Endocrine Tbl10 Pcos/infertility

Front 1

Potential mechanisms of PCOS (3)

Back 1

1)endocrine disturbance from inappropriate secretion of gonadotropins (LH) from the pituitary
2)endocrince disturbance from defective sex steroid syn or metabolism
3)metabolic disorder that results from a defect in insulin axn or signal transduction leading to insulin resistance and hyperinsulinemia

Front 2

Intro PCOS (2)

Back 2

1)most common endocrinopathy in premoenopausal women (6-10% of em)
2)leading cause of infertility due to ovulatory dysfxn

Front 3

Characteristics FINDINGS of PCOS (2) and how are these found

Back 3

1)bilaterally enlarged ovaries (ovarian vol over 10mL)
2)12 or more follicles in each ovary measuring 2-9cm in diameter

1)transvaginal ultrasound

Front 4

PCOS Clinical Characteristics (5)

Back 4

1)menstrual dysfxn, ovulatory dysfxn, infertility
2)hyperandrogenism
3)insulin resistance
4)obesity
5)acanthosis nigricans (AN)

Front 5

Menstrual dysfxn, ovulatory dysfxn, infertility in PCOS (7)

Back 5

1)see oligomenorrhea/amenorrhea in 70% (oligo= less than 9 periods per year; ameno=no periods for 3+ months)
2)usually begins within first few years of puberty
3)periods are anovulatory causing heavy bleeding and incr risk of endometrial hyperplasia
4)ovulatory dysfxn causes infertility
5)miscarriages in 1st trimester in 50% of women (due to incr LH)
6)recurrent miscarriages
7)will take longer time to conceive and have fewer kids

Front 6

Hyperandrogenism in PCOS includes... (3)

Back 6

1)hirsutism
2)acne
3)alopecia

Front 7

Hirsutism and PCOS (4)

Back 7

1)excess growth that is coarse, stiff, pigmented and long
2)distributed in male like pattern (upper lip, nipples, chest hair)
3)more common on blacks and less in asians
4)impact ONLY on self-esteem and appearance

Front 8

Acne and PCOS
a)2 things
b)hormonal evaluation for acne is indicated (to rule out PCOS) if: (4)

Back 8

1)commonly occurs in teenage years
2)young women w/ polycystic acne have high incidence of PCOS

b1)acne is recalcitrant to supportive dermatological therapy
b2)there is early onset b4 age 9
b3)there is presence of severe cystic acne even in early teen yrs
b4)persistent acne into late teens or 20+

Front 9

Alopecia and PCOS (1)

Back 9

1)scalp hair loss in crown area (frontal hairline is intact)

Front 10

Insulin resistance and PCOS
a)happens in...
b)results in COMPENSATORY hyperinsulinema which yields: (3)
c)clinical findings suggestive of insulin resistance: (4)

Back 10

a1)happens in obese and non-obese women

b1)inappropriate LH production in pituitary
b2)incr androgen secretion by ovary, adrenal gland, liver
b3)long term effects: impaired glc tolerance, DM2 (w/ earlier age of onset), hyperlipidemia, incr in GDM

c1)BMI over 27
c2)waist to hip ratio (WHR) over 0.8
c3)waist over 40in
c4)acanthosis nigricans (AN)

Front 11

Obesity and PCOS (7)

Back 11

1)BMI at or over 30
2)fat dist. in android pattern (WHR over 0.8)
3)will have normal wt until after menarche
4)sig wt gain in mid-teens and incr more in late teens/early 20's
5)most common in hispanic, black, whites; least common in asians
6)obesity will contribute to hyperandrogenism and infertility
7)obestiy has synergistic deleterious effect on glc tolerance and insulin sensitivity

Front 12

Acanthosis Nigricans and PCOS (3)

Back 12

1)epidermal hyperplasia
2)characterized by brown/gray hyperpigmented, velvety, occasionally verrucous skin
3)on neck, submammary, umbilicus, vulva, groin

