Infertility and pelvic floor disorders Flashcards
what kind of history would you get on woman that has presence of excessive body and facial hair?
Hx of PCOS, menstrual irregularities, fertility history, insulin resistance, obesity, or acne. Med history use- valproic acid, testosterone, danazol, athletic performance drugs. If glactorrhea present, workup for hyperprolactinemia.
WORKUP on hirsutism
random testosterone level, TSH, fasting glucose
if testosterone is greater than 150, suspect…? What is used to diagnose?
ovarian (ultrasound) or adrenal tumor (CT)
tx for hissutism
oral contraceptives- 6 months to show effect, eflornithine HCL cream, cosmetic measures- hydrogen peroxide, plucking, waxing, shaving, chemical depilatories, electrolysis, laser therapy
the only FDA approved hirsutism treatment
vaniqa (eflornithine) HCL cream
inability of a couple to conceive within 1 year=
infertility
difference between infertility and sterility
infertility- can’t conceive. sterile- intrinsic inability to achieve pregnancy (vasectomy, hysterectomy)
how can you have both fecundity and infecundity
fecundity- can reproduce, but inability to achieve live birth- infecundit
likelihood of conception per month of exposure
fecundability
primary and secondary infertility inc or dec?
primary infertility increasing with concurrent decrease in secondary infertility
4 key aspects in lab and radiologic tests that are looked at in infertility
sperm, oocyte, transport, and implantaion of ova
causes of infertility in women
fallopian tubal occlusion d/t PID (oocyte cannot be transported to uterus), ovulatory disorders (gonadal dysgenesis), endometriosis, HIV, toxic exposures, untreated cervicitis, untreated STD’s
majority of cases in infertlity caused by
testicular pathology (varicocele) in 25-40% of cases and ovulatory dysfunction in 20-25% of cases
male factors causing infertility
endocrine (pituitary failure), anatomic, abnormal spermatogenesis (chromosomal abnormalities, cryptorchidism), abnormal mobility (varicocele, absent cilia), and sexual dysfunction (impotence, retrograde ejaculation)
molimina
premenstrual symptoms
ovulatory factors causing infertility
follicular pool (less as you get older) and ovarian reserve (older eggs, less quality)- inverse relationship between fecundity and age
confirmation of ovulation
serum progesterone assay, pelvic ultrasound (looks at follicular phase), urinary LH kit/serum LH assay (detects LH surge), basal body temp, endometrial biopsy
serum progesterone assay detects…
progesterone in mid luteal phase or third week of cycle. 3 or more ng/MI consistent with ovulation
List main 4 characteristics seen in PCOS
Chronic anovulation- amenorrhea, oligomenorrea, infertility. Hyperandrogenism- acne, hirsutism, seborrhea, acanthosis nigricans, metabolic syndrome. Polycistic ovaries on ultrasound causing ovarian enlargement Insulin resistance, also causes increased testosterone
PCOS testing
Ultrasound- polycistic appearing ovaries, hCG to r/o pregnancy and GTD. FSH to exclude premature ovarian failure. TSH, testosterone increased. 2 hr glucose tolerance test for insulin resistance check. lipid panel to check metabolic syndrome. CMP to check liver function, electrolytes. 17-hydroxyprogesterone- r/o congenital adrenal hyperplasia
vaginal ultrasound in PCOS
polycystic appearing ovaries, multiple small follicles around periphery, increased ovarian volume (enlarged ovaries), increased uterine lining thickness
tx of PCOS
exercise and healthy eating imp for insulin resistance, Birth control pills, depot provera, mirena IUD, metformin, spironolactone for androgen excess hirsutism, ovulation induction with clomiphene
Rotterdam consensus
2 of the following satisfied in PCOS: chronic anovulation, hyperandrogenism, or polycystic appearing ovaries by ultrasound
4 types of pelvic organ prolapse
cystocele, rectocele, enterocele, uterine prolapse
