B8-008 CBCL Female Infertility Flashcards
female infertility is defined as unprotected intercourse for […] under the age of 35 and […] over the age of 35
12 months
6 months
lack of menses by 15 years of age
primary amenorrhea
secondary amenorrhea is the absence of menses for […] in females with a prior regular cycle OR
absence of menses for […] in females with prior irregular cycles
3 months
6 months
characterized by follicular and endometrial growth/proliferation
follicular phase
characterized by the LH surge
midcycle
characterized by corpus luteum
luteal phase
controls the release of both FSH and LH
GnRH
high frequency, high amplitude GnRH favors […] release
LH
low frequency, low amplitude GnRH favors […] release
FSH
[…] increases GnRH pulse frequency
estrogen
[…] decreases GnRH pulse frequency
progesterone
low FSH
low LH
low E2
hypothalamic amenorrhea (WHO 1)
causes of WHO 1 amenorrhea (hypothalamic amenorrhea)
systemic illness
marathon runner
famine
(overall bad conditions to have a baby)
normal FSH
normal LH
normal E2
WHO 2 amenorrhea
(normogonadotropic state)
PCOS is an example of WHO […] amenorrhea
2
elevated FSH
elevated LH
low E2
WHO 3 amenorrhea (primary ovarian insufficiency)
most commonly related to stress and low energy states
WHO 1 (hypothalamic amenorrhea)
must be ruled out before considering a diagnosis of hypothalamic amenorrhea
pathology affecting the brain (tumors/scars) via MRI
risk factors for hypothalamic amenorrhea [3]
excess exercise
stress
nutritional deficiency (hypoleptinemia)
criteria for diagnosis of PCOS (Rotterdam criteria)
> 12 antral follicles on US
hyperandrogenism
irregular menses
2 or more
chromosomal causes primary ovarian insufficiency [4]
turner’s syndrome (short stature)
galactosemia (seen on newborn screen)
fragile X (CGG repeats 80-100)
perrault syndrome (deafness)
treatment for WHO 1 amenorrhea
decrease stress, increase energy intake
gonadotropins
treatment for WHO 2 amenorrhea
decrease energy intake
letrozole
clomid, gonadotropins, ovarian drilling
treatment for WHO 3 amenorrhea
donor oocytes
WHO 1 women need less than […] of exercise per week
3
WHO 2 women should aim for […]% weight loss to induce ovulation
10
steroidogenic cells present in the ovarian follicles [2]
granulosa cells
thecal cells
(separted by basement membrane)
the LH surge requires […] positive feedback
estrogen
also called premature ovarian failure
primary ovarian insufficiency
premature atresia of ovarian follicles in females of reproductive age
primary ovarian insufficiency
frequently associated with chromosomal abnormalities so requires karyotype screening
primary ovarian insufficiency
MOA of letrozole
aromatase inhibitor
surgical option for PCOS resistant to pharmacotherapy
ovarian drilling
common etiology for tubal factor infertility and hydrosalpinx
untreated STI
accumulation of fluid/pus in the fallopian tubes due to chronic inflammation and consequent stenosis
hydrosalpinx
before a Turner’s patient uses donor oocytes rule out
aortic dilation
via cardiac MRI
first line therapy for women with WHO 1 amenorrhea
behavioral modification
(gonadotropin therapy is next most appropriate)
what test should be ordered for low levels of anterior and posterior pituitary hormones
pituitary MRI
diagnosis of POI is made with […] in menopausal range
repeat FSH
risk of […] is reduced in women with POI
hormonally sensitive breast cancer
panhypopituitarism or fractional pituitary failure is also known as
Sheehan syndrome
history of […] is indication for HSG
STI
history of […] is indication for AMH
smoking
the diagnosis of PCOS is a diagnosis of exclusion based on ruling out other causes of […] and […]
anemorrhea
hirsutism
bilateral salpingectomy should be completed […] IVF
before
(eliminates cytotoxic reflux into the uterine cavity)
next best step following abnormal karyotype
referral to genetics/endocrine
