Naz teaches infertility Flashcards
Most likely cause of anovulation
PCOS
Labs of PCOS
↑ Lh/ FSH ratio (LH> FSH)
↑ Testosterone
What is infertility
cannot get pregnant for 1 year (pts over 35 get worked up quicker)
80% of couples get pregnant in one year
What makes GnRH
Hypothalamus
When is HCG made
hCG secretion begins around the time of
implantation of blastocyst.
Blastocyst “sticks” at day 6
When does the heart beat?
4 weeks
also upper and lower limb buds begin to form.
4 weeks = 4 limbs and 4 heart chambers
When can you see the heartbeat on US
6 weeks
Aminoglycosides do what to baby
ototoxic
When do you measure FSH
Day 3 labs
(3 days into period)
Day 3 labs are
FSH and estradiol levels, AMH levels, and AFC).
What test do you do to see if you ovulate
LH surge at home urine kit
Basal body temperature (↑ progesterone –> ↑ temp)
if progesterone is low, so is fertility
Estrogen stimulates __________
endometrial proliferation.
Progesterone does?
maintains endometrium to support implantation.
Oligomenorrhea is
> 35-day cycle.
Polymenorrhea is?
Metrorrhagia
Frequent or irregular menstruation.
Menorrhagia
Heavy menstrual bleeding; > 80 mL blood loss or > 7 days of menses.
Menometrorrhagia
Heavy, irregular menstruation.
Day 21 serum progesterone labs help because?
Basal body temperature (↑ progesterone –> ↑ temp)
if progesterone is low, so is fertility
Ovarian causes of infertility
- PCOS
- Advanced maternal age
- Premature ovarian failure
- Hypothalamic amenorrhea
- Hyperprolactinemia
Tubal factors of infertility
- PID/ salpingitis
- Tubal ligation
- Endometriosis
- Pelvic adhesions
Uterine factors of infertility
- Congenital malformations
- Submucosal fibroids
- Uterine polyps
- Intrauterine synechiae (Asherman’s syndrome)
Cervical factors of infertility
- Müllerian duct abnormalities
- Cervical stenosis
- Cervicitis or chronic inflammation
List the Medications Used in the Treatment of Infertility and in Assisted Reproductive Technologies
- Clomiphene citrate
- Metformin
- HCG
- Pulsatile GnRH/ gonadorelin
- Letrozole
Letrozole is?
Aromatase inhibitor,
reduces androgen conversion to estrogen,
stimulates follicular development for ovulatory induction
gonadorelin is?
GnRH agonist, stimulates release of FSH/LH from pituitary
Novarel is?
Human chorionic gonadotropin
Similar structure to LH, triggers ovulation after gonadotropin folliclestimulation
metformin helps get pregnant via?
Insulin sensitizer, decreases insulin,testosterone, BMI; promotes ovulation
Clomiphene citrate is
Anti-estrogen, stimulates follicular development for ovulation induction
Day 3 labs are:
FSH and estradiol levels, AMH levels, and AFC
Clomiphene citrate works via?
- antiestrogen, binds to estrogen receptors in the hypothalamus–>
- ↑ FSH and LH –>
- follicular maturation and ovulation
Clomiphene citrate is best used for?
women with chronic anovulation or mild hypothalamic insufficiency after specific causes of hypothalamic dysfunction have been ruled out.
Human menopausal gonadotropins are used for?
a form of FSH, or FSH + LH
directly stimulate follicular maturation in patients for whom Clomid has failed,
ovarian Hyper-stimulation syndrome
Very dangerous
fertility stuff–> ovarian enlargement, torsion, and rupture
Risk factors for endometrial carcinoma include
nulliparity late menopause hypertension exposure to unopposed estrogens. *obesity confers the greatest risk of developing endometrial carcinoma,
Approximately 80-90% of women with endometrial carcinoma present with ?
vaginal bleeding or discharge as their only presenting symptom
Top Five Cancers Detected in Women:
Breast 28% Lung 14% Colon 10% Uterine 6% Ovary 3%
Risk factors for endometrial cancer include
late menopause unopposed estrogen therapy nulliparity obesity Tamoxifen therapy diabetes mellitus.
Unopposed estrogen replacement therapy does increase the risk of endometrial cancer, but not when?
taken in combination
Routine eval for endometrial ca would include
chest x-ray- lungs most common site for mets
The recommended components of the surgical approach to an early endometrial cancer are ?
extrafascial total abdominal hysterectomy
bilateral salpingo-oophorectomy
pelvic and para-aortic lymphadenectomy.
The most common causes of postmenopausal bleeding are
atrophy of the endometrium (60-80%) hormone replacement therapy (15-25%) endometrial cancer (10-15%) polyps (2-12%) hyperplasia (5-10%).
Any history of vaginal bleeding requires assessment of the endometrium.
Tamoxifen is known to cause changes to the endometrium, including?
thickening
thus US does not help you eval if apt is getting CA from the drug
If they do get CA, likely to show symptoms
Dermoid tumors usually have solid components or appear echogenic on ultrasound, as they may contain ?
teeth, cartilage, bone, fat and hair
An intravenous pyelogram (IVP) is an x-ray examination of the?
kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins.
The most likely diagnosis of the adnexal mass that would also explain the finding of endometrial hyperplasia would be a?
granulosa cell tumor (sex-cord stromal tumor)
In all patients with advanced ovarian cancer, post-operative chemotherapy with a combination of _______________- is considered standard of care in the United States.
a taxane and platinum adjunct
The most common tumor found in women of all ages is the ?
dermoid. The median age of occurrence is 30 years, and 80% occur during the reproductive years. Dermoids may contain differentiated tissue from all three embryonic germ layers.
dermoid median age of occurrence is ?
30 years, and 80% occur during the reproductive years.
Dermoids may contain?
differentiated tissue from all three embryonic germ layers.
Dermoid tumors can contain teeth, hair, sweat and sebaceous glands, cartilage, bone, and fat.
