Infertility, PCOS, Endometriosis

Question 1

what is the common presentation of endometriosis

Answer 1

nulliparity, early menarche, short menses, hx dysmenorrhea

Question 2

what is the clinical presentation of endometriosis

Answer 2

may be symptomatic or asymptomatic: symptoms do not necessarily correlate with extent or location of disease
dysmenorrhea, dyspareunia, spotting/AUB, pelvic pain
infertility common
depression/anxiety issues

Question 3

what is the internal appearance of endometriosis

Answer 3

varies:
clear or white, dark red or brown lesions
dark red or blue “domes”
described surgically as “cigarette burns”
on the ovary, cysts may develop - endometrioma

Question 4

what is endometrioma

Answer 4

cysts that develop on the ovaries

Question 5

what labs are ordered for endometriosis workup

Answer 5

quantitative hCG, UA, cervical cultures, CBC

Question 6

what is seen on pelvic exam for endometriosis workup

Answer 6

usu. normal findings
may be fixed retroverted uterus, uncomfortable during pelvic exam
if something to find, maybe nodularity of uterosacral ligaments

Question 7

what is the imaging used for endometriosis diagnosis

Answer 7

TVUS

Question 8

what is the treatment for endometriosis

Answer 8

expectant, hormonal, surgical and combination medical-surgical
choice of treatment dependent on individual patient case
-NSAID and OCP - first line

Question 9

What are complications of PCOS

Answer 9

4x increase risk of T2DM
increased risk of ovarian and breast cancers
increase prevalence NAFLD, OSA, dyslipidemia
Increased prevalence of CVD (but not increased mortality)
increased risk for mood disorders (esp. depression)

Question 10

what is the pathophysiology of PCOS

Answer 10

altered LH function with insulin resistance and predisposition to hyperandrogegism
increased resistance exacerbates hyperandrogegism; increases adrenal and ovarian synthesis
increased androgens leads to irregular menses and physical symptoms

Question 11

what is the clinical presentation of PCOS

Answer 11

asymptomatic to obvious
signs of androgen excess with oligo/amenorrhea and infertility (anovulation)

Question 12

what are the goals for PCOS evaluation

Answer 12

exclude other manageable conditions
diagnosis/manage complications

Question 13

what needs to be ruled out when working up PCOS

Answer 13

pregnancy
thyroid dysfunction
hyperprolactinemia
congenital adrenal hyperplasia
primary ovarian insufficiency, cushing’s, acromegaly

Question 14

What is the Rotterdam criteria

Answer 14

2 out of 3 diagnostics for PCOS
-oligomenorrhea and/or anovulation (ovulatory dysfunction)
-clinical or biochemical signs of hyperandrogenism
-PCOS appearing ovaries on TVUS

Question 15

What lab work is needed for the work up of PCOS

Answer 15

LH and FSH
LF/FSH ratio > 2 indicative of PCOS

Question 16

what is the first line management for PCOS

Answer 16

lifestyle modification -> weight loss (if overweight)

Question 17

what also needs to be discussed with the management of PCOS

Answer 17

infertility
menstrual concerns/endometrial prevention
Hirsutism
Acne

Question 18

how is Hirsutism managed in PCOS

Answer 18

first line: oral contraceptives
spironolactone 100mg daily - monitor K
cosmetic treatment

Question 19

what is the first line management for acne with PCOS

Answer 19

hormonal contraceptives
adjunctive tx: usu. topical acne therapies

Question 20

what are routine screenings for PCOS

Answer 20

BP every visit
lipids
glucose testing (strongly consider 2hr OGTT at initial diagnosis)
depression
OSA

Question 21

what is the definition of infertility

Answer 21

12 months of unprotected intercourse without conception (<35yo)
6 months of unprotected intercourse without conception (>35yo)

Question 22

what are the main causes of infertility in women

Answer 22

PCOS
Hormonal factors impaction ovulation
endometriosis

Question 23

what are the most common causes of ovarian and oocyte abnormalities

Answer 23

PCOS
premature ovarian failure

Question 24

what are anatomical abnormalities for females

Answer 24

fallopian tube disease
endometriosis
uterine fibroids
asherman’s syndrome
other implantation abnormalities; luteal phase deficiencies

Question 25

what are anatomical abnormalities for males

Answer 25

varicoceles
blockage of vas deferens or epididymis
damage to bladder neck or lumbar sympathetic nerve injury
gonadal failure

Question 26

what is the treatment of infertility

Answer 26

identify and correct any underlying medical or surgical concerns
strongly consider specialist referral (reproductive endocrinology)
encourage: good sleep, healthy eating and exercise, prenatal vitamins
cycle and fertility awareness
STRESS management for both

correct timing of attempts (days 10 - 20, QOD)