Ovulatory Dysfunction and Infertility Flashcards Preview

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Flashcards in Ovulatory Dysfunction and Infertility Deck (19):

evaluation of oligo/amenorrhea: initial tests

hCG, baseline FSH and estradiol


evaluation of oligo/amenorrhea: what test should you order if low or normal FSH?

progestin challenge to assess estrogenization of uterine lining


when should you order a progestin challenge?

if patient is experiencing oligo/amenorrhea and has low/normal FSH


what is the basis of the progestin challenge?

in order to have bleeding after progesterone administration, patient needs to have been exposed to estradiol because estradiol induces expression of progesterone receptors


criteria for polycystic ovarian syndrome (PCOS)

two of three features:
1. polycystic-like ovaries on ultrasound
2. oligomenorrhea
3. hyperandrogenism (hirsutism)


first-line treatments for ovulation induction in polycystic ovarian syndrome (PCOS)

weight loss, clomiphene citrate


clomiphene citrate: mechanism of action, use

reduces concentration of intracellular estrogen receptors --> diminished negative feedback --> activates GnRH secretion --> ovulation
use: first-line treatment for ovulation induction in polycystic ovarian syndrome (PCOS)


potential reasons for lack of withdrawal bleeding in response to progesterone therapy

1. lack of circulating estradiol resulting in inadequate endometrial proliferation
2. severe endometrial adhesions (Asherman's syndrome)
3. pregnancy


ddx: low/normal FSH and low estradiol

hypogonadotropic hypogonadism: absence of sellar mass, Kallman's syndrome, GnRH receptor mutations


Asherman's syndrome: pathogenesis

intrauterine adhesions resulting from procedures that damage the endometrial cavity; can cause secondary amenorrhea and lack of withdrawal bleed in response to progesterone


premature ovarian failure: pathogenesis, clinical presentation, lab findings

premature atresia of ovarian follicles in women of reproductive age
present with signs of menopause after puberty but before age 40
decreased estrogen, increased LH and FSH (HYPERgonadotropic hypogonadism)


causes of premature ovarian failure

genetic (Turner's syndrome, Fragile X), autoimmune, iatrogenic (chemo, radiation)


risk factors for tubal disease

history of pelvic infections, tubal or pelvic surgery, endometriosis


steps of IVF

1. ovarian stimulation with injectable gonadotropins (FSH, FSH/LH)
2. oocyte retrieval
3. fertilization
4. embryo transfer


expected diagnosis, lab findings, and response to progestin challenge: marathon runner with infertility

hypothalamic amenorrhea: low estradiol, low/normal FSH; no withdrawal bleed with progestin challenge


dx: 34 year old with irregular menstrual cycles and increased FSH

premature ovarian failure


what patients with problems with fertility should be given genetic tests for karyotype and screening for Fragile X?

patients in which you suspect premature ovarian failure


what hormone 'triggers' ovulation?



signs of ovulation

cramping, change in cervical mucus, headaches, bloating