Infertility Flashcards

Question

2h OGTT how is it done

Answer 1

75mg, draw blood 2x (after 2hrs normal <140mg/dL, impaired glucose tolerance 140-199, DM >200). prev of impaired glucose tolerance 35%, DM 10%) screen q3-5yrs.

Answer 2

1. The P component suppress LH secretion and lead to a decrease in ovarian androgen production. 2. The estrogenic component increases the levels of sex hormone–binding globulin (SHBG), which, in turn, results in a decrease in circulating free T levels. The E also potentiates P receptors (P is always the dominant hormone) 3. progestin in the pill can compete for 5a-reductase at the level of the androgen receptor. 4. decreases adrenal androgen production by a mechanism yet unclear, possibly due to a decrease in adrenocorticotropin hormone (ACTH) production.

Answer 3

lower values depicting higher degrees of insulin resistance. A G/I ratio of less than 4.5 has been shown to be sensitive (95 percent) and specific (84 percent) for insulin resistance in a group of women with PCOS, when compared to a control group.

Answer 4

Decreased FSH, LH, E2, IGF1 Increased cortisol, rT3 Same: prolactin, TSH, T4

Answer 5

Females: IBW (kg) = 45.5 kg + 2.3 kg for each inch over 5 feet.

Answer 6

Clomiphene Citrate Challenge test: baseline FSH/E2 then 100 mg x 100 and repeat FSH/E2 on CD 10 Patients are notified of test results by their coordinator or physician: A level from 10-12.5 mIU/mL predicts resistance to fertility medications and a diminished prognosis. At 12.5-15 mIU/mL, the prognosis is poor but pregnancies do occur with aggressive treatment. Levels greater than 15 mIU/mL indicate that infertility treatment with the patient’s own eggs is not likely to succeed and that egg donation should be offered.

Answer 7

nausea, postural hypotension, mental fogginess

Answer 8

most fatal form of CAH, as it disrupts adrenal and gonadal steroidogenesis. Most cases of lipoid CAH are caused by recessive mutations in the gene encoding steroidogenic acute regulatory protein (StAR). Affected patients typically present with signs of severe adrenal failure in early infancy and 46,XY genetic males are phenotypic females due to disrupted testicular androgen secretion.

Answer 9

Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Intense fear of gaining weight or becoming fat, even though underweight. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia.

Answer 10

X linked disorder caused by expansion of a repeated trinucleotide segment of DNA, cytosine–guanine–guanine that leads to altered transcription of the fragile X gene FMR1. The large number of repeats in a full mutation allele causes the FMR1 gene to become methylated and inactivated. The number of cytosine–guanine–guanine repeats varies among individuals and has been classified into four groups depending on the repeat size: 1) unaffected (5–44 repeats), 2) intermediate (45–54 repeats), 3) premutation (55–200 repeats), and 4) full mutation (greater than 200 repeats)

Answer 11

Most common inherited form of intellectual disability, autism, ADHD Most affected males have significant intellectual disability. Long, narrow face and prominent ears, enlarged testicles (macroorchidism), joint and skin laxity, hypotonia, mitral valve prolapse, delay in speech, and delay in gross and fine motor skills. The abnormal facial features are subtle in infancy and become more noticeable with age, making phenotypic diagnosis difficult, especially in the newborn. Affected females may have a milder phenotype, and it is sometimes hard to establish the diagnosis based on clinical findings alone.

Answer 12

CC causes depletion of hypothalamic estrogen receptors leading to increased GnRH secretion, thereby increasing pituitary gonadotropin release and ovarian activity [2]. Though high ovulation rate (60–90%) make it an attractive therapy, the pregnancy rate of 10 to 20% [3] is disappointing. Sub-optimal pregnancy rates with CC have been attributed to its peripheral anti-estrogenic effects, mainly on the endometrium and the cervical mucus [4] or its interference with the functioning of the corpus luteum

Answer 13

60% endometrial cancer risk 24% ovarian cancer risk