>
  14. 14. <ul><li>Fertility Center of Illinois http://www.fcionline.com/treatment-of-infertility/metformin-pcos.html </li></ul><ul><li>Clinical Pharmacology </li></ul><ul><li>Wilcox, Allen J. “The timing of the ‘fertile window’ in the menstrual cycle: day specific estimates from a prospective study.” British Medical Journal . 321 (2000):1259-1262. </li></ul><ul><li>Clearblueeasy.com </li></ul><ul><li>Drugstore.com </li></ul><ul><li>Harborne, Lyndal. “Descriptive review of the evidence for the use of metformin in polycystic ovary syndrome.” The Lancet . 361 (2003): 1894-1901. www.thelancet.comhttp://dspace.dial.pipex.com/town/estate/aquc35/book/pcosmet.pdf </li></ul><ul><li>Emedicine.com: Infertility </li></ul><ul><li>The American Fertility Association www.theafa.org </li></ul><ul><li>American Pregnancy Association www.americanpregnancy.org </li></ul>