REI

Question 1

Risk factors for development of OHSS? (8)

Answer 1

1. previous OHSS
2. Age <30
3. PCOS
4. high estradiol at trigger or rapidly rising serum estradiol
5. large # of small follicles during stim
6. use of bhcg rather than progesterone for luteal support
7. high AMH
8. large # of oocytes retrieved (>20)

Question 2

Tests for ovarian reserve?

Answer 2

AMH -
AFC - follicles 2-10mm
FSH - >14 is bad
Clomiphene challenge - give on d5-9, should have low FSH

Question 3

List 6 methods of secondary prevention of OHSS

Answer 3

1. metformin
2. coasting
3. cabergoline
4. cycle cancellation
5. freeze-all
6. eSET

Question 4

Treatment of mild-mod OHSS as outpatient

Answer 4

1. pain: tylenol +/- narcotics, NO NSAIDs
2. aggressive rehydration (2-3L/day), monitor UO
3. no vigorous exercise, intercourse
4. paracentesis, pleuracentesis, culdocentesis prn
5. daily communication re weight, abdomen circ.
6. r/o S/S of severe/critical OHSS (SOB, calf pain, neuro deficits)

Question 5

What do you want to monitor in patient with OHSS?

Answer 5

weight, abdomen circumference
urine output, spec gravity
vital signs
Hb, hematocrit, Cr, lytes, albumin

Question 6

of oocytes @ 20 weeks? @ birth? @ puberty?

Answer 6

20 wks: 6-7million

birth: 1-2 million
puberty: 300,000-500,000

Question 7

2 factors affecting age of menopause

Answer 7

genetics, smoking

Question 8

At what age does the birth rate begin to decline?

Answer 8

35

:(

Question 9

Disorders associated with advanced paternal age

Answer 9

New single gene mutations
AD disorders: Alport, achondroplasia, neurofibromatosis
ASD
Schizophrenia
?T21

Question 10

Absolute CI for UAE?

Relative?

Answer 10

Absolute: uterine malignancy, pregnancy, PID, asymptomatic fibroids
Relative: wishing fertility, postmenopausal, pedunculate fibroids

Question 11

Where should incision be made on uterus to decrease adhesion risk after abdominal myomectomy?

a) anterior
b) posterior

Answer 11

a) anterior (57% rate vs. 94% with posterior)