Naz teaches infertility

Question 1

Most likely cause of anovulation

Answer 1

PCOS

Question 2

Labs of PCOS

Answer 2

↑ Lh/ FSH ratio (LH> FSH)

↑ Testosterone

Question 3

What is infertility

Answer 3

cannot get pregnant for 1 year (pts over 35 get worked up quicker)

80% of couples get pregnant in one year

Question 4

What makes GnRH

Answer 4

Hypothalamus

Question 5

When is HCG made

Answer 5

hCG secretion begins around the time of
implantation of blastocyst.

Blastocyst “sticks” at day 6

Question 6

When does the heart beat?

Answer 6

4 weeks

also upper and lower limb buds begin to form.

4 weeks = 4 limbs and 4 heart chambers

Question 7

When can you see the heartbeat on US

Answer 7

6 weeks

Question 8

Aminoglycosides do what to baby

Answer 8

ototoxic

Question 9

When do you measure FSH

Answer 9

Day 3 labs
(3 days into period)

Day 3 labs are
FSH and estradiol levels, AMH levels, and AFC).

Question 10

What test do you do to see if you ovulate

Answer 10

LH surge at home urine kit

Basal body temperature (↑ progesterone –> ↑ temp)

if progesterone is low, so is fertility

Question 11

Estrogen stimulates __________

Answer 11

endometrial proliferation.

Question 12

Progesterone does?



Answer 12

maintains endometrium to support implantation.

Question 13

Oligomenorrhea is

Answer 13

> 35-day cycle.

Question 14

Polymenorrhea is?

Question 15

Metrorrhagia

Answer 15

Frequent or irregular menstruation.

Question 16

Menorrhagia

Answer 16

Heavy menstrual bleeding; > 80 mL blood loss or > 7 days of menses.

Question 17

Menometrorrhagia

Answer 17

Heavy, irregular menstruation.

Question 18

Day 21 serum progesterone labs help because?

Answer 18

Basal body temperature (↑ progesterone –> ↑ temp)

if progesterone is low, so is fertility

Question 19

Ovarian causes of infertility

Answer 19

• PCOS
• Advanced maternal age
• Premature ovarian failure
• Hypothalamic amenorrhea
• Hyperprolactinemia

Question 20

Tubal factors of infertility

Answer 20

• PID/ salpingitis
• Tubal ligation
• Endometriosis
• Pelvic adhesions

Question 21

Uterine factors of infertility

Answer 21

• Congenital malformations
• Submucosal fibroids
• Uterine polyps
• Intrauterine synechiae (Asherman’s syndrome)

Question 22

Cervical factors of infertility

Answer 22

• Müllerian duct abnormalities
• Cervical stenosis
• Cervicitis or chronic inflammation

Question 23

List the Medications Used in the Treatment of Infertility and in Assisted Reproductive Technologies

Answer 23

• Clomiphene citrate
• Metformin
• HCG
• Pulsatile GnRH/ gonadorelin
• Letrozole

Question 24

Letrozole is?

Answer 24

Aromatase inhibitor,
reduces androgen conversion to estrogen,
stimulates follicular development for ovulatory induction

Question 25

gonadorelin is?

Answer 25

GnRH agonist, stimulates release of FSH/LH from pituitary

Question 26

Novarel is?

Answer 26

Human chorionic gonadotropin Similar structure to LH, triggers ovulation after gonadotropin folliclestimulation

Question 27

metformin helps get pregnant via?

Answer 27

Insulin sensitizer, decreases insulin,testosterone, BMI; promotes ovulation

Question 28

Clomiphene citrate is

Answer 28

Anti-estrogen, stimulates follicular development for ovulation induction

Question 29

Day 3 labs are:

Answer 29

FSH and estradiol levels, AMH levels, and AFC

Question 30

Clomiphene citrate works via?

Answer 30

- antiestrogen, binds to estrogen receptors in the hypothalamus--> - ↑ FSH and LH --> - follicular maturation and ovulation

Question 31

Clomiphene citrate is best used for?

Answer 31

women with chronic anovulation or mild hypothalamic insufficiency after specific causes of hypothalamic dysfunction have been ruled out.

Question 32

Human menopausal gonadotropins are used for?

Answer 32

a form of FSH, or FSH + LH | directly stimulate follicular maturation in patients for whom Clomid has failed,

Question 33

ovarian Hyper-stimulation syndrome

Answer 33

Very dangerous | fertility stuff--> ovarian enlargement, torsion, and rupture

Question 34

Risk factors for endometrial carcinoma include

Answer 34

``` nulliparity late menopause hypertension exposure to unopposed estrogens. *obesity confers the greatest risk of developing endometrial carcinoma, ```

Question 35

Approximately 80-90% of women with endometrial carcinoma present with ?

Answer 35

vaginal bleeding or discharge as their only presenting symptom

Question 36

Top Five Cancers Detected in Women:

Answer 36

``` Breast 28% Lung 14% Colon 10% Uterine 6% Ovary 3% ```

Question 37

Risk factors for endometrial cancer include

Answer 37

``` late menopause unopposed estrogen therapy nulliparity obesity Tamoxifen therapy diabetes mellitus. ```

Question 38

Unopposed estrogen replacement therapy does increase the risk of endometrial cancer, but not when?

Answer 38

taken in combination

Question 39

Routine eval for endometrial ca would include

Answer 39

chest x-ray- lungs most common site for mets

Question 40

The recommended components of the surgical approach to an early endometrial cancer are ?

Answer 40

extrafascial total abdominal hysterectomy bilateral salpingo-oophorectomy pelvic and para-aortic lymphadenectomy.

Question 41

The most common causes of postmenopausal bleeding are

Answer 41

``` 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.

Question 42

Tamoxifen is known to cause changes to the endometrium, including?

Answer 42

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

Question 43

Dermoid tumors usually have solid components or appear echogenic on ultrasound, as they may contain ?

Answer 43

teeth, cartilage, bone, fat and hair

Question 44

An intravenous pyelogram (IVP) is an x-ray examination of the?

Answer 44

kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins.

Question 45

The most likely diagnosis of the adnexal mass that would also explain the finding of endometrial hyperplasia would be a?

Answer 45

granulosa cell tumor (sex-cord stromal tumor)

Question 46

In all patients with advanced ovarian cancer, post-operative chemotherapy with a combination of _______________- is considered standard of care in the United States.

Answer 46

a taxane and platinum adjunct

Question 47

The most common tumor found in women of all ages is the ?

Answer 47

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.

Question 48

dermoid median age of occurrence is ?

Answer 48

30 years, and 80% occur during the reproductive years.

Question 49

Dermoids may contain?

Answer 49

differentiated tissue from all three embryonic germ layers. Dermoid tumors can contain teeth, hair, sweat and sebaceous glands, cartilage, bone, and fat.