fertility

Question 1

which gene can cause 46XY problems eg f external genitalia but no ovaries

Answer 1

NR5A1

Question 2

where is NR5A1 active (2)

Answer 2

urogenital ridge and gonadal primordium

Question 3

definition of infertility

Answer 3

unabble to conceive, even with medical interventions

Question 4

primary vs 2ary infertility

Answer 4

1 no conception
2 conception but no baby (either previous live birth or miscx etc)

Question 5

subfertility

Answer 5

12 mo

Question 6

what stimulates gnrh release re start of puberty

Answer 6

leptin

Question 7

why anorexia no periods

Answer 7

no fat, no leptin, no gnrh

Question 8

what would cause pituitary infertility?
What tx

Answer 8

hyperprolactinaemia -> inhibition of LH FSH,
bromocriptine or cabergoline (dopamine agonists)

Question 9

what are type 1,2,3,4 infertility

Answer 9

1 hypothalamic
2 pituitary
3 ovarian failure
4 PCOS

Question 10

what hormonal profile PCOS

Answer 10

Raised LH with normal FSH, raised free testosterone
raised anti-mullerian hormone

Question 11

PCOS diagnosis requires 2/3 Rotterdam criteria. what are they

Answer 11

oligomenhorroea
raised androgens - hirsutism or acne
polycystic ovaries on USS

Question 12

what preserves thecal cells in PCOS

Answer 12

insulin

Question 13

which cells in PCOS release too much androgen and why are they there

Answer 13

obesity - insulin resistance - hyperinsulinaemia - preservation of thecal cells - too much testosterone released

Question 14

is GnRH raised in PCOS

Answer 14

no. just raised sensitivity to it (supposedly)

Question 15

which cells release AMH and what is the relevance of that in PCOS

Answer 15

granulosa cells - multiple follicles stimulated at once

Question 16

what other endocrine disorder is also common in women with PCOS

Answer 16

thyroid

Question 17

what type of tumour are fibroids

Answer 17

leiomyoma

Question 18

what side effects associated with Diethylstilbesterol

Answer 18

when taken by mother, uterine and vaginal structural defects
also vaginal carcinoma in the mother

Question 19

LH levels in women dependent on…

Answer 19

insulin sensitivity

Question 20

abnormal secretion of what found in 81% women with recurrent miscarriage

Answer 20

LH

Question 21

50-60% women with recurrent miscarriage have what problem give 2 examples

Answer 21

too much coagulation defect

Defects in factor XIII and factor XII
Anticardiolipin antibodies (aCL) or lupus anticoagulant antibodies in antiphospholipid syndrome (APS or sticky blood syndrome): ↑ the risk of developing blood clots

Question 22

IgG, IgA can both be anti-sperm antibodies.

what do they inhibit

Answer 22

IgG blocks sperm- ovum fudion
IgA stops motility of sperm and penetration of cervical mucus

Question 23

what tests constitute PCOS screen

Answer 23

Day 21 progesterone (16 to 28 nmol/l), LH, FSH, serum testosterone, glucose
HbA1C (if glucose abnormal on PCOS screen)

Question 24

which molecule is inversely related to Anti Mullerian Hormone

Answer 24

Vitamin D

Question 25

Answer 25

Question 26

Answer 26

Question 27

folate recommended for high BMI or family history of spina bifida

Answer 27

5mg

Question 28

what drug used for ovulation induction in PCOS

Answer 28

clomiphene citrate

Question 29

moa clomiphene citrate

Answer 29

Inhibits E2 negative feedback and activate GnRH secretion, correct the imbalance levels of FSH and LH

Question 30

what 2nd line tx for ovulation induction in fertility tx

Answer 30

Human Menopausal Gonadotropin or hMG (75 IU FSH & 75 IU LH – Menotropins (Menopur))

Question 31

what drug is Used for final preparation of the eggs before retrieval in IVF

Answer 31

HCG injection

Question 32

what drug can overcome luteal phase defects (stimulates better develpmnt of corpus luteum)?

Answer 32

HCG

Question 33

why would you give HMG as fertility tx

Answer 33

CC failure

Question 34

what is ovarian drilling

Answer 34

drilling 10 holes into ovaries laparoscopically to redress FSH LH balance wtf