RPL, infertility

Question 1

Fetal demise

Answer 1

Fetus with cessation of cardiac activity after 10 wga

Question 2

Early pregnancy loss

Answer 2

Non-viable IUP prior to 13 wga

Question 3

Criteria for pregnancy loss

Answer 3

1. CRL >7 mm with no heart beat
2. Mean sac diameter > 25 mm and no embryo
3. Absence of embryo with heartbeat > 2 wks after gestational sac without yolk sac
4. Absence of embryo with heartbeat > 11 days after gestational sac with yolk sac

Question 4

Antibiotic ppx for MVA

Answer 4

Docycycline 200 mg x 1 dose

Question 5

Prevalence of miscarriage

Answer 5

12-15% of pregnancy

Question 6

Most common etiology of RPL

Answer 6

Unexplained, chromosomal abnormality (90% of these aneuploidy or polyploidy)

Question 7

Anatomic abnormalities that can lead to RPL

Answer 7

Congenital uterine anomalies, fibroids, endometrial polyps, intrauterine adhesions

Question 8

Most common uterine anomaly that leads to miscarriage

Answer 8

Septate uterus

Question 9

What to do next if you diagnose a unicornuate uterus

Answer 9

Urologic evaluation

Question 10

Best-linked infectious causes for RPL and treatment

Answer 10

Ureaplasma and mycoplasma; 2 weeks of azithro, erythro, or doxy

Question 11

Can empiric progesterone or ASA treat RPL of unknown cause?

Answer 11

Nope

Question 12

Testing recommended for RPL

Answer 12

Karyotype POC and both partners, TVUS, HSG / sonohyterography, APS, TSH

Question 13

Monthly pregnancy rate for average, normal couple

Answer 13

25% (20% live birth)

Question 14

Most common causes of infertility

Answer 14

Male (35%), tubal and pelvic (35%), ovulatory (15%), unexplained (10%), other (5%)

Question 15

What to do if HSG shows hydrosalpinx

Answer 15

Doxy 100 mg BID x 5 days

Question 16

Normal semen analysis

Answer 16

Volume 1 mL or more
Concentration 15 mill/mL or more
Motility 40% or better
Morphology at least 4% normal

Question 17

Length of spermatogenesis

Answer 17

3 months

Question 18

Mechanism of letrozole

Answer 18

Aromatase inhibitor, inhibits estrogen production which decreases negative feedback to hypothalamus and pituitary

Question 19

Mechanism of clomiphene citrate

Answer 19

SERM, blocks estrogen at hypothalamus and pituitary to decrease negative feedback

Question 20

Risk of multiples with ovulation induction

Answer 20

~10% (<0.5% are triplets)

Question 21

Side effects of ovulation induction

Answer 21

Headache, hot flashes, mood changes, rare visual changes (all due to anti-estrogen)

Question 22

Mechanism of gonadotropins in ovulation induction

Answer 22

Recombinant FSH is given to induce ovulation directly

Question 23

Abdominal distension, pain, nausea, SOB, hemoconcentration, renal failure, DVT related to IVF

Answer 23

Ovarian hyperstimulation syndrome

Question 24

Treatment for ovarian hyperstimulation syndrome

Answer 24

Supportive: fluids, DVT ppx
Prevent: leuprolide trigger

Question 25

Standard tests for infertility evaluation

Answer 25

HSG, US, sonohysterogram, mid-luteal progesterone, semen analysis, TSH, prolactin, day 3 FSH + estradiol, AFC, AMH