5 - ovulation disorders Flashcards
what is done pre-treatment for infertility?
- stabilise weight
- lifestyle (smoking & alcohol)
- folic acid 5mg daily
- check prescribed drugs
- cervical smear
- rubella immune
- semen analysis
what are the 4 types of ovulation disorders by FIGO classification?
type 1 = hypothalamic (low LH & FSH)
type 2 = pituitary (low LH & FSH)
type 3 = ovarian (high LH & FSH)
type 4 = PCOS
HyPO-P
what is management of each FIGO problem (4 classes)?
(lifestyle for all!)
- pulsatile GnRH (pump worn continuously) or gonadotrophin daily injections
- clomifene or citrate (anti-oestrogen triggering feedback). If these unresponsive try metformin (reduces insulin resistance & androgens so can restore menstruation/ovulation). if all fails then FSH injections
- HRT or egg donation (premature ovarian insufficiency)
- just symptomatic relief
what is progesterone challenge test?
when you give progesterone to induce period
- if no bleeding = low oestrogen levels and uterine/endometrial abnormality
what can cause premature ovarian insufficiency? (ovaries not working properly)
- menopause before 40
- genetic thing like turner syndrome (46XO)
- autoimmune ovarian failure
- bilateral oophrectomy
- pelvic radiotherapy or chemo
what are the criteria for diagnosis of PCOS?
- amenorrhea
- polycystic ovaries (US)- 12-20 2-9mm follicles, increased ovarian volume
- clinical or biochemical signs of hyperandrogenism (acne, hirsutism)
what are some risks of ovulation induction?
ovarian hyperstimulation, multiple pregnancy, theoretical risk of ovarian cancer
why is more pregnancies potentially bad?
= more complications
- hyperemesis
- anaemia
- higher risk of hypertension/pre-eclampsia, gestational diabetes
- delivery problems
- postnatal depression & stress
- increased still birth or miscarraige or premature (loads of problems like disability, IQ, speech problems)