Front 13

Intermediate and long-term consequences of PCOS (from most to least common) (7)

Back 13

1)infertility
2)recurrent miscarriages
3)depression/anxiety
4)hyperlipidemia
5)DM2
6)CAD
7)endometrial cancer

Front 14

Dx of PCOS (3) and etiologies that must be exclused (3)

Back 14

2 of 3 criteria reqd to make dx
1)oligo-ovulation or anovulation
2)clinical and/or biochemical s/sx of hyperandrogenism
3)polycystic ovaries (by ultrasound)

1)Cushing's
2)hyperprolactinemia
3)adrenal hyperplasia

Front 15

Tx goals of PCOS (6)

Back 15

1)block axns of androgen on target tissues
2)reduce insulin resistance and hyperinsulinemia
3)correct anovulation and improve fertility
4)wt reduction
5)prevent long-term complications
6)tailor therapy to pts clinical presentation and desire for pregnancy

Front 16

Wt Reduction in PCOS
a)mechanism
b)primary benefits (4)

Back 16

a)diet/exercise, wt reduction and relieve obesity-related hyperinsulinemia

b1)global improvement in CV risks
b2)improves insulin sensitivity
b3)decr hyperandrogenism
b4)improves menstrual regularity and ovulatory fxn

Front 17

Wt Reduction in PCOS
a)additonal benefits (4)
b)clinical efficacy (3)

Back 17

a1)improves body image
a2)reduces depression
a3)restores a sense of control
a4)improves lipids

b1)10-15% wt loss = sig decr in hyperandrogenism and restored spontaneous ovulation/fertility
b2)5% wt loss = normal cycles and decr insulin resistance and decr in hirsutism/acne
b3)exercise is independently effective in improving insulin sensitivity

Front 18

Wt Reduction in PCOS place in therapy (4)

Back 18

1)diet/exercise are first-line therapies for obese women in PCOS
2)should be used b4 resorting to medications******
3)used adjunctively, improves reproductive outcomes of all fertility tx's
4)most efficient, cost-effective, safe way to control obesity, hyperinsulinemia, restore fertility

Front 19

Hair Removal in PCOS
a)options (3)
b)place in therapy

Back 19

a1)OTC (shave, pluck, wax)
a2)Eflornithine cream (Vaniqa)--- BID to affected area of face/neck-- will slow hair growth
a3)excess hair follicles remain for atleast 3months following tx and should be removed by mechanical means

b)may be used alone or in combo w/ pharma therapy

Front 20

COMBO OC's and PCOS
a)MOA
b)primary benefits (3)

Back 20

a)suppression of LH = reduction of plasma androgens, incr in hepatic SHBG, inhibits 5-alpha reductase and androgen receptor binding

b1)suppresses hyperandrogenism (MOST EFFECTIVE MEANS)
b2)tx acne/hirsutism
b3)restores menstrual regulariy and prevents endometrial hyperplasia

Front 21

COMBO OC'S and PCOS
a)clinical efficacy (2)
b)product selection and dosing (4)

Back 21

a1)gets rid of hirsutism/acne(70% success but takes 8months)
a2)restores menstrual regularity

b1)Combo OC
b2)daily for 21days every month
b3)estrogen component: should be low dose (less than 35mcg of ethinyl estradiol)
b4)progestin component: use low to non-androgenic progestin

Front 22

Low to Non-androgenic Progestin's to use w/ PCOS (4)

Back 22

1)desogestrel
2)norgestimate
3)norethindrone
4)drospirenone

Front 23

COMBO OC's place in therapy w/ PCOS (2)

Back 23

1)first line in women who do NOT want pregnancy for tx of hyperandrogenism, acne, hirsutism
2)used alone or in combo w/ anti-androgen (combo may be necessary for mod to severe cystic acne, hirsutism, alopecia)

Front 24

Hirsutism and PCOS
a)medication
b)MOA (2)
c)benefits (2)

