PCOS 2017 TOG

Question 1

How common is polycystic ovaries

Answer 1

20-33%

Question 2

Definition of polycystic ovaries according to ESRH/ASRM consent

Answer 2

12+ follicles measuring 2-9mm in diameter
Ovarian voluma > 10cm3

Suggestions with better USS this should be increased to 25 and AMH should be added potentially >35

Question 3

Prevalence of PCOS

Answer 3

25%

Question 4

Risk of 1st degree relatives being effected?

Answer 4

50%

Question 5

Definition of diabetes, impaired fasting gynaecamia and normal base on fasting glucose

Answer 5

DM >7
Impaired >6.1 <7
Normal <6.1

Question 6

Definition of diabetes, impaired fasting and normal based on 2 hour BM post glucose

Answer 6

DM >11.1
Impaired 7.8-11.1
Normal <7.8

Question 7

When to measure fasting glucose in PCOS

Answer 7

BMI >30
Unless asian then >BMI 25

Question 8

Management of hirsutism

Answer 8

• Weight loss
• Hair removal - electrolysis, waxing, bleaching, topical eflornithine
• Hormonal therapy - COCO e.g. Dianeete (35ug ethinylloestrdaiol and cyproterone acetate), Yasmin - drosperinone (like spironolactone)
• Spironolactone - wear diuretic + antiandrogenic if COCP CI.

Question 9

To reduced risk of endometrial cancer how often should shed endometrium?

Answer 9

Every 3 months
If decline cyclical hormones
USS ET every 5-12 months - if >10mm - should induced artificial bleeding and a repeat USS, EB if endoemerium has not shed

Or offer IUD

Question 10

PCOS account for what proportion of anoultary infertility

Answer 10

80-90%

Question 11

How is clomifebe citrate prescribed?

Answer 11

Day 2-5 of menstrual cycle for 5 days.
If oligo/amenhorrhea - exclude pregnancy the induce withdrawal bleed with short course progesterone such as medroxyprogestoner 20mg/day for 5-10days

Start with doses 50mg/day can increase to 100mg/day

Question 12

What proportion of patients would be pregnant by 6 cycles of clomifene

Answer 12

60-70%

Question 13

What proportion of women with PCOS have high LH? Which women is it more likely toe effect? Effect of high LH on pregnancy

Answer 13

40% - more likely in thin women
Reduced conception, increased risk miscarriage

If using clomifene - can have exaggerated LH, measure LH on day 8 if persistently raised consider alternative therapy

Question 14

Risk of multiple pregnancy with clomifene

Answer 14

10%

Question 15

If anovulatory infertiliy resistant to anti-estrogens, what else can be offered

Answer 15

Gonadotrophin therapy
Lap ovarian drilling

Question 16

Benefits of tetrazole over clomifene?

How does it work?

Answer 16

Higher live birth rates, lower risk multiple pregnancy

Decreases atomisation of androgens to oestrogens.

Question 17

How gonadotrophin therapy used?

Answer 17

Starting dose 25-50IU FSH or human menopausal gonadotrophin - only increased after 14 days if no response, ovulation trigger by hCG 5000 units, when there has been development of at least 1 dominant folicle atleast 17mm in diameter.

Question 18

Conception rate/live birth after should 6 months gonadoptrophin therapy

Answer 18

70% conception
55-60% live birth rate

If no conception after 6 months - IVF

Question 19

Multiple pregnancy rate with gonadotropin therapy

Answer 19

5%

Question 20

How does metformin work

Answer 20

Inhibits hepatic glucose production
Enhances insulin sensitivity

Question 21

Does metformin impact fertility rates

Answer 21

Yes some increase clinical pregnancy rate in those taking metformin

Question 22

Benefits of Lap ovarian drilling

Answer 22

No risk multiple pregnancy and OHSS
Good for those who fail to response to CC or hyper secret LH

Question 23

how LOD is it performed

Answer 23

4 diathermy points per ovary for 4 second at 40 wars

Question 24

What additional risks in pregnancy for patient with PCOS

Answer 24

GDM
PIH/PET
Adverse neonatal outcomes
preterm birth