Infertility and PCOS Flashcards
What is the definition of Infertility?
Regular, unprotected intercourse without conception for 12 mon
What are risk factors of Infertility?
Irregular Cycles
Endometriosis
What factors need to be addressed in HPI of infertility Eval?
Menses char Timing/freq of intercourse Length of infertility Lubrication use Dysparunia
What factors need to be addressed in Past OBGYN History of infertility Eval?
Prev pregnancies including miscarriage
STI
Pap results
Past contraception
What factors need to be addressed in Meical History of infertility Eval?
DM Thyroid Hirsuitism Galacotorrhea Hx of Chemo/rad Wt Changes
What factors need to be addressed in Partner History?
Testicular injury/torsion/inf Cryptorchidism Surgical Hx Anabolic Steroids STI Tobacco/Alcohol Occupation
What factors are assessed in the Semen analysis?
Volume
Morphology
Concentration
Motility
What are the lab studies done in Evaluation of Infertility?
UA, Vaginal Culture, Pap Smear, wet mount
CBC, TSH, T4, D3 FSH, prolactin, DHEA, Testosterone
BBT or ovulation LH predictor kit
Day 21 serum progesterone
Progesterone Challenge
What is the Purpose of Hysterosalpingogram?
Imaging of Fallopian tubes with contrast to assess patency
What is the Spinbarkeit test?
Test for cervical mucous consistency
What are the Treatments of Infertility?
Surgery for Endometriosis
Clomiphene(low BMI)/Letrozole (High BMI)
Progesterone
Better control of co-morbidities
How is Pregnancy monitored once fertilization is achieved?
Check Quant of hCG and serum progesterone
Progesterone Suppositories
Ultrasound
What are the Diagnostic Criteria and Associated conditions associated with PCOS?
Hyperandrogen, ovulatory dys, PCO on US
Associated: Obesity, T2DM, dyslipidemia, infert, Thyroiditis
What si the clinical presentation in PCOS?
Menses Irregularities Acne Hirsuitism Androgenic Alopecia Obesity
WHat is the Biochemical PResentation of PCOS?
Hyperandrogen: Free Testost
LH: FSH >2
Hyperinsulinemia
Dyslipidemia
WHat is the Tx of PCOS?
1) Lessen symp of Hyperandrogen
2) Manage metabolic comorbid
3) Prevent chronic Anovulation
4) Contraception or Ovulation induction
What is the first line Tx of PCOS? second line?
#1 Lifestyle Change Oral Contraceptives #2 Spironolactone
What was Metformin used for in PCOS?
Dec insulin resistance AND Dec Free serum Test Inc HDL Weight loss Restores Ovulation in 50% of PCOS Pts
What is the Medical Tx of PCOS induced infertility?
No menses? Provera challenge Test
No Spon ovulation, start on day 3-5 Clomiphene
Check serum progesterone on day 21
What are the Lifelong implications of PCOS?
CV disease
T2 DM
Endometrial Cancer
