Infertility

Question 1

Initial Eval of Infertility

Answer 1

TSH, prolactin, testosterone, 17 OHP, day 3 FSH and Estradiol, day 21
Progesterone (greater than 3 is ok)

AMH- granulosa cells

Ultrasound and HSG/SIS

Question 2

Most common causes of couple infertility

Answer 2

Tubal and pelvic disease

Male factor

Question 3

Clomid MOA/ side effects

Answer 3

clomiphene competing with estrogen for binding sites at the hypothalamic level,

-doesn’t work well in women with low estrogen

Hot flashes
Visual disturbances

Question 4

letrazol MOA/ side effects

Answer 4

Block estrogen production and release
the HPO axis from estrogenic negative
feed back.

short half-life and more likely to produce monofollicular development

Better endometrial thickness

Hot flashes
Leg cramps
Headaches

Question 5

When to use Dexamethasone for OI

Answer 5

In a subgroup of patients elevated

DHEAS levels are detected

Question 6

Who to use gonadotropin therapy for OI

Answer 6

Low estrogen
or failed CC or AI

monitoring every 2-3 days and goal is to grow monofollicular development to 16-18 mm

Question 7

ovarian hyperstimulation syndrome

Answer 7

 Increase in capillary permeability
resulting in fluid shift to the
extravascular spaces.

abdominal ascites
pulmonary edema
hemoconcentration
increased risk for VTE

Hospitalization:
hematocrit >45 percent, leukocytes >25,000/L, and creatinine >1.6 mg/dL. Women with severe abdominal pain, intractable vomiting, oliguria, dyspnea ,electrolyte imbalance, or abnormal liver function tests