SUB FERTILITY AND REPRODUCTIVE MEDICINE

Question 1

Hirsutism causes

Answer 1

idiopathic
PCO
androgen secreting tumors (ovaries/ adrenal)
late onset CAH

Question 2

hirsutism investigations

Answer 2

testosterone (ovaries and adrenal)
DHEAS (adrenal)
17ohp (CAH)
TVUSS
OGTT (hyperinsulinemia)

Question 3

reduced SHBG

Answer 3

hyperinsulinemia 
hyperprolactinemia 
hypothyroidism 
liver disease 
androgens

Question 4

hirsutism and menopause

Answer 4

eflornithine cream
spironolactone
cyproterone acetate + HRT
estradiol + drospirenone

Question 5

Rotterdam criteria for PCOS

Answer 5

2 out of the 3:

1) irregular/ anovulatory cycles (oligomenorrhea)
2) biochemical/ clinical hyperandrogegism (acne, hirsutism/ alopecia)
3) more than or equal to 12 follicles per ovary/ ovary volume more than 10 ml

Question 6

PCOS pathology

Answer 6

increased LH = 1. increased androgen secretion from theca cells= hirsutism and decreases liver SHBG production
2. increased estrogen from granulosa cells = unopposed estrogen (risk for endometrial hyperplasia)
anovulatory cycles= sub fertility and irregular bleeding
hyperinsulinemia= increases androgen production
genetic factors
obesity worsens insulin resistance (central obesity)

Question 7

PCO management

Answer 7

LIFESTYLE hirsutism= COCP
irregular menstruations COCP, metformin
sub fertility=
wt loss/ diathermy clomiphene/ GnRH analogues
±metformin

Question 8

infertility causes

Answer 8

anovulation
male problems  
tubal problems
unexplained 
endometriosis

Question 9

infertility investigations

Answer 9

anovulation mid luteal progesterone levels (more than 30) and hormone profile (LH, FSH, testosterone, thyroid(low), prolactin(high).
semen analysis
chlamydia screening hystersalpingography
laparoscopy (therapeutic)
karyotyping
cystic fibrosis in males

Question 10

semen analysis

Answer 10

volume more than 1.5 ml 
sperm count more than 15 million/ml 
morphology more than 4% normal 
total motility more than 40 %
progressive motility more than 32% 
abstinence from ejaculation 2-7 days prior 
if abnormal repeat after 3 months

Question 11

most common gynecological complaint amongst adolescences

Answer 11

dysmenorrhea

Question 12

hirsutism treatment

Answer 12

COCP 
medroxyprogesterone 
laser/ waxing 
spironolactone 
finasteride 
cyproterone acetate
flutamide 
eflornithine hydrochloride 
GnRH agonist 
ketoconazole

Question 13

ketoconazole in hirsutism

Answer 13

inhibits cytochrome p450