Back 24

a)Spironolactone

b1)aldosterone antagonist/diuretic
b2)inhibits steroidogenesis

c1)suppression of hyperandrogenism
c2)tx of hirsutism

Front 25

PCOS and Spironolactone
a)dosing (3)
b)clinical efficacy (2)

Back 25

a1)initiate at 100mg/d in BID intervals
a2)and incr by 25mg/d increments every 3months based on response/ADRs
a3)max dose is 200-300mg/d

b1)reduce hair growth by 40-88% in 6-12months
b2)combo w/ OCs is very effective since each act in different mechanism

Front 26

PCOS and Spironolactone ADRs (5)

Back 26

1)polymenorrhea (can reduce bleeding by adding OCs or decr dose of Spironolactone)
2)hyperkalemia (rare w/ normal renal fxn)
3)pregnancy cat C (possible teratogenic and contraception should be used and dc use if become pregnant)
4)diuretic effect
5)light headed

Front 27

PCOS and Spironolactone place in therapy (2)

Back 27

1)SECOND line option for hirsutism (ie in pts w/ CI to OCs)
2)often used in combo w/ OC's from mod to severe cystic acne, hirsutism, alopecia

Front 28

Improved insulin sensitivity in PCOS
a)drug
b)MOA (2)

Back 28

a)metformin

b1)enhances peripheral tissue sensitivity to insulin
b2)inhibits glc production

Front 29

Metformin and PCOS
a)primary benefits (4)
b)clinical efficacy (4)

Back 29

a1)reduce hypersinsulinemia and insulin resistance
a2)facilitate wt loss
a3)suppress hyperandrogenism
a4)improve menstrual regularity and ovulatory fxn

b1)good in lean and obese anovulatory women w/ insulin resistance
b2)8X incr in spontaneous ovulation
b3)decr in 1st trimester miscarriages (from 70% to 10%)
b4)hyperandrogenism relieved

Front 30

Metformin and PCOS
a)predictors of clinical response to metformin (3)
b)dosing (2)
c)place in therapy

Back 30

a1)higher plasma insulin
a2)lower serum androstenedione
a3)less severe menstrual adnormalities

b1)initiate at 500mg po QD
b2)max is 500-850mg po TID

c)1st line pharma tx option in women who are obese or have insulin resistance

Front 31

SECOND line tx for insulin resistance and PCOS
a)drug
b)MOA

Back 31

a)TZD's
b)decr insulin resistance by improving sensitivity to insulin in muscle/adipose via inhibiting hepatic gluconeogenesis

Front 32

TZD's and PCOS
a)primary benefits (3)
b)efficacy (3)

Back 32

a1)incr insulin sensitivity w/o sig wt changes
a2)restore ovulation in obese women
a3)reduces androgen excess

b1)improved insulin sensitivity/hirsutism/ovulation
b2)restoration of menstrual regularity
b3)decr in LH and LH/FSH ratio

Front 33

Tx of infertility in PCOS
a)drug
b)benefits/MOA
c)efficacy (2)

Back 33

a)Clomiphene (Clomid)

b)induce/facilitate ovulation

c1)ovulation in 50-80% and pregnancy in 35-50%
c2)clomiphene is more effective than metformin in achieving pregnancy

Front 34

Clomiphene and PCOS
a)dose/admin (2)
b)place in therapy

Back 34

a1)start @ 50mg qd for 5 days a month
a2)range in 50-150mg daily for 5 days a month

b1)FIRST LINE in pharmacologic treatment option for ovulation induction in women w/ PCOS

Front 35

SECOND line med for tx of infertility in PCOS
a)drug
b)benefits/MOA

Back 35

a)Follitropins (LH/FSH)
b)induce/facilitate ovulation

Front 36

Follitropins (FSH/LH)
a)clinical efficacy (3)
b)dosing
c)ROA

Back 36

a1)pregnancy in 70%
a2)pure/recombo FSH is of particular benefit in women w/ PCOS who have incr LH to FSH ratio
a3)recruits fewer follicles resulting in lower risks of OHSS and multiple gestations (under 6%)

b1)low doses appears equally effective to higher doses in terms of pregnancy rates

c)SC/IM*****

Front 37

Def:
a)infertility
b)primary infertility
c)secondary infertility
d)unexplained infertility

