ovulation disorders

Question 1

oligomenorrhea

Answer 1

cycles>42 days (<8 periods/yr)

Question 2

GNRH

Answer 2

stimulates FSH (low frequency pulses) and LH (high frequency pulses) synthesis / release

Question 3

hormone levels in menstrual cycle (key points)

Answer 3

estradiol peaks before ovulation
progesterone peak following ovulation (produced by corpus luteum)

Question 4

assessing ovulation REGULAR cycles

Answer 4

midluteal (D21) serum progesterone (>30nmol/L)

Question 5

assessing ovulation IRREGULAR cycles

Answer 5

further hormone evaluation required (FSH, LH, TSH, prolacting, estradiol, testosterone, SHBG, FAI)

Question 6

WHO classification of ovulatory disorders GROUP I

Answer 6

hypothalamic, pituitary failure

Question 7

WHO classification of ovulatory disorders GROUP II

Answer 7

hypothalamic pituitary dysfunction

Question 8

WHO classification of ovulatory disorders GROUP III

Answer 8

ovarian failure

Question 9

Type I

Answer 9

GAIN
genetic, autoimmune, iatrogenic, neoplasm

Question 10

Type II

Answer 10

FIT
functional, infectious/inflammatory, trauma & vascular

Question 11

Type III

Answer 11

PIE
physiological, idiopathic, endocrine

Question 12

hypothalamic causes

Answer 12

kallman’s syndrome, drugs, brain/pit tumours, stress, head trauma, excessive exercise, anorexia / low BMI

Question 13

polycycstic ovaries (USS appearance)

Answer 13

12/more 2-9mm follicles
increased ovarian volume > 10ml
unilateral / bilateral

Question 14

what is a common symptom associated w/ pcos

Answer 14

insulin resistance (seen in 50 - 80%)

Question 15

management

Answer 15

clomifene citrate (anti-oestrogen)
alternatives (tamoxifen, letrozole)

Question 16

metformin (fertility)

Answer 16

can restore mentruation and ovulation

Question 17

consequences of OI assisted conception

Answer 17

ovarian hyperstimulation
multiple pregnancy
theoretical risk ovarian cancer