infertility/endometriosis/PCOS

Question 1

What is the peak prevalence for endometriosis

Answer 1

25-35 y/o

Question 2

What is the common presentation of endometriosis

Answer 2

nulliparity
early menarche
short menses
dysmenorrhea
Dypareunia

Question 3

What is the genetic component of endometriosis

Answer 3

hx of first degree relatives have nearly 10fold increased risk

Question 4

What is endometriosis

Answer 4

presence of endometrial glands and storm at extrauterine sites

*estrogen dependent disorder

Question 5

Where is endometrial tissue found with endometriosis

Answer 5

Found in the ovaries - typically bilaterally and generally remains in pelvic region but can occur anywhere

Question 6

What is the appearance of endometriosis

Answer 6

Clear or white, dark red or brown lesions

dark red or blue domes

surgically describes as cigarette burns

Question 7

Where might endometriomas develop

Answer 7

on the ovaries

Question 8

What MAY be seen on a pelvic exam with endometriosis

Answer 8

a fixed retroverted uterus

nodularity of uterosacral ligaments

Question 9

What is the imaging of choice for endometriosis

Answer 9

TVUS

Question 10

What is the first line treatment for endometriosis

Answer 10

NSAIDs and OCP

Question 11

What is the most common endocrine/metabolic disorder of reproductive age women

Answer 11

PCOS

Question 12

What disorder is a big cause of menstrual irregularity, ovulatory dysfunction and androgen excess in women

Answer 12

PCOS

Question 13

What are complications of PCOS

Answer 13

4x increase for T2DM
Increase breast/ovarian CA risk
Increased prevalence of CVD
Increased risk mood disorder

Question 14

What causes PCOS

Answer 14

Altered LH function with insulin resistance and predisposition to hyperandrogenism = increase in adrenal and ovarian synthesis

Question 15

What is the common presentation of PCOS

Answer 15

Signs of androgen excess with oligo/amenorrhea and infertility

Question 16

How do you diagnose PCOS

Answer 16

Rotterdam criteria

Question 17

What makes up the Rotterdam criteria

Answer 17

1. Oligomenorrhea/ an ovulation
2. Clinical/biochemical signs of hyperangrogenism
3. PCOS appearing ovaries of TVUS

Question 18

What LH/FSH ratio is indicative of PCOS

Answer 18

> 2

Question 19

How do you manage PCOS

Answer 19

OCP
Routine screening (Lipid, glucose, depression, OSA)
BP

Question 20

What is the first line management for PCOS

Answer 20

Lifestyle modification (weightless if overweight)

Question 21

What is the first line for managing hirsutism

Answer 21

OCP

Question 22

When is a women <35 considered infertile

Answer 22

12mos of unprotected sex

Question 23

When is a women>35 considered infertile

Answer 23

6 months of unprotected sex

Question 24

What are the most common causes of infertility

Answer 24

PCOS

Hormonal factors impacting ovulation

Endometriosis

Question 25

What is the most common cause of ovarian dysfunction and oocyte abnormalities

Answer 25

PCOS

Question 26

What are some anatomic abnormalities that can cause infertility

Answer 26

Fallopian tube disease (PID)
endometriosis
Fibroids
Ashermans syndrome
Luteal phase deficiencies

Question 27

What are some anatomic abnormalities in males that can lead to infertility

Answer 27

varicoceles
blockage of vas defrens
Damage to bladder neck
Gonadal failure

Question 28

What are some infertility treatments

Answer 28

Identify and correct any underlying medical / surgical concerns

strongly consider specialist referral

Question 29

What is considered a “correct timing” of attempts to become pregnancy

Answer 29

days 10-20 QOD