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Flashcards in Infertility/PCOS Deck (63)
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1
Q

What is the definition for infertility before 35 years of age? After?

A
  • Unable to conceive for more than 12 months

- 6 months if women is over 35

2
Q

What is fecundability?

A

Ability to conceive within a given month/cycle

3
Q

What is the prevalence of infertility?

A

10-15% of reproductive aged couples

4
Q

What are the general etiologies of infertility?

A

1/3 male
1/3 female
1/3 idiopathic

5
Q

What is the most common female factor that causes infertility?

A

Ovulatory dysfunction

6
Q

What is the best amount of sex to have in order to achieve? Why?

A

Every other day, to allow for sperm to accumulate

7
Q

What history bits should be obtained when evaluating infertility?

A
  • Menstrual cycle characteristics
  • Timing of intercourse in cycle
  • Length of infertility
8
Q

What specific ob/gyn history should be obtained when evaluating infertility? (4)

A
  • STIs
  • Previous pregnancies
  • Pap results
  • Past contraception
9
Q

How do ruptured appys caused infertility?

A

Scarring causing tubal damage

10
Q

What is the LEEP procedure, and what is its effect on fertility?

A

Excision of the ectocervix in the case of abnormal pap smears

11
Q

What is Asherman syndrome?

A

Scar band in the uterus 2/2 repeated D and Cs

12
Q

What is the effect of hyperthyroidism on menstruation?

A

Lighter periods

13
Q

How do varicosities in the testes lead to infertility?

A

Increased heat

14
Q

What is the normal amount of semen?

A

1.5 mL

15
Q

What is the usual concentration of sperm in seme?

A

15 million /mL

16
Q

What is the normal motility of sperm?

A

32%

17
Q

True or false: you only need 4% sperm with the correct morphology to be fertile

A

True

18
Q

What sort of labs, generally, are useful for evaluating for infertility?

A
  • UA/ STI screen
  • CBC
  • Hormonal levels
19
Q

When should FSH be drawn for evaluation of infertility?

A

Day 3 of ovulatory cycle

20
Q

What is the homework assignment for patient who are experiencing infertility?

A

Basal body temperature

21
Q

When should progesterone levels be obtained?

A

Day 21 of menstrual cycle

22
Q

What is the thinking behind the progesterone challenge?

A

Give 10 days of progesterone, then withdraw to assess for HPA axis and normal vaginal bleeding

23
Q

What lab test is useful is there is an abnormal LH:FSH ratio? Why?

A

Fasting glucose to look for insulin resistance

24
Q

How do you confirm tubal patency?

A

HSG or sonohysterogram

25
Q

What is a hysterosalpingogram?

A

Injecting dye into the uterus to assess for patency of fallopian tubes

26
Q

What are hydrosalpinx?

A

A distally blocked fallopian tube filled with serous or clear fluid

27
Q

What does the 17 hydroxyprogesterone test assess for?

A

21 or 11 hydroxylase deficiency

28
Q

What is the postcoital test?

A

Couple has sex, then you take a vaginal swab and assess

29
Q

What is the Spinnbarkeit test? What is the basis for this?

A

Assessing for the stretch of the cervical mucus

Increases stretchiness near ovulation

30
Q

When should couples be having intercourse to help achieve conception?

A

day 10-20, every other day

31
Q

What is the “infertility path”?

A

The fact that insurance companie do not usually pay for fertility testing, so may be spending a lot with consults

32
Q

What is clomifene? Use? MOA?

A

Selective estrogen receptor modulator that induces ovulation to help achieve conception with PCOS

33
Q

What is the treatment for luteal phase defects?

A

Exogenous progesterone

34
Q

What is the treatment for PCOS pts who want to achieve conception?

A

Clomiphene

35
Q

What is the use and MOA of letrozole?