Back 37

a)inability to carry/conceive pregnancy to live birth after 1yr of frequent contraception free sex

b)couple has never conceived a child

c)couple has previously conceived a kid and is unable to achieve another

d)couple undergoes a complete infertility eval and it does NOT detect any abnormalities

Front 38

Epidemiology of infertility (3)

Back 38

1)1 of 10 couples of reproductive age experience some degree of infertility
2)increasing incidence due to more women delaying pregnancy til later in life and incr incidence of PID
3)sig reduction in pregnancy rates for women ages 35-39 and even further reduction over 40yo

Front 39

Male Infertility
a)% of all causes of infertility
b)3 main causes

Back 39

a)40%

b1)testicular disease
b2)hypothalamic-pituitary disease
b3)post-testicular disease (disorder of sperm transport)

Front 40

Testicular disease causes (6)

Back 40

1)azospermia/oligospermia
2)incr scrotal temperature
3)immunologic (anti-sperm Ig's)
4)meds (CCBs, chemo, steroids)
5)substance abuse (alcohol, tobacco, weed)
6)90% of cases or idiopathic

Front 41

Female Infertility
a)% of cause of infertility
b)causes (6)

Back 41

a)40-50%

b1)ovulatory dysfxn
b2)luteal phase defect
b3)fallopian tube or pelvic abnormalities
b4)endometriosis
b5)uterine anomalies, polyps, fibroids
b6)cervical abnormalities

Front 42

Causes of ovulatory dysfxn (2)

Back 42

1)anovulation or oligoovulation is most common cause of female infertility (50% of cases)
2)may be related to PCOS or disorders of hypothalamus, pituitary, ovarian, adrenal gland

Front 43

Unexplained fertility (% of cases)

Back 43

is 10-20% of cases

Front 44

Timing of infertility evaluation (6)

Back 44

1)after 12+ months of being unable to achieve pregnancy

2)do it after 6mon of inability to concieve if:
a)female is over 35 (b/c decr oocyte quality)
b)has hx of oligomenorrhea or amenorrhea
c)has uterine or tubual disease or endometriosis
d)male is known to be infertile

Front 45

Calendar method (fertility awareness methods) how to do it? (2)

Back 45

1)on a calender, record when menses begin
2)if regular menses ovulation can be predicted to occur 14d before the expected day of the next menstrual cycle

Front 46

Basal Body Temp (BBT) (fertility awareness methods) how to do it? (7)

Back 46

1)use BBT thermometer (requires measurement to nearest 0.1F)
2)take first temp on first day of menstrual cycle
3)take temp each morning upon waking b4 any activity or getting out of bed
4)chart temp on graph daily
5)temp will be lower b4 ovulation than after ovulation (97-98=follicular phase; over 98=luteal phase)
6)Nadir (atleast 0.1F lower than previous 6d) signals approach of ovulation
7)rise of 0.4-0.6F b/w 2 consecutive days = ovulation occured (occurs b/c of rise in progesterone after ovulation)

Front 47

Ovulation Prediction Kits (fertility awareness methods) how to do it? (5)

Back 47

1)like urine kits for pregnancy
2)test urine daily @ same time of day
3)tests urine for high LH signaling ovulation will occur within 36h
4)stop testing for the cycle after a (+) color change
5)read/follow instructions in each kit

Front 48

Lifestyle mods to incr fertility (3)

Back 48

1)quit smoking/drinking
2)wt reduction in obese women (BMI over 29=decr fertility)
3)avoid excess dieting/exercise (lead to menstrual irregularity)

Front 49

Meds that have (-) impact on fertility (3)

Back 49

1)NSAIDS/ASA can prevent release of oocyte to avoid before/around time of ovulation
2)marijuana impairs spermatogenesis
3)vaginal lubricants b/c of impaired sperm motility

