POI

Question 1

Hallmark of autoimmune oophoritis

Answer 1

lymphocytic infiltrates around secondary and antral follicles but not primordial follicles

Question 2

autoimmune causes

Answer 2

MG
SLE
Hashimoto’s Thyroiditis
Addison
APS Type I and II

Question 3

Genetic Causes

Answer 3

FMR1 premutation (Fragile X)
Mutation in short arm Xp and long arm Xq
Galactosemia
Turner Syndrome

Question 4

radiosensitivity of ovary

Answer 4

2gy (50% will survive)

6gy = dead

Question 5

chemotherapy

Answer 5

depletes ovarian reserve in a drug-dependent and dose-dependent manner

Question 6

high gonadal toxicity

Answer 6

cyclophosphamide
chlorambucil
melphalan
busulfan
procarbazine
nitrogen mustard

Question 7

worst chemo drug and MOA

Answer 7

alkylating agents ie cyclophosphamide - non-cell cycle specific. alters base pairs and breaks DNA

Question 8

moderate gonadal toxicity

Answer 8

cisplatin
adriamycin

Question 9

low gonadal toxicity

Answer 9

bleomycin
actinomycin
vincristine
methotrexate
5-flurouracil
taxanes

Question 9

Fertility preservation

Answer 9

Ovarian transposition
GnrRH agonist
OTC
Oocyte and embryo cryopreservation

Question 10

MOA of GnRH protection

Answer 10

decrease blood flow due to hypoestrogenism = less chemo to ovary
decrease number of primordial follicles damaged
direct effect to ovary = upregulation of intraovarian antiapoptoti factor or protection of germline stem cells

Question 11

MOA galactosemia

Answer 11

deficiency of GALT enzyme = toxocity of galactose metabolites on germ cell migration and survival

Question 12

resistant ovary syndrome/ savage syndrome

Answer 12

amenorrhea, hyper-hypo and resistant to high doses of exogenous gonadotropins
normal # of follicles