Flashcards in Reproduction Deck (37):
What is the length of a regular menstrual cycle?
What s the definition of oligomenorrhoea?
What is amenorrhoea?
What is the HPO axis?
Ovaries: eostradiol and progesterone
nb, negative feedback
What are the 2 phases of the menstrual cycle?
What triggers ovulation?
Surge in LH (36hrs before ovulation)
When do eostradiol levels peak?
When do progesterone levels peak? where are the produced?
produced by corpus luteum
How is ovulation assessed in regular cycles?
midluteal serum progesterone (>30nmol/L) x2 samples
How is ovulation assessed in irregular cycles?
need further hormone investigation
When is the early follicular phase and what is assessed here?
serum FSH, LH, eostradiol
Serum PRL, TSH
Free androgen index
What is the progesterone challenge test?
menstrual bleed in response to 5 day course progesterone
indicates normal eostrogen levels
What radiological investigations can be done to assess ovulation?
TVUS of ovaries
MRI pit fossa
What other types of tests can be used to assess ovulation?
What happens in hypothalamic pituitary failure?
low levels gonadotrophins
What can cause hypothalamic pituitary failure?
drugs (steroids, opiates)
How do you manage hypothalamic anovulation?
Stabilise weight (BMI>19)
pulsatile GnRH if hypog hypog (administer every 90 mins, IV or SC pump worn continuously)
Gonadotrophin daily injections (FSH+LH)
US monitoring for follicle tracking
What is hypothalamic pituitary dysfunction?
How is polycystic ovary syndrome diagnosed?
2+ of: oligo/amenorrhoea
polycystic ovaries (USS)
-12/more 2-9mm follicles
-increased ovarian volume >10ml
Clinical +/- biochemicalsigns hyperandrogenism (acne/hirsutism)
What is the significance of insuin resistance in PCOS?
hyperinsulinaemia as normal pancreatic reserves compensate
insulin is cogonadotrophin to LH (inc LH, alther LH:FSH)
Insulin lowers SHBG levels, inc testoterone, hyperandrogensim
What are the symptoms of PCOS?
How is PCOS pre treated?
weight loss (BMI
How is ovulation induced in PCOS?
*Clomifene citrate (50-100mg tab days 2-6)
Gntrophin therapy (daily injections)
Laparoscopic ovarian diathermy (risk destruction)
How can metformin be used to induce ovulation in PCOS?
improves insulin resistance
restores menstruation and ovulation
What happens in ovarian failure?
What can cause ovarian failure?
How is premature ovarian failure defined?
menopause before 40yrs
raised FSH >30 x2 samples
How can premature ovarian failure be treated?
How is reduced overain reserved diagnosed?
low Anti Mullerian Hormone (AMH)
reduced antral follicle count on USS
What are the risks of stimulating ovulation?
What are the complications with multiple pregnancy?
Low birth weight
What is the definition of infertility?
failure to achieve pregnancy in 12 months unprotected sex with no other reason
What is the difference between primary and secondary infertility?
P:never conceived before
S: conceived before (not necessarily successful)
What decreases chance of conception?
No previous pregnancy
More than 3 years trying
intercourse incorrectly timed
F BMI 30
What are the female causes of infertility?
How does anorexia affect fertility?
low FSH, LH and oestradiol