REI Flashcards
Infectious contraindications to oocyte donation
Chlamydia or gonorrhea in the last 12 months
Hepatitis B, C
Treponemal positive syphilis
HIV
HSG with bilateral hydrosalpinx, management of infertility
bilateral salpingectomy then IVF
XY
Breasts (testosterone –> estradiol at puberty), no uterus
Tanner 1 pubic/axillary hair
Male testosterone level
Androgen insensitivity syndrome
46XX
Breasts, no uterus
Normal pubic/axillary hair
Normal female testosterone level
Mullerian agenesis
46XY
Uterus is present, no breast development
Delayed puberty
No gonads
Swyer syndrome
45X
Uterus is present, minimal breast development
No gonads, delayed puberty
Puberty can happen with mosaicism (45X/46XX)
Turner syndrome
Ejaculate is propelled into the bladder and the bladder neck fails to contract
Retrograde ejaculation
Treatment for retrograde ejaculation
Sympathomimetic agents (psuedoephedrine)
+/- parasympatholytic agents (imipramine)
To stimulate contraction of the bladder neck
Infertility management for insufficient sperm in the antegrade ejaculate
Retrograde sperm for IUI
How to collect sperm for retrograde IUI
Voided or cath sample
Alkalinize urine with oral acetazolamide, sodium carbonate, or potassium citrate
OR instill bladder with culture media, ejaculate, then void or cath specimen
Which treatment of pituitary adenoma is preferred in pregnancy?
Bromocriptine (both are safe, there’s just more data)
Patients that have better success after IVF with frozen embryo than fresh
PCOS
How do the rates of IVF with frozen vs fresh embryo differ (in patients without PCOS)
They’re similar
Most effective medical treatment of pituitary adenoma
Cabergoline
Testosterone and DHEAS values that are concerning for ovarian or adrenal tumor in premenopausal women
Testosterone >200
DHEAS >700
Severe form of PCOS
Overproduction of androgens by ovarian stromal cells
Progressive hirsuitism/hyperandrogenism after menopause
Treated with bilateral oophorectomy
Ovarian hyperthecosis
Contraceptive method shown to decrease the risk of ovarian cancer
Combined OCPs
Infertility management for endometriomas under 3cm
IVF
Preferred hormonal birth control in patients after bariatric surgery
IUD
Combined estrogen/progestin vaginal ring]
(OCPs may have worse absorption but better than nothing)
Most common cause of hyperandrogenism during pregnancy
Hyperreactio luteinalis
Bilateral cystic masses of the ovaries
Multiple gestation, GTN, CKD (reduced clearance of hcg)
Pathologic mechanism by which PID predisposes to ectopic pregnancy
Infection results in a loss of ciliated epithelial cells –> impaired intratubal transport of an embryo
The physiologic event that induces completion of the first meiotic division of the oocyte is the:
midcycle LH surge
LH surge causes:
- First meiotic division and creation of metaphase II oocyte
- Granulosa cells and outer theca cells start to favor progesterone over estrogen
- Progesterone receptor expression increases
- Follicle rupture and extrusion of the oocyte in 24-36 hours
When does second meiotic division of the oocyte take place?
Fertilization
Treatment of asymptomatic labial adhesions in prepuberty
Observation (spontaneously resolve with estrogen in puberty)
Treatment of symptomatic labial adhesions in prepuberty
Estrogen cream 1-2x per day for 2-6 weeks
Female sexual interest/arousal disorder diagnostic criteria
Must have 3 of 6 present for 6 months
- Absent or reduced interest in sexual activity
- Absent or reduced sexual thoughts or fantasies
- No or reduced initiation of sexual activity and seldom receptive to partner’s attempts
- Absent or reduced sexual excitement in sexual encounters
- Absent or reduced sexual interest/arousal to external cutes
- Absent or reduced genital or nongenital sensations during sexual activity
Most effective therapy for smoking cessation
Behavioral modification counseling
Stats table
DZ + DZ - T + a b E S - c d T
Sensitivity
a / (a + c)
Specificity
d / (b+d)
Risk associated with ICSI
Imprinting disorders
Monozygotic twinning
Cortisol in anorexia
Increased
Main reason to diagnose an manage central precocious puberty
To achieve appropriate adult height (concern for accelerated bone growth and closure of epiphyseal plates)
Size cutoff for following up on simple cyst in premenopausal patient
10cm
When should sperm sample be collected
72 hours of abstinence
WHO lower reference limits (5%ile) for sperm analysis
15million sperm per mL 39 million sperm per ejaculate 32% progressive motility 40% total motility 4% normal morphology 58% vitality 1.5mL of ejaculate
When to freeze oocytes in transgender patients
Prior to initiation of testosterone therapy
Stem cells that are used to treat Asherman syndrome are derived from
Bone marrow
Patient with PCOS and worsening hirsutism, lab test includes testosterone and
DHEAS
Can delay gonadectomy until after puberty
Androgen insensitivity syndrome
Gonadectomy in patients with 45X/46XY karyotype
Immediately (risk of gonadoblastoma)
Risk factors for opioid addiction
Younger age
Certain types of illicit drug use
Tobacco use
Psychiatric comorbidities (depression, etc)
Tests to perform with premature thelarche
Bone age
FSH, LH, estradiol
Ovulation induction in patients with hypogonadotropic hypogonadism
Urinary human menopausal gonadotropins
Why can’t anonymous sperm donors stay completely anonymous?
Direct-to-consumer genetic testing
Nonhormonal options for vasomotor symptoms
SSRI
Clonidine
Gabapentin
single catastrophic event that results in extensive locally clustered genomic rearrangements and an oscillating pattern of DNA copy number levels, all curiously restricted to one or a few chromosomes
Chromothripsis
how fibroids happen
Must evaluate before attempting pregnancy with donor eggs
Uterine cavity (HSG, sonohysterography, etc)
Most common chromosomal abnormality causing azospermia
47XXY
Tubal ligation risk of regret age cutoff that was studied
30
Uterine artery embolization for fibriods causes highest risk of
Miscarriage Preterm delivery Malpresentation Postpartum hemorrhage (Myomectomy has higher risk of uterine rupture)
Fecundability rate in one year
90%
How many weeks after fertilization does neural tube form
3-4
Fecundity declines significantly at what age
32
What days of menstrual cycle constitutes window of implantation of the human embryo
20-24
Side effects of spironolactone
Vomiting
PMB
Dizziness
Mastalgia
What muscle overlies the sacrospinous ligament
Coccygeus
Main support to the vagina
Uterosacral ligament