Front 50

Pharmacologic therapy may be used to induce ovulation for: (2)

Back 50

1)natural conception
2)as part of IUI and ART protocols

Front 51

Pharmacologic therapy precautions in Infertility (4)

Back 51

1)use in women w/ anovulation or oligo-ovulation
2)meds only work if woman has ability to release LH/FSH and ovulate
3)meds do NOT improved quality of ovum
4)all are pregnancy risk cat X (so once meds are used confirm if pregnancy did/didn't occur)

Front 52

Clomiphene and Infertility
a)MOA (5)
b)therapeutic uses (2)

Back 52

a1)acts on hypothalamus where it binds to estrogen receptors
a2)blocks negative feedback of circulating estrogen levels
a3)leads to an incr in gonadotropin-releasing hormone, LH, FSH
a4)followed by promotion of follicular growth and maturation
a5)stimulates spermatogenesis in males

b1)tx of ovulatory dysfxn in women wanting pregnancy
b2)male infertility (off label)

Front 53

Clomiphene and Infertility
a)efficacy
b)place in therapy

Back 53

a)in anovulatory or oligo-ovulatory infertility, 80% will ovulate and 50% will become pregnant

b)FIRST LINE b/c is oral, less expensive and associated w/ fewer risks (multi births/OHSS)

Front 54

Clomiphene and Infertility
a)ADR's (5)

Back 54

a1)multiple gestations (8% get twins, less than 1% get triplets or more)
a2)hot flashes/mood swings due to anti-estrogen effects
a3)n/v
a4)floaters/color changes (visual changes)---call MD and consider dc
a5)OHSS is rare

Front 55

Clomiphene and Infertility
a)dosing (6)

Back 55

a1)50mg qd for 5 days starting on 5 day cycle (following spontaneous or stimulated menses)
a2)if ovulation is NOT achieved, incr dose to 100mg next cycle
a3)stimulated menses (w/ OC's or 5-10d of progesterone) may be reqd for anovulatory women
a4)may combine w/ hCG to trigger ovulation if ovulation doesn't occur w/ clomiphene (given when follicle is over 18mm in diameter)
a5)once ovulation achieved, attempt conception for 3-6cycles w/o further dose incr
a6)OVER 90% of pregnancies w/ clomiphene occur within 6 cycles, CLOMIPHENE FAILURE if pregnancy does NOT occur within this time*****

Front 56

Timing of Attempted conception w/ Clomiphene (2)

Clomiphene resistance (2)

Back 56

a1)timed according to results of ovulation prediction kit
a2)OR sex every 48h for 1wk starting every 5d after last day of clomiphene

b1)lack of response/ovulation to max dose
b2)if no ovulation @ max dose, choose alternative tx

Front 57

Follitropins and Infertility
a)MOA (3)
b)therapeutic uses (3)
c)efficacy

Back 57

a1)FSH stim development/maturation of ovarian follicles
a2)LH cause ovulation, stim development of corpus luteum
a3)LH stim spermatogenesis in males

b1)tx of ovulatory dysfxn in women wanting to get pregnant WHEN CLOMIPHENE FAILS
b2)induce ovulation and stimulate multiple follicular development for ART protocols
b3)male infertility (off label)

c)99.9% ovulation rates; 45-90% pregnancy rates

Front 58

Follitropins formulations (3)

Back 58

1)Urinary human menopausal gonadotropin (hMG)
2)Highly purified Urinary FSH (HP-FSH)
3)Recombinant FSH

Front 59

Urinary human menopausal gonadotropin (hMG)
3 things about it and 2 drug names

Back 59

1)contains equal amts of LH/FSH
2)natural product that has potential for batch to batch inconsistency, impurities, demand exceeding supply
3)injected IM

Repronex
Menopur

Front 60

Highly Purified Urinary FSH (2 things about it and one drug name)

