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.

Hormone levels, follicle maturation, and development of the endometrium

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?

• Basal body temperature

• Hormone levels

• Direct endoscopic examination

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…

• 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?

3 2

1

Uterine geography lesson

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#1, Cranial diameter

#2, “Hi there! (and ribs)

#3, Cranial diameter

Femur length

Abdominal circumference

Heart rate

3 2

1

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 odds of RDS > 2.0 1 in 50*

1.5-2.0 1 in 3 < 1.5 3 in 4

*Action level 2.4From Practical Clinical Biochemistry 6th ed.,

Gowenlock, p. 867

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.

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

~2.5 years later

~ 22 yrs later