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Stage 3: EJR - Gynae > PCOS and ovulation induction > Flashcards

PCOS and ovulation induction Flashcards

1
Q

3 Diagnostic criteria of PCOS

A

2/3 features

  1. Oligomenorrhoea (>35 days apart)
  2. Hirsutism
  3. Polycystic ovaries on USS
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2
Q

What 3 hormone levels are changed in PCOS

A

++ LH (leading to peripheral insulin resistance)
++ INSULIN (leading to increased androgen production)
++ free ANDROGEN levels

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3
Q

What causes the formation of many small follicles in PCOS

A
  • Raised free androgen levels
  • Disruption of folliculogenesis
  • Excess poorly developed follicles
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4
Q

How are FSH and LH levels changed in PCOS

A

FSH is normal (would be raised in ovarian failure)

LH is raised

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5
Q

What other hormonal problem is associated with PCOS

A

T2DM

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6
Q

Why do women with PCOS have an increased risk of miscarriage

A

Why do women with PCOS have an increased risk of miscarriage

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7
Q

3 methods of ovulation induction in PCOS

A
  1. Clomiphene
  2. Metformin
  3. Laparoscopic ovarian diathermy
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8
Q

How does Clomiphene work

A

Blocks oestrogen receptors in hypothalamus and pituitary

Given at start of cycle -> initiates follicular maturation (which is thereafter self-perpetuating)

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9
Q

Complications of clomiphene

A

Can cause thin endometrium <7mm

leads to lower live birth rate

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10
Q

Benefits of metformin over clomiphene

A
  • Does not promote multiple ovulation
  • Also treats hirsutism
  • If continued during pregnancy, lowers risk of early miscarriage and development of gestational diabetes
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11
Q

2 methods of ovulation induction in hypothalamic hypogonadism

A
  1. Subcutaneous FSH and LH -> stimulate follicular growth

2. Continuous GnRH pump -> stimulate FSH and LH in a physiological manner

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12
Q

2 methods of measuring ovarian reserve before IVF

A
  1. Antimullarian hormone

2. Antral follicle count (USS measurement of no. of resting small follicles in ovaries)

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13
Q

2 complications of ovulation induction

A
  1. Ovarian hyperstimulation syndrome

2. Multiple pregnancy

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14
Q

Pathology of ovarian hyperstimulation syndrome

A
  • Gonadotrophin overstimulates follicles

* Follicles get large and painful

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15
Q

Risk factors for ovarian hyperstimulation syndrome

A
  • IVF
  • Gonadotrophin stimulation
  • Age <35 years
  • Previous OHSS
  • Polycystic ovaries on USS
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16
Q

Complications of ovarian hyperstimulation syndrome

A
  • Hypovolaemia
  • Electrolyte disturbances
  • Ascites
  • VTE
  • Pulmonary oedema

Stage 3: EJR - Gynae (12 decks)

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