Infertility

Question 1

PCOS Treatmetn for infertility

Answer 1

1. Best = lifestyle modification (diet, exercise)
2. Clomid (22.5%)alone better than metformin, comparable to clomid + metformin (26.8%)
3. Metformin alone (7.2%)

Question 2

Phases of Menstrual Cycles and Test

Answer 2

HSG: Early in the proliferative phase of the cycle. Postcoital test: (cervical mucus and sperm) mid-cycle, coincident with ovulation.
EMB, serum progesterone assay: Assess ovulation and corpus luteal function, middle to latter part of the secretory phase

Question 3

Infertility Definition

Answer 3

No pregnancy after 1 year adequate unprotected intercourse

- 15% of all couples

Question 4

Infertility Etiology

Answer 4

20% Isolated Male Factor

10% Unexplained

Question 5

Basic Infertility Workup

Answer 5

Ovulatin: Hx, BBT, LH predictor kit, Timed serum P
Sperm: Vol 2mL, conc 20m/ml, motility 50%, morphology 14%
Anatomy: HSG (54% sens for blockage, 85% specific for patency)
Ovarian Reserve
- Elevated D3 FSH (>10 IU/mL)
- Elevated D3 Estradiol (Abnormal if >75pg/ML
- Predicts outcomes with IVF, not established for general public

Question 6

Fertility and various Uterin conditions (septum, fibroids, polyps, endometriosis, obesity, cigarettes)

Answer 6

Intracavitary fibroids: decrease
Polyps >2cm; decrease
Endometriosis: decrease (via egg quality)
Septate uterus: no decrease
obesity and cigarettes: decrease

Question 7

Normal fertility fecundity by age

Answer 7

20s & early 30s: 20% per cycle
Age 40: Approximately 10%
Age 45: Most infertile; age more predictive of fertility than ovarian reserve

Question 8

RPL

Answer 8

0030
If no prior live births
- 70% live birth in next pregnancy
- 40% livebirth after 4 losses
If prior live births:
- 70% livebirth until 6 losses
Increased risk of ectopic, NTDs

Question 9

RPL: GEISHA

Answer 9

Genetic 5%
Endocrine 20%
Infections: 5% (controversial)
Immune: 20%
Structural 20%
Anybody's Guess: 30%

Question 10

RPL workup

Answer 10

Thrombophilia (anticardiolipina nd lupus anticoagulant - only two for treatment as shown benefit

Question 11

Maternal Recognition of pregnancy

Answer 11

Progesterone secreated by CL exclusively for 5-7wks 2/2 hCG

• After 9th week removal of ovaries has no effect on pregnancy
• Progesterone production peaks at term
• HCG peaks at 10 weeks (stops doubling at 6-7wks at ~10K)

Question 12

Placenta and steroid hormone production

Answer 12

Placenta and steroid hormone production
What does the mother contribute to placental steroid production?
Cholesterol from LDL.
What does the baby contribute?
DHEAS
Which enzymes does placenta lack?
17hydroxylase/17,20lyase and 21 hydroxylase
Consequence
Placental steroid production stops at P (No androgens or cortisol)
E3 is produced by conversion of DHEAS