A

Oral nonsteroidal aromatase inhibitor for the treatment of hormonally sensitive breast cancer, or to induce fertility by releasing follicles

36
Q

What labs should be obtained after conception is achieved in an infertile couple?

A

Serum hCG and once again in 48 hours

37
Q

What is the role of progesterone suppositories in fertility?

A

Add them after pregnancy is attained, to ensure that the pregnancy is maintained

38
Q

When does cardiac activity become apparent by US?

A

4.5 weeks ish

39
Q

What is the hCG level that indicates when TVUS can visualize the pregnancy? Abdominal?

A

1500 for TVUS

6500 for abdominal

40
Q

What is the most common cause of female infertility?

A

PCOS

41
Q

What is the prevalence of PCOS?

A

4-12% of reproductive age women

42
Q

What is the etiology of PCOS?

A

Idiopathic

43
Q

What is the triad that defines PCOS?

A
  • Hyperandrogenism
  • Ovulatory dysfunction
  • Polycystic ovaries on US
44
Q

What are the associated conditions with PCOS? (5)

A
  • Obesity
  • DM II
  • OSA
  • Dyslipidemia
  • Thyroiditis
45
Q

What are the conditions that need to be ruled out before diagnosing PCOS? (6)

A
  • Hypothyroidism
  • Hyperprolactinemia
  • Androgen-secreting tumor
  • Adult onset congenital hyperplasia
  • Cushing’s
  • Pregnancy
46
Q

What is the usual clinical presentation of PCOS? (5)

A
  • Menstrual irregularities
  • Acne
  • Hirsutism
  • Androgenic alopecia
  • Obesity
47
Q

What is the classic US finding of PCOS?

A

“String of pearls” that circumscribe the ovary

48
Q

What are the labs that are useful for assessing hyperandrogenism in PCOS?

A

Free testosterone and/or total

49
Q

What is the LH:FSH ratio that is indicative of PCOS?

A

more than 2

50
Q

Hyper of hypoinsulinemia with PCOS?

A

hyperinsulinemia

51
Q

What are the lipid levels like with PCOS?

A

Dyslipidemia

52
Q

What are the HPA axis hormones that should be checked with PCOS? (4)

A

Thyroid
Prolactin
17-OH progesterone
Cortisol

53
Q

What is the role of insulin in PCOS? (3)

A
  • Increases ovarian androgen production
  • Inhibits hepatic production of SHBG
  • increases free androgens
54
Q

What are the four major goals of treatment for PCOS (generally)?

A
  • Lessen s/sx of hyperandrogenism
  • Manage metabolic comorbidities
  • Prevent chronic anovulation
  • Contraception
55
Q

What is the major consequence of untreated anovulation with PCOS?

A

Endometrial hyperplasia and carcinoma

56
Q

What are the two major first line therapies for PCOS?

A
  • Lifestyle changes

- Oral contraceptive pills

57
Q

What is the role of oral contraceptive pills with PCOS?

A
  • Protects against endometrial hyperplasia

- Helps with acne, hirsutism

58
Q

What are the oral contraceptives that should be used in the treatment of PCOS?

A

Those with minimal androgenicity

59
Q

What is the major second line pharmacotherapy for PCOS? MOA?

A

Spironolactone—aldosterone and androgen antagonist

60
Q

What is the role of metformin in treating PCOS?

A
  • Restores ovulation in PCOS pts
  • Decreases testosterone level
  • Weight loss

But ONLY if they have hyperglycemia

61
Q

When should Clomiphene be started after a failed progesterone challenge? When should f/u be done? What should be done if she is still not ovulating at f/u?

A

3-5 days later

Check serum progesterone on day 21 to assess for ovulation. If not ovulating, then up dose

62
Q

In whom is Clomiphene / letrozole better for?

A

Clomiphene for normal weight women

Letrozole for overweight

63
Q

What are the lifelong complications of PCOS? (3)

A
  • CV disease
  • DM II
  • Endometrial cancer