infertility/endometriosis/PCOS Flashcards
What is the peak prevalence for endometriosis
25-35 y/o
What is the common presentation of endometriosis
nulliparity
early menarche
short menses
dysmenorrhea
Dypareunia
What is the genetic component of endometriosis
hx of first degree relatives have nearly 10fold increased risk
What is endometriosis
presence of endometrial glands and storm at extrauterine sites
*estrogen dependent disorder
Where is endometrial tissue found with endometriosis
Found in the ovaries - typically bilaterally and generally remains in pelvic region but can occur anywhere
What is the appearance of endometriosis
Clear or white, dark red or brown lesions
dark red or blue domes
surgically describes as cigarette burns
Where might endometriomas develop
on the ovaries
What MAY be seen on a pelvic exam with endometriosis
a fixed retroverted uterus
nodularity of uterosacral ligaments
What is the imaging of choice for endometriosis
TVUS
What is the first line treatment for endometriosis
NSAIDs and OCP
What is the most common endocrine/metabolic disorder of reproductive age women
PCOS
What disorder is a big cause of menstrual irregularity, ovulatory dysfunction and androgen excess in women
PCOS
What are complications of PCOS
4x increase for T2DM
Increase breast/ovarian CA risk
Increased prevalence of CVD
Increased risk mood disorder
What causes PCOS
Altered LH function with insulin resistance and predisposition to hyperandrogenism = increase in adrenal and ovarian synthesis
What is the common presentation of PCOS
Signs of androgen excess with oligo/amenorrhea and infertility
How do you diagnose PCOS
Rotterdam criteria
What makes up the Rotterdam criteria
- Oligomenorrhea/ an ovulation
- Clinical/biochemical signs of hyperangrogenism
- PCOS appearing ovaries of TVUS
What LH/FSH ratio is indicative of PCOS
> 2
How do you manage PCOS
OCP
Routine screening (Lipid, glucose, depression, OSA)
BP
What is the first line management for PCOS
Lifestyle modification (weightless if overweight)
What is the first line for managing hirsutism
OCP
When is a women <35 considered infertile
12mos of unprotected sex
When is a women>35 considered infertile
6 months of unprotected sex
What are the most common causes of infertility
PCOS
Hormonal factors impacting ovulation
Endometriosis
What is the most common cause of ovarian dysfunction and oocyte abnormalities
PCOS
What are some anatomic abnormalities that can cause infertility
Fallopian tube disease (PID)
endometriosis
Fibroids
Ashermans syndrome
Luteal phase deficiencies
What are some anatomic abnormalities in males that can lead to infertility
varicoceles
blockage of vas defrens
Damage to bladder neck
Gonadal failure
What are some infertility treatments
Identify and correct any underlying medical / surgical concerns
strongly consider specialist referral
What is considered a “correct timing” of attempts to become pregnancy
days 10-20 QOD
