Infertility and Sexuality

Question 1

What measures are used to assess for mid cycle ovulation?

Answer 1

Progesterone levels (day 21, mid-luteal)
Cervical mucus monitoring

Question 2

What are markers of ovarian reserve?

Answer 2

Antimullerian hormone
Day 3 FSH and estradiol
Clomiphene citrate challenge
Antral follicle count

Question 3

How does quetiapine cause infertility?

Answer 3

Antidopaminergic effect –> increased prolactin –> suppresses ovulation

Question 4

What is flibanserin?

Answer 4

5-HT1A receptor agonist used for hypoactive sexual desire disorder

Question 4

When should intercourse occur for best success at pregnancy?

Answer 4

Middle of cycle (Day 14) - since sperm can survive up to 5 days, intercourse up to 3 days before ovulation can still result in pregnancy

Question 4

What is first-line for PCOS? Second-line?

Answer 4

Weight loss is first-line
Ovulation induction agents (Letrozole) are next

Laparoscopic ovarian drilling is for those who have failed conservative measures

Question 5

What causes deep dyspareunia?

Answer 5

Conditions that cause pelvic inflammation:
Endometriosis
Prior pelvic surgery

Question 6

What is first-line for postmenopausal insertional dyspareunia?

Answer 6

Water-based lubricants and frequent vaginal intercourse

Question 7

What provides natural vaginal lubrication during arousal phase of intercourse?

Answer 7

Transudate across vaginal mucosa from increased engorgement with blood

Question 8

What do the terms sexual orientation, identity, and expression refer to?

Answer 8

Orientation: Who a person is attracted to
Identity: What gender the person identifies with
Expression: How a person publicly expresses or presents their gender

Question 9

Pathophysiology of idiopathic hirsutism

Answer 9

Excessive conversion of testosterone to dihydrotesterone in hair follicles
Usually positive family history

Question 10

Tubal flushing

Answer 10

Clear fallopian tubes of debris to improve likelihood of pregnancy in those with tubal blockage, mostly with hx of PID from STI

Done during diagnostic hysterosalpingogram or laparoscopy

Question 11

Estrogen antagonist

Answer 11

Clomiphene - helpful for anovulation by inhibition of negative feedback at hypothalamus, leading to GnRH and FSH

Question 12

Ovarian hyperstimulation syndrome

Answer 12

Exaggerated response to clomiphene caused by VEGF overexpression
Bilaterally enlarged, cystic ovaries with increased vascular (Doppler increased), causing third spacing (e.g. ascites, pulmonary edema)

Question 13

Progesterone withdrawal test - purpose

Answer 13

Secondary amenorrhea - determine if simply anovulatory (see bleeding) or no estrogen (no bleeding)