Week 4: Infertility

Question 1

Definition of infertility

Answer 1

Failure to conceive despite 12 months of frequent intercourse without contraception

Question 2

What is the most appropriate test for amenorrhea?

Answer 2

Progestin challenge

Question 3

Question

Question 4

Question

Question 5

Question

Question 6

2 questions

Answer 6

Question 7

What is IUI

Answer 7

Intrauterine insemination

Question 8

Question

Answer 8

Question 9

Question

Question 10

What is PCOS

Answer 10

Question 11

Question

Question 12

Question

Question 13

Question

Question 14

What is Clomiphene?

Answer 14

Question 15

Question

Question 16

Letrozole

Answer 16

Question 17

Letrozole and failure to ovulate

Answer 17

Question 18

Letrozole failure to ovulate and IVF

Answer 18

Question 19

What is IVF?

Answer 19

Question 20

Question

Question 21

ART success rates

Answer 21

Question 22

Question

Question 23

Definition of infertility

Answer 23

Question 24

Describe management options for infertility

Answer 24

Question 25

Ethical issues confronted by patients w/ infertility

Answer 25

Question 26

Genetic screening and testing on infertility associated treatments

Answer 26

Question 27

Progestin challenge

Answer 27

The progestogen challenge test, or progesterone withdrawal test, is a test used in the field of obstetrics and gynecology to evaluate a patient who is experiencing amenorrhea. Due to readily available assays to measure serum estradiol levels, this test is now rarely used.[1]

The test is performed by administering a progestogen, such as progesterone either as an intramuscular injection or oral medroxyprogesterone acetate (Provera). If the patient has sufficient serum estradiol (greater than 50 pg/mL), withdrawal bleeding should occur 2-7 days after the progestin is withdrawn, indicating that the patient’s amenorrhea is due to anovulation. However, if no bleeding occurs after progesterone withdrawal, then the patient’s amenorrhea is likely to be due to either a) low serum estradiol (i.e. premature ovarian failure), b) hypothalamic-pituitary axis dysfunction (such as low GNRH or low FSH that lead to low estrogen level ) , c) a nonreactive endometrium, or d) a problem with the uterine outflow tract, such as cervical stenosis or uterine synechiae (Asherman’s syndrome). In order to distinguish between hypoestrogenism or a uterine outflow tract problem/nonreactive endometrium, estrogen may be administered followed by a course of progestin in order to induce withdrawal bleeding. If the patient experiences withdrawal bleeding with the combined estrogen/progestin therapy, then the amenorrhea is likely due to low estrogen