Back 60

1)derived from urine of postmenopausal women w/ same disadvantages of hMG
2)injected SC (less painful and better tolerated than IM)

Bravelle

Front 61

Recombinant FSH (4 things and 2 drug names)

Back 61

1)produced from human recombinant DNA
2)pharmacokinetically similar to HP-FSH
3)good if dermatologic/allergic rxn occur w/ natural products
4)injected SC (less painful and better tolerated than IM)

Gonal-F
Follistim

Front 62

Dosing/admin of Follitropins (6) IN INFERTILITY

Back 62

1)initially 50-150IU FSH daily beginning on day 3 or 5 of cycle
2)low dose step up: start at 50-75IU and titrate up
3)high dose step down: start @ 150IU and titrate down
4)admin daily until follicular development achieved (measure by serum estradiol b/w 500-2000pg/mL AND 1 or 2 follicles having reached diameter of 17-20mm per ultrasound)
5)FSH therapy can suppress LH surge so exogenous stim w/ hCG therapy may be necessary for ovulation to occur
6)withhold therapy and conception not attempted if ovaries are abnormally enlarged or estradiol over 2000

Front 63

Follitropins
A)ADRs IN INFERTILITY (6)
b)place in therapy

Back 63

1)OHSS risk are sig and dose-related
2)25% of twins; 5% triplets or more
3)febrile rxns
4)rash/swelling @ injexn site
5)n/v/d
6)breast tenderness

b)SECOND LINE to clomiphene due to higher cost, close monitoring, higher risk of OHSS, multiple gestations

Front 64

hCG in Infertility
a)MOA (3)
b)products (2)
c)place in therapy

Back 64

a1)hCG is a substitute for LH to stimulate ovulation
a2)hCG is identical to LH except has longer half-life
a3)in males it stim's production of gonadal steroid hormones by causing androgen production in testes

b1)uniary hCG
b2)recombinant hCG (Ovidrel)

c)adjunct tx for ovulation induction

Front 65

hCG in Infertility
a)therapeutic use (3)
b)ADR's (4)

Back 65

a1)adjunct to induce ovulation in women w/ ovulatory dysfxn who want to get pregnant
a2)adjunctive therapy to induce ovulation as part of an ART protocol
a3)male infertility (off label)

b1)OHSS risk
b2)HA
b3)irritability
b4)gynecomastia

Front 66

hCG in Infertility
a)dosing (5)

Back 66

a1)5,000-10,000IU IM or 250mcg SC as a single dose
a2)when using w/ clomiphene give 3-4 days after last clomiphene dose

a3)when using w/ follitropins
i)give 1 day following adequate follicular development (diameter is 10-20mm by ultrasound)
ii)withhold if over 3 follicles mature together

Front 67

LH in Infertility
a)MOA
b)product
c)place in therapy
d)therapeutic use

Back 67

a)stimulates ovulation
b)Lutorpin alfa (recombo LH) (Luveris)
c)adjunct for ovulation production in pts w/ LH deficiency
d)adjunct to recombo FSH for women w/ LH deficiency (LH under 1.2)

Front 68

GnRH Antagonists in Infertility
a)MOA (3)
b)place in therapy

Back 68

a1)GnRH antagonists suppress the LH surge that causes ovulation
a2)effects are reversible upon dc
a3)allows for controlled ovarian stimulation

b)3rd line

Front 69

GnRH Antagonists in Infertility
a)therapeutic use
b)products (2)
c)dose

Back 69

a)adjunct to prevent premature LH surge and premature ovulation in women undergoing controlled ovarian hyperstimulation

b)Ganirelix
b)Cetrorelix (Cetrotide)

c)0.25mg/d SC starting on day 5 or 6 (after follitropin therapy) and cont until hCG given

Front 70

ART? (4) (ASSISTED REPRODUCTIVE TECHNOLOGY)

Back 70

1)retrieval of oocytes from the ovary and manipulation of sperm and/or embryos to achieve pregnancy
2)allows for selection and manipulation of oocytes and sperm
3