Reproduction

Question 1

What is the length of a regular menstrual cycle?

Answer 1

28-35 days

Question 2

What s the definition of oligomenorrhoea?

Answer 2

cycle>35 days

Question 3

What is amenorrhoea?

Answer 3

absent menstruation

Question 4

What is the HPO axis?

Answer 4

Hyp: GnHR+
Pit: LH+,FSH+
Ovaries: eostradiol and progesterone

nb, negative feedback

Question 5

What are the 2 phases of the menstrual cycle?

Answer 5

follicular (1-14)

Luteal (14-28)

Question 6

What triggers ovulation?

Answer 6

Surge in LH (36hrs before ovulation)

Question 7

When do eostradiol levels peak?

Answer 7

before ovulation

Question 8

When do progesterone levels peak? where are the produced?

Answer 8

after ovulation

produced by corpus luteum

Question 9

How is ovulation assessed in regular cycles?

Answer 9

midluteal serum progesterone (>30nmol/L) x2 samples

Day 21

Question 10

How is ovulation assessed in irregular cycles?

Answer 10

probably anovulatory

need further hormone investigation

Question 11

When is the early follicular phase and what is assessed here?

Answer 11

2-5 days
serum FSH, LH, eostradiol
Serum PRL, TSH
Free androgen index

Question 12

What is the progesterone challenge test?

Answer 12

menstrual bleed in response to 5 day course progesterone

indicates normal eostrogen levels

Question 13

What radiological investigations can be done to assess ovulation?

Answer 13

TVUS of ovaries
MRI pit fossa
DEXA scan

Question 14

What other types of tests can be used to assess ovulation?

Answer 14

karyotyping
visual field
autoantibodies

Question 15

What happens in hypothalamic pituitary failure?

Answer 15

Hypogonadotrophic hypogonadism
low levels gonadotrophins
oestrogen deficiency
normal PRL
Amenorrhoea

Question 16

What can cause hypothalamic pituitary failure?

Answer 16

stress
exercise
anorexia
brian tumours
head trauma
Kallman's syndrome
drugs (steroids, opiates)

Question 17

How do you manage hypothalamic anovulation?

Answer 17

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

Question 18

What is hypothalamic pituitary dysfunction?

Answer 18

Normal gonadotrophins
Normal oestragen
Anovulation (oligo/amenorrhoea)
PCOS

Question 19

How is polycystic ovary syndrome diagnosed?

Answer 19

2+ of: oligo/amenorrhoea
polycystic ovaries (USS)
-12/more 2-9mm follicles
-increased ovarian volume >10ml
-uni/bilateral
Clinical +/- biochemicalsigns hyperandrogenism (acne/hirsutism)

Question 20

What is the significance of insuin resistance in PCOS?

Answer 20

hyperinsulinaemia as normal pancreatic reserves compensate
insulin is cogonadotrophin to LH (inc LH, alther LH:FSH)
Insulin lowers SHBG levels, inc testoterone, hyperandrogensim

Question 21

What are the symptoms of PCOS?

Answer 21

subfertility 
oligo/amenorrhoea
hirsutism
obesity
acne
alopecia

Question 22

How is PCOS pre treated?

Answer 22

weight loss (BMI

Question 23

How is ovulation induced in PCOS?

Answer 23

*Clomifene citrate (50-100mg tab days 2-6)
Gntrophin therapy (daily injections)
Laparoscopic ovarian diathermy (risk destruction)

Question 24

How can metformin be used to induce ovulation in PCOS?

Answer 24

improves insulin resistance

restores menstruation and ovulation

Question 25

What happens in ovarian failure?

Answer 25

High gonadotrophins | Low oestragen

Question 26

What can cause ovarian failure?

Answer 26

``` Premature menopause Turner's syndrome Autoimmune pelvic radiotherapy chemo ```

Question 27

How is premature ovarian failure defined?

Answer 27

menopause before 40yrs amenorrhoea raised FSH >30 x2 samples Low eostradiol

Question 28

How can premature ovarian failure be treated?

Answer 28

HRT* assisted conception cryopreservation

Question 29

How is reduced overain reserved diagnosed?

Answer 29

raised FSH low Anti Mullerian Hormone (AMH) reduced antral follicle count on USS

Question 30

What are the risks of stimulating ovulation?

Answer 30

ovarian hyperstimulation multiple pregnancy Cancer

Question 31

What are the complications with multiple pregnancy?

Answer 31

``` miscarriage HT/preeclampsia Gestational diabetes Low birth weight prematurity stillbirth ```

Question 32

What is the definition of infertility?

Answer 32

failure to achieve pregnancy in 12 months unprotected sex with no other reason

Question 33

What is the difference between primary and secondary infertility?

Answer 33

P:never conceived before S: conceived before (not necessarily successful)

Question 34

What decreases chance of conception?

Answer 34

``` F >35yrs No previous pregnancy More than 3 years trying intercourse incorrectly timed F BMI 30 Smoking Caffeine Alcohol ```

Question 35

What are the female causes of infertility?

Answer 35

ovulation failure endometriosis tubal damage

Question 36

How does anorexia affect fertility?

Answer 36

low FSH, LH and oestradiol

Question 37

What can cause tubal disease?

Answer 37

Infective (STD, TB, transperitioneal spread, following procedure) Noninfective (endometriosis, surgical,fibroids, polyps)