Dr Clark Gynae

Question 1

what id endometriosis?

Answer 1

ectopic endometrial tissue outside the uterus. commonly in pelvic peritoneum

Question 2

Causes of endometriosis?

Answer 2

retrograde menstration

Question 3

what are the pathology od endometriosis?

Answer 3

deposit thickens with hormonal cycle

pain worse pre-menstrual and during period

cause scarring and adhesions
forzen pelvics
chocolate cysts

Question 4

sympoms of endometriosis?

Answer 4

dysmenorrhoea

dysoareunia

pelvic pain

subfertility

Question 5

management of endometriosis?

Answer 5

analgesia

prevent hormonal stimulation of ectrpic endometrium

remove endometriosis (lazer, excision)

Question 6

what are the hotmomal preventions used to treat endometriosis?

Answer 6

COC pill

progesterone only

mirena coil

GnRH agalgogues

Oophorectomy

Question 7

the effect of prolactin on ouvluation?

Answer 7

prolactin inhibits ovulation

Question 8

causes of amenorrhoea?

Answer 8

pregnancy
prolactinoma
PCOS
premature ovarian failure

Question 9

investigations used in amenorrhoea?

Answer 9

pregnanacy test
prolactinoma
LH/FSH;

riaised–> ovarian failure
reduced–>hypothalamic/pituary problem
increased–> PCOS

testerone–> rule our androgen secreting tumour

US

Question 10

what is subfertility?

Answer 10

failure to conceive after 12 months of regular unprotected intercourse

Question 11

what is primary subfertility?

Answer 11

someone who has never conceived.

as oppose to secondary where someone has previously conceived

Question 12

causes of subfertility?

Answer 12

anovulation - 30%

male factor- 25 %

tubal-20 %

Question 13

25% couple have unexplained subfertility t/f?

Answer 13

t

Question 14

what is anovulation?

Answer 14

failure of ovulation due to a problem in the hypothalamo-pituary-ovarian (HPO) axis

Question 15

what problems of the hypothalamic can lead to anovulation?

Answer 15

stress
anorexia
weight loss

Question 16

what problems of the pitutary can lead to anovulation?

Answer 16

prolactinone
pituitary necrosis (sheehan's)

Question 17

what problems of the ovaries can lead to anovulation?

Answer 17

PCOS

Ovarian failure/tumour

Question 18

what problems of the tubal can lead to anovulation?

Answer 18

PID (chlamydia)

endometriosis

surgical adhesions

Question 19

what are the male factors in subfertility?

Answer 19

absent spermatozoa-azoospermia

few spermatozoa-oligospermia

excessive number of abnormal sperm- tetratozoospermia

large number of immotile sperm-asthenozoospermia

Question 20

investigations into subfertility in female?

Answer 20

laparoscopy and dye

hysterosalpingogram

Question 21

what sort of assessments to do in HPO axis to assess subfertility?

Answer 21

prolactin

FSH/LH–> low in hypothalamopituitary failure, raised in primary ovarian failure (ovaries don’t work)

oesterogen
testerone
progesterone

The surge triggers the process of ovulation. On the surge day, LH levels should be greater than 20 mIU/ml. Levels of FSH and LH are found to be abnormal in PCOS (ovarian cyst). LH levels higher than FSH levels indicate that the woman has ovarian cyst or polycystic ovarian syndrome (PCOS). Low FSH levels and low LH levels in women indicate secondary ovarian failure due to a pituitary or hypothalamic problem while low FSH serum levels are associated with increased risk of ovarian cancer. High LH levels and high FSH levels are consistent with primary ovarian failure (ovaries themselves fail to work).

Question 22

treatment for subfertility?

Answer 22

*********lifestyle:******
weight loss(if overweight)

smoking cessation/reduce caffine intake/ reduce alchole intake

intercourse aim for 2-3 times a week

Question 23

treatment for anovulation?

Answer 23

clomifene

gonoadotropines (FHS/LH)

GnRH

Question 24

treatment for premature ovarian failure?

Answer 24

egg donation or IVF

Question 25

treatment for tubal damage?

Answer 25

tubal surgery or IVF

Question 26

treatment for male factor in subfertility?

Answer 26

assisted reproduction

intrauterine insemination

intracytoplasmic sperm injection