Chapter 1: Physiology Of Conception Flashcards
PHYSIOLOGY OF CONCEPTION. You are a trainee intern in a general practice and are seeing Amanaki, a 28 year old para 0 Samoan woman who wishes to conceive. You ascertain that Amanaki is fit and well with a normal BMI. Her smear 6 months ago was normal. Amanaki’s periods occur every 28 days and have always been regular. She and her husband stopped using condoms 3 months ago. They had used condoms for 2 years. Her husband is aged 29 and is a fit, healthy non-smoker. They have been having sex three to four times a week. Amanaki has started folate and iodine. She wants to know if there is anything else she should be doing now she is anxious to get pregnant as soon as possible. Which of the following options is the BEST response?
Yes – you should start charting your temperature daily
Yes - you should start using an LH urine kit
Yes - you should call by and have a progesterone blood test on Day 21 of your cycle
Yes – you should start charting your cervical mucus daily
Not yet - you have a 28 day cycle so you should be ovulating about 14 days before your period
Not yet - you have a 28 day cycle so you should be ovulating about 14 days before your period
temp LH progesterone mucus all tell when ovulating - not neccessary yet
PHYSIOLOGY OF CONCEPTION. You are a trainee intern in a general practice, drafting a reply to an email from Mia, a 28 year old P0G0 wahine Māori who wishes to conceive. Mia’s email states “I am still fit and well since I saw you six months ago for my regular smear test. We have been trying to get pregnant for six months. Previously we were using condoms for contraception. My periods are occurring about every six weeks. We are having sex at least four times a week. I have started folate and iodine. Are there any tests or investigations we should do as we want to conceive as soon as possible?’
Of the following options, which is the BEST response?
Yes – you should start charting your cervical mucus daily
Not yet - you have a regular cycle so it is highly likely you are ovulating
Yes – you should start charting your temperature daily
Yes - you should start using an LH urine kit
Yes - you should have a blood progesterone test a week before your period is due
Yes - you should have a blood progesterone test a week before your period is due
irregular cycles and 6 months - do formal test for ovulation
PHYSIOLOGY OF CONCEPTION. You are a trainee intern in a general practice, drafting a reply to an email from Aria, a 35 year old para 0 wahine Māori who wishes to conceive. Aria’s email also states “I am still fit and well since I saw you a year ago for my smear test. My husband, who is also 35, is fit and well too. I stopped the pill three months ago, and have had three periods since the withdrawal bleed, all exactly four weeks apart – the last was last Wednesday. We are trying to have sex each day at midcycle, but my husband finds that frequency difficult because of work stresses (he has always been like that!). I have started folate and iodine. A friend said that I should buy some kits, or start some charting but what do you think?” Which of the following options is the best response?
Recommend review now
No special charting is necessary at the moment, but if you are not pregnant within 3 months arrange review
Start charting your temperature daily for the next three cycles, and make an appointment for review after that if you are not pregnant
Start using an LH urine kit to detect ovulation and time sex for the next three cycles, and make an appointment for review after that if you are not pregnant
Start charting your cervical mucus daily for the next three cycles, and make an appointment for review after that if you are not pregnant
Advise focussing timing of intercourse from day 10-18 of menstrual cycle, aiming for intercourse every day or every second day and review if not pregnant in 3 months
Advise focussing timing of intercourse from day 10-18 of menstrual cycle, aiming for intercourse every day or every second day and review if not pregnant in 3 months
>6 months for further investigations for this 35 year old
PHYSIOLOGY OF CONCEPTION. You are a trainee intern in a general practice, seeing Amelia, a 28 year old para 0 Pākehā woman of who wishes to conceive. Amelia is fit and well. Her husband, who is also 28, is fit and well too. She stopped the pill six months ago, and has had five periods since then. Her menstrual cycle is 28-30 days long. She is worried that she is not ovulating. She asks you if there is anything she should be doing to ensure that she is ovulating.
Of the following options, which is the best response to Amelia?
Chart your cervical mucus daily for the next three cycles. Have sex daily at midcycle when the mucus is profuse, clear and stringy. Come in for review if you are not pregnant after 3 months.
You won’t be able to get pregnant on your own and so need to be referred for IVF
Chart your temperature daily for the next three cycles and come in for review if you are not pregnant after 3 months.
We don’t need to do anything at the moment, but if you are not pregnant within a further three months, come in for a further review.
You should have a blood test for progesterone day 21 – 23 to confirm that ovulation is occurring. If it is, keep trying for a further 6 months then attend for review.
You should have a blood test for progesterone day 21 – 23 to confirm that ovulation is occurring. If it is, keep trying for a further 6 months then attend for review.
