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General Gynecology > Infertility > Flashcards

Infertility Flashcards

1
Q

What is the definition of Infertility?

A

Failure to achieve pregnancy after 12 months or more of regular, unprotected intercourse

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2
Q

After what period of time should you evaluate a 35 yr old with infertility?

A

after 6 months

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3
Q

What percentage of couples in the US are affected by infertility?

A

15%

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4
Q

What is the approximate pregnancy rate (fecundability) for a normal couple?

A

25%

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5
Q

What percent of infertility can be attributed to male factor?

A

10 %

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6
Q

What percent of infertility can be attributed to Tubal or pelvic pathology?

A

35%

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7
Q

What percent of infertility can be attributed to ovulatory dysfunction?

A

15%

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8
Q

What percent of infertility is unexplained?

A

35%

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9
Q

What method of imaging should be used in patients with infertility likely secondary to tubal disease?

A

Hysterosalpingogram

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10
Q

What method of imaging should be used to assess for intracavitary causes of infertility?

A

Sonohysterogram

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11
Q

What is the rate of infection following hysterosalpingogram?

A

1.4 - 3.4%

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12
Q

If HSG demonstrates dilated fallopian tubes, what is the next best step in management?

A

Doxycycline 100 mg BID for 5 days

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13
Q

What test should you order to determine if ovulation has occurred and on what day of the menstrual cycle?

A

serum progesterone, day 20

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14
Q

What value of serum progesterone indicates ovulation has occured?

A

> 3 ng/ml

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15
Q

Ovarian reserve can be estimated by what 3 tests?

A

Cycle day 3 FSH, AMH, Antral follicle count

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16
Q

What level of cycle day 3 FSH indicates diminished ovarian reserve?

A

> 10 - 12

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17
Q

What antral follicle count indicates diminished ovarian reserve?

A

< 5 follicles in both ovaries

18
Q

What level of AMH indicates diminished ovarian reserve?

A

< 0.7ng/ml

19
Q

Endometriosis is found in what percentage of infertile women?

A

30 - 40%

20
Q

What percent of reproductive age women have endometriosis?

A

5- 10%

21
Q

Semen analysis: Normal Volume?

A

1.0 ml or more

22
Q

Semen analysis: normal concentration?

A

15 million/ml or more

23
Q

Semen Analysis: Normal Motility/progression?

A

40% or more with forward progression

24
Q

Semen Analysis: Morphology?

A

> 4% with normal morphology

25
Q

How long does spermatogenesis take?

A

3 months

26
Q

What type of medication is Letrozole?

A

Aromatase inhibitor

27
Q

What is the mechanism of action of Letrozole?

A

Inhibits production of Estrogen, thereby decreasing the negative feedback and increasing release of GnRH

28
Q

What is the starting dose of Letrozole?

A

2.5 mg/day

29
Q

On what cycle day should you start taking letrozole?

A

Cycle day 3

30
Q

What is the max dose of letrozole that you can use?

A

7.5 mg daily

31
Q

What type of medication is Clomiphene Citrate?

A

selective estrogen receptor modulator (SERM)

32
Q

What is the mechanism of Clomphine Citrate?

A

blocks negative feedback of estrogen and increases gonadotropin secretion

33
Q

What is the starting dose of clomiphene citrate?

A

50 mg

34
Q

On what cycle day should you start taking clomid?

A

Cycle day 3

35
Q

For how many days do you take clomid?

A

5 days

36
Q

What is the max dose of clomid that you can use?

A

200 - 250 mg

37
Q

What is the risk of multiple gestation when using clomid or letrozole?

A

10%

38
Q

up to how many hours after ovulation can an egg be fertilized?

A

12 - 24 hrs

39
Q

When do you use gonadotropins for ovulation induction?

A

Generally in IVF treatments for hyperstimulation

40
Q

What is the national clinical pregnancy rate for IVF?

A

35%

41
Q

in what percent of IVF cycles does ovarian hyper stimulation occur?

A

10%

General Gynecology (11 decks)

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