Ovulatory dysfunction and infertility

Question 1

hormonal features of hyothalamic-pituitary failure

examples

Answer 1

hyopgonadotropism

low or normal FSH

low estradiol

Kallman syndrome, Anorexia, Stress or weight related

Question 2

progestin chellenge test

Answer 2

if estrogen status unclear

medroxyprogesterone acette admin daily for 7-14d

normal should have withdrawal bleeding after

Question 2

like ___ and ___ Climiphene citrate is a SERM and thus can act as ___-

Answer 2

likeDiethylstilbestrol and Tamoxifen,

act as estrogen agonist and antagonist

Question 3

confirm dx of intrauterine adhesions or synechiae

Answer 3

hysterosalpingogram

hysteroscopy

Question 4

hormonal features of ovarian failure

examples

Answer 4

hypergonadotropism

high FSH

low estradiol

premature ovarian failure, premenopause

Question 5

aromatase inhibtors for ovulation induction

specific mechanism

Answer 5

Letrozole

inhibition of E2 production, negative feedback causes increase in FSH levels

Question 7

GnRH antagonists

specific mechanism

Answer 7

Ganirelix and cetroelix

prevent LH surge during controlled ovarian hyperstimulation

Question 8

indications Clomiphene citrate

Answer 8

induce ovulation in infertilty

stiumulation of mutlifollicualr ovulation or enhancing ovulation in ovulatory infertile women

Question 9

gonadotropins indicated for

Answer 9

hypothalamic amenorrhea

anovulatory paatients who do no respond to Clomiphene citrate or aromatase inhibitors

Patients udnergoing hormonal stimulation for in vitro

Question 10

infertility presentating with High FSH - screening protocol and results

Answer 10

confrim FSH one month later, on day three if possible

=Premature ovarian failure

(if

Question 11

dx criteria for PCOS

Answer 11

oligoovulation or anovulation

clinical or biochemical signs of hyperandrogenism

polycystic ovaries in each ovary (2 to mm, and/or ovarian vol

Question 12

hormonal features of secondary HPO dysfunction

exaamples

Answer 12

variable, lownormal FSH and estradiol

hyperproalctinemia

thyroid disease

congenital adrenal hyperplasia

tumors

Question 12

chromosomal causes

Answer 12

45X

47XXY

variable mosaicism

Fragile X (FRMR1 triplet repeat within exon 1)

Question 14

serum progesterone levels of ___ indicate presence of ovulation

Answer 14

> 3ng/ml

Question 15

sufficient for Dx of SOI

Answer 15

FSH levels >40 on two ocassions in woman

Question 16

hormonal features of hyopthalamic pituitary *dysfunction *(not failure)

Answer 16

Normogonadotropism

normal FSH

normal estradiol

with or without Hyperandrogenism

PCOS, stress or weight related, iodpathic

Question 17

if presenting infertility with low or normal FSH, testing procedure and results

Answer 17

Acess estrogenization with progestin challenge

if progestin withdrawal bleed= hypothalamic amenorrhea