B8-008 CBCL Female Infertility

Question 1

female infertility is defined as unprotected intercourse for […] under the age of 35 and […] over the age of 35

Answer 1

12 months
6 months

Question 2

lack of menses by 15 years of age

Answer 2

primary amenorrhea

Question 3

secondary amenorrhea is the absence of menses for […] in females with a prior regular cycle OR
absence of menses for […] in females with prior irregular cycles

Answer 3

3 months
6 months

Question 4

characterized by follicular and endometrial growth/proliferation

Answer 4

follicular phase

Question 5

characterized by the LH surge

Answer 5

midcycle

Question 6

characterized by corpus luteum

Answer 6

luteal phase

Question 7

controls the release of both FSH and LH

Answer 7

GnRH

Question 8

high frequency, high amplitude GnRH favors […] release

Answer 8

LH

Question 9

low frequency, low amplitude GnRH favors […] release

Answer 9

FSH

Question 10

[…] increases GnRH pulse frequency

Answer 10

estrogen

Question 11

[…] decreases GnRH pulse frequency

Answer 11

progesterone

Question 12

low FSH
low LH
low E2

Answer 12

hypothalamic amenorrhea (WHO 1)

Question 13

causes of WHO 1 amenorrhea (hypothalamic amenorrhea)

Answer 13

systemic illness
marathon runner
famine

(overall bad conditions to have a baby)

Question 14

normal FSH
normal LH
normal E2

Answer 14

WHO 2 amenorrhea
(normogonadotropic state)

Question 15

PCOS is an example of WHO […] amenorrhea

Answer 15

2

Question 16

elevated FSH
elevated LH
low E2

Answer 16

WHO 3 amenorrhea (primary ovarian insufficiency)

Question 17

most commonly related to stress and low energy states

Answer 17

WHO 1 (hypothalamic amenorrhea)

Question 18

must be ruled out before considering a diagnosis of hypothalamic amenorrhea

Answer 18

pathology affecting the brain (tumors/scars) via MRI

Question 19

risk factors for hypothalamic amenorrhea [3]

Answer 19

excess exercise
stress
nutritional deficiency (hypoleptinemia)

Question 20

criteria for diagnosis of PCOS (Rotterdam criteria)

Answer 20

> 12 antral follicles on US
hyperandrogenism
irregular menses

2 or more

Question 21

chromosomal causes primary ovarian insufficiency [4]

Answer 21

turner’s syndrome (short stature)
galactosemia (seen on newborn screen)
fragile X (CGG repeats 80-100)
perrault syndrome (deafness)

Question 22

treatment for WHO 1 amenorrhea

Answer 22

decrease stress, increase energy intake

gonadotropins

Question 23

treatment for WHO 2 amenorrhea

Answer 23

decrease energy intake
letrozole

clomid, gonadotropins, ovarian drilling

Question 24

treatment for WHO 3 amenorrhea

Answer 24

donor oocytes

Question 25

WHO 1 women need less than [...] of exercise per week

Answer 25

3

Question 26

WHO 2 women should aim for [...]% weight loss to induce ovulation

Answer 26

10

Question 27

steroidogenic cells present in the ovarian follicles [2]

Answer 27

granulosa cells thecal cells (separted by basement membrane)

Question 28

the LH surge requires [...] positive feedback

Answer 28

estrogen

Question 29

also called premature ovarian failure

Answer 29

primary ovarian insufficiency

Question 30

premature atresia of ovarian follicles in females of reproductive age

Answer 30

primary ovarian insufficiency

Question 31

frequently associated with chromosomal abnormalities so requires karyotype screening

Answer 31

primary ovarian insufficiency

Question 32

MOA of letrozole

Answer 32

aromatase inhibitor

Question 33

surgical option for PCOS resistant to pharmacotherapy

Answer 33

ovarian drilling

Question 34

common etiology for tubal factor infertility and hydrosalpinx

Answer 34

untreated STI

Question 35

accumulation of fluid/pus in the fallopian tubes due to chronic inflammation and consequent stenosis

Answer 35

hydrosalpinx

Question 36

before a Turner's patient uses donor oocytes rule out

Answer 36

aortic dilation via cardiac MRI

Question 37

first line therapy for women with WHO 1 amenorrhea

Answer 37

behavioral modification (gonadotropin therapy is next most appropriate)

Question 38

what test should be ordered for low levels of anterior and posterior pituitary hormones

Answer 38

pituitary MRI

Question 39

diagnosis of POI is made with [...] in menopausal range

Answer 39

repeat FSH

Question 40

risk of [...] is reduced in women with POI

Answer 40

hormonally sensitive breast cancer

Question 41

panhypopituitarism or fractional pituitary failure is also known as

Answer 41

Sheehan syndrome

Question 42

history of [...] is indication for HSG

Answer 42

STI

Question 43

history of [...] is indication for AMH

Answer 43

smoking

Question 44

the diagnosis of PCOS is a diagnosis of exclusion based on ruling out other causes of [...] and [...]

Answer 44

anemorrhea hirsutism

Question 45

bilateral salpingectomy should be completed [...] IVF

Answer 45

before (eliminates cytotoxic reflux into the uterine cavity)

Question 46

next best step following abnormal karyotype

Answer 46

referral to genetics/endocrine