Chapter 29 Management of Infertile Couple

Question 1

___ is the best serum marker of OVARIAN RESERVE (#of follicles/oocytes available in a given month)

Answer 1

anti-mullerian hormone (AMH)

Question 2

___ is first line treatment for ovulation induction in anovulatory pts with polycystic ovary syndrome

Answer 2

clomiphene citrate

Question 3

women with PCOS, and all obese pts, should be encouraged to

Answer 3

lose weight prior to attempting fertility.

Question 4

evaluation of infertility:

Answer 4

chlmydia antibody (CAT) and hysterosalpingogram (HSG). should be integrated into the diagnostic evaluation.

Question 5

anti mullerian hormone has been shown to be superior to other hormonal markers of ovarian reserve. there is evidence that AMH levels are significantly more associated with ___ retrieved following stimulation from IVF than other serum markers.

Answer 5

AMN levels are associated with egg numbers retrieved following stimulation from IVF. AMH is highly is correlated with the antral follicles count.

Question 6

Polycystic Ovarian Syndrome is characterized by 2 of the following:

Answer 6

1. oligomenorrhea
2. hyperandrogenism/hyperandrogenemia
3. polycystic ovaries.

Question 7

for conception, the most critical of the factors is

Answer 7

irregular cycles with anovulation.

Question 8

__ is first line fertility treatment for PCOS.

Answer 8

Clomiphene citrate.

Question 9

addition of metformin to clomiphene citrate conferred no additional benefit with respect to conception, pregnancy or live birth rate in pcos population.

Answer 9

true

Question 10

clomiphene citrate has ___ effect on endometrium and cervical mucus

Answer 10

antiestrogenic effects.

Question 11

2nd type of ovulation induction medication is __

Answer 11

letrozole (aromatase inhibitor).

Question 12

letrozole acts by

Answer 12

inhibiting conversion of androgens into estrogens; thus estrogen feedback to the pituitary is decreased and endogenous gonadotropin release is increased.

Question 13

Letrozole is as effective as clomiphene citrate in ovulation induction, without the associated negative effects on the endometrium.

Answer 13

true

Question 14

as opposed to obesity or insulin resistance, extent of clinical and biochemical hyperandrogenism appears to be the STRONGEST negative predictor of successful ovulation induction

Answer 14

true.

Question 15

weight reduction as little as 5% of total body weight has been associated with increase in __ and decrease in __

Answer 15

SHBG sex hormone binding globulin; testosterone

Question 16

improvement in hirsutism has also been shown with weight reduction

Answer 16

true

Question 17

miscarriage rates appear to increase with marked obesity, BMI of

Answer 17

> = 35

Question 18

fewer lifetime ovulatory evens associated with __ risk of breast cancer

Answer 18

decreased risk of breast CA

Question 19

ovulation induction could be linked to increased breast cancer risk by increasing the # of lifetime ovulatory events

Answer 19

true

Question 20

there is no strong evidence to support relationship between the use of fertility drugs and either breast or ovarian cancer.

Answer 20

true

Question 21

submucosal leiomyomata; several studies demonstrated association btwn submucosal leiomyomata and __ , __, and )

Answer 21

1. decreased implantation
2. decreased ongoing pregnancy rates
3. increased miscarriage rates
   this led to recommendation for resection of submucosal myomata prior to embarking on IVF.

Question 22

Intramural leiomyomata. insufficient evidence to offer routine resection of intramural myomata for reproductive optimization. studies showed significant decrease in both clinical pregnancy rates and live birth rate following IVF in pts with noncavity distorting intramural leiomyomata

Answer 22

true. decrease in pregnancy rates, and decrease in live birth rate?

Question 23

data regarding impact of intramural leiomyomata are conflicting.

Answer 23

true.

Question 24

Tubal Factor: dx

Answer 24

testing for chlamydia antibody CAT) is most cost-effective test.

Question 25

Male subfertility. circulating hormone levels of__ and __ are reflective of Sertoli cell function and spermatogenesis

Answer 25

follicle stimulating hormone (FSH)
and Inhibin B.
reflective of sertoli cell function and spermatogenesis.

Question 26

clomiphene citrate has both estrogenic and antiestrogenic effects, depending on tissue type.

Answer 26

true

Question 27

CC acts as a competitive INHIBITOR OF estrogen feedback at the level of HYPOTHALAMUS, increasing release of gonadotropin releasing hormone (GnRH) and as a result, endogenous gonadotropins.

Answer 27

inhibits estrogen feedback at the level of hypothalamus, thus increase release of GNRH => increase of endogenous gonadotropins.

Question 28

CC+IUI, <41, 90% or more of all pregnancies were initiated in the first 3 cycles of CC-IUI. in the 41,42 age group, 83.3% of all pregnancies occured in the first 4 cycles.

Answer 28

true.

Question 29

Letrozole - IUI.

Answer 29

pregnancy outcomes after ovulation induction similar to pregnancies achieved via CC or gonadotropins.

Question 30

letrozole has significantly lower rate of multiple gestations when comared to CC, exogenous gonadotropins.

Answer 30

true.

Question 31

Letrozole appears to be as effective as clomiphene citrate in ovulation induction, without associated negative effects on the endometrium .

Answer 31

letrozole can be considered an alternative to clomiphene citrate for ovulation induction.