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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
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

See Bettelheim et al. Fig. 20.7, p. 491, for hormone levels during a cycle.

Hormone levels, follicle maturation, and development of the endometrium

not getting pregnant
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)
is the patient ovulating
Is the patient ovulating?
  • Basal body temperature
  • Hormone levels
  • Direct endoscopic examination
slide5

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.

back in the good olde days
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?
slide14
Obtain sample of amniotic fluid for analysis of lecithin/sphingomyelin (L/S)Amniocentesis needle was inserted into sac #3

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l s ratios and respiratory distress syndrome rds
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

what if the l s ratio 2 4
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.