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Clinical Aspects of Lipids & Human Reproduction

Clinical Aspects of Lipids & Human Reproduction. Induce ovulation (Clomid) Assess lung maturation (L/S ratio) Accelerate lung development (glucocorticoids). See Bettelheim et al. Fig. 20.7, p. 491, for hormone levels during a cycle.

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Clinical Aspects of Lipids & Human Reproduction

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  1. Clinical Aspects of Lipids & Human Reproduction • Induce ovulation (Clomid) • Assess lung maturation (L/S ratio) • Accelerate lung development (glucocorticoids)

  2. See Bettelheim et al. Fig. 20.7, p. 491, for hormone levels during a cycle. Hormone levels, follicle maturation, and development of the endometrium

  3. Not getting pregnant? • Male problems: not as readily approached hormonally • Female problems: • Physical (Can you think of an example?) • Chemical, two possibilities: • Not ovulating (peptide, protein, or steroid hormone) • Luteal insufficiency (not enough progesterone)

  4. Is the patient ovulating? • Basal body temperature • Hormone levels • Direct endoscopic examination

  5. Clomid has few side effects.1. This is why it was historically prescribed as a first line treatment. 2. One notable side effect: increased incidence of fraternal multiples.

  6. Back in the (good?) olde days… • Clomid was often the first drug of choice regardless of the actual cause of infertility. • If a patient was ovulating naturally, and Clomid was administered, what do you think would happen?

  7. Uterine geography lesson Top 2 3 1

  8. #1, Cranial diameter

  9. #2, “Hi there! (and ribs)

  10. #3, Cranial diameter

  11. Femur length

  12. Abdominal circumference

  13. Heart rate

  14. Obtain sample of amniotic fluid for analysis of lecithin/sphingomyelin (L/S)Amniocentesis needle was inserted into sac #3 Top 2 3 1

  15. L/S ratios and Respiratory Distress Syndrome (RDS) L/Sodds of RDS > 2.0 1 in 50* 1.5-2.0 1 in 3 < 1.5 3 in 4 *Action level 2.4 From Practical Clinical Biochemistry 6th ed., Gowenlock, p. 867

  16. What if the L/S ratio < 2.4? 1. Administer corticosteroids to mom-to-be. 2. These lipids are transferred to the fetus where they increase the rate of lung maturation. Wait for an appropriate time. 3. After waiting (for time,see McEvoy C, et al. Am J Obstet Gynecol 2000 Oct;183(4):895-9), induce labor or do elective Ceasarean.

  17. What if your wombmates L/S ratio > 2.4, but yours isn’t? (~2.5 days later)

  18. ~2.5 years later

  19. ~ 22 yrs later

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