PHYSIOLOGY OF CONCEPTION You are a trainee intern in general practice seeing Charlotte, a 37 year old G2P2 Pākehā woman. Charlotte is anxious about her fertility as she is in a new relationship. Charlotte had an FSH test arranged 2 weeks ago because she was then having hot flushes and thought she may be menopausal. However, her periods were still occurring regularly every month. The FSH result was elevated at 25iu/l [SS1] (N early follicular phase level < 10 iu/L) and Charlotte has read that this is in the menopausal range. Today Charlotte got her period - she is confused and would like an explanation.
Which of the following answers is correct?
Charlotte’s elevated FSH means that she is menopausal and this bleeding is a postmenopausal bleed that needs to be investigated
FSH levels rise with menopause but this level is not high enough to diagnose menopause as FSH is not a sensitive test
Charlotte’s FSH may be elevated because of a pituitary tumour
Charlotte’s FSH was elevated because she was ovulating, Menopause is, by definition, no periods for 12 months
Charlotte should have another test next month to see if it was a false positive
Charlotte’s FSH was elevated because she was ovulating, Menopause is, by definition, no periods for 12 months
PHYSIOLOGY OF CONCEPTION. You are a trainee intern in a general practice with Isla, a 22 year old para 0 European woman who has made an appointment to discuss her anxiety about her future fertility. Isla was seen in the gynaecology clinic yesterday with a 15cm left ovarian cyst that is likely a dermoid. She has been told that the whole ovary may need to be removed. Because of the size of the cyst, Isla was advised that it might not be possible to preserve her left ovary at the time of laparoscopic surgery. Which of the following options is the best response to Isla?
Your fertility will not be affected because although your follicle numbers would be halved by oophorectomy, your egg quality is better than that of a woman a few years older than you
Your fertility will not be affected as you will still have your right ovary
Your future fertility may be affected because your total number of follicles will be halved
Your fertility will not be affected as the remaining ovary compensates
You should ask for freezing of the unaffected ovarian tissue that is removed in case IVF is later required
Your future fertility may be affected because your total number of follicles will be halved
PHYSIOLOGY OF CONCEPTION You are a trainee intern in a general practice with Olivia, a 26 year old NZ European woman who has recently stopped the pill as she wishes to conceive. Olivia presents wishing to know whether she is ovulating. From the following options, which question would best confirm for her that she is likely ovulating?
Are your periods painful on the first or second day?
Are you aware of thicker mucus at midcycle?
Do you have breast tenderness a week before your period?
Are your periods still regular and predictable each month?
Is your menstrual loss each month heavy?
Do you have clots with your periods?
Are your periods still regular and predictable each month?
PHYSIOLOGY OF CONCEPTION You are a trainee intern in general practice seeing Ruby, a 37 year old G0P0 Pākehā woman who has not fallen pregnant since stopping the pill a year ago. Ruby’s BMI is 24. She gets regular periods 5/28, but has had irregular spotting throughout her cycle. This started a few months before she stopped the pill. There are no obvious precipitating factors of that bleeding. She has no pelvic pain or postcoital bleeding. Her partner aged 38, and is in good health. He has 2 children from a previous relationship. Based on this history, which is the most likely organ to have a dysfunction and be causing Ruby’s irregular spotting?
Cervix
Fallopian tubes
Anterior pituitary
Hypothalamus
Vagina
Ovary
Uterus
Uterus
PHYSIOLOGY OF CONCEPTION You are a trainee intern in general practice seeing Lekaleka, a 37 year old G2P2 woman of Tongan descent who has come to see you following a pelvic ultrasound that was performed because of pelvic pain. The ultrasound was performed yesterday and Lekaleka is worried as the sonographer told her that there was “a 20 mm simple cyst on her left ovary”. Lekaleka’s last period was 14 days ago and she has a regular 28 day cycle. She asks whether she needs to have the cyst removed. From the following options, what is the best response?
This is a worrying finding and you need to get a Ca125 blood test done to assess the risk of malignancy
You need another ultrasound but at a different time of the cycle, to ensure the cyst has resolved
This is a normal finding midcycle, because a follicle about to ovulate will be about 20mm in size
You need to see a gynaecologist to have the cyst removed
Ovaries should have lots of cysts in them and it is concerning that they could only see one
This is a normal finding midcycle, because a follicle about to ovulate will be about 20mm in size
PHYSIOLOGY OF CONCEPTION You are a trainee intern in general practice seeing Sophie, a 48 year old G2P2 woman of British descent whose last period was 2 years ago. Sophie has recently remarried, and wishes to know whether she still has “enough eggs to conceive with fertility treatment”. Which of the following options is the correct response?
Your ovary can be stimulated to produce eggs with fertility drugs
You are menopausal because you have not had a period for more than 1 year. Unfortunately you won’t be able to conceive with your own eggs.
You had about 300,000 eggs when you started having periods so it depends how many periods you have had since then as you release one egg per cycle
When women are born, they have 5 million eggs so you will have some left to conceive with
You need to have an FSH level and AMH tested to tell how many eggs you have left
You are menopausal because you have not had a period for more than 1 year. Unfortunately you won’t be able to conceive with your own eggs.
