Clin Wk 1

Question 1

Why is the pre-conception consult important for both mother and child?

Answer 1

• Periconceptional period can influence intrauterine, childhood, and adult development of offspring
• Associated with lower infant mortality, and increased positive health behaviours in mother (e.g. inc smoking cessation, taking folic acid etc)

Question 2

Describe/elaborate on the components of a preconception history

Answer 2

• Reproductive hx (past pregnancies? baby complications [LBW, miscarriage, birth defects] or mother complications [gestational diabetes]?)
• Medical hx (any conditions - diabetes? past c-section? neuromuscular disorders? iron deficiency? autoimmune? renal? vacciantoion? medications?)
• Fhx (ethnicity [black ~ sickle cell, asian ~ thalassaemia], genetic disorders, disability)
• Social hx (smoking, alcohol, drugs, STI risk, ?vegetarian, exercise, ?environmental toxins)

Question 3

Components of pre-conception physical exam

Answer 3

• BMI calc (?macrosomia risk)
• Oral cavity check (can affect outcomes)
• Cardiac (BP, pulse, auscultation)
• Resp auscultation
• Breast exam
• Abdo palpation

Question 4

What 4 nutrients should be considered in pre-conception planning (including one that’s only really considered in vegetarians/vegans)? Why?

Answer 4

• Folate (prevent neural tube defect)
• B12 (in vegetarians/vegans)
• Calcium (for pre-eclampsia prevention; may be met by diet alone)
• Iodine (maternal thyroid/fetal CNS development)

Question 5

What foods should be avoided during pregnancy?

Answer 5

• Vitamin A (increased miscarriage risk; link this to an Rx)
• Caffeine (limit 2-3 coffees a day)
• Mercury (can be found in fish)

Question 6

Weight and exercise recommendations during pregnancy (which types of exercise are okay?)

Answer 6

• Obesity linked to macrosomia, gestational HTN etc
• Obese women should lose 5-10% of bodyweight before trying to be pregnant
• Maintain normal exercise, but avoid contact sports/scuba

Question 7

Components of infertility Hx

Answer 7

• Sexual history (freq/timing relative to menstrual cycle)
• Past pregnancies? Complications?
• Menstrual history (freq/duration? abnormal bleeding? dysmenorrhoea?)
• Other medical conditions (which are important?) Past surgeries?
• Medications/allergies?
• Heritable conditions (e.g. POI)
• Smoking/alcohol?

Question 8

What’s a useful way to categorise anovulation, and some corresponding differentials?

Answer 8

• Hypogonadotrophic (hypothalamic amenorrhoa, pituitary disease, congenital gonadotrophin deficiency, hyperprolactinaemia [why?])
• Normogonadotrophic (PCOS, CAH)
• Hypergonadotrophic (POI)

Question 9

What bloods do we order to assess infertility? What is this similar to?

Answer 9

• Blood group
• FBC
• IgG for varicella and rubella
• Serology for Hep B/C, HIV, syphilis

Similar to preconception planning

Question 10

How do we test for ovulation in infertility presentation?

Answer 10

• Mid-luteal progesterone (why?)
• FSH, LH, and Oestrogen if oligo/amenorrhoea
• Test for hyperandrogenism (free T, free androgen, bioavailable T)
• 17-hydroxyprogesterone for CAH

Question 11

Most common blood test to measure ovarian reserve

Answer 11

Anti-Mullerian Hormone (AMH)

Question 12

Anatomical investigations for female infertility

Answer 12

• Transvaginal ultrasound (?endo, ?polyps/fibroids)
• Hysterosalpingography

Question 13

How do we exam/assess for male infertility?

Answer 13

• Exam: 2° characteristics (facial hair, broad shoulders), penile/scrotal exam
• Endocrine (morning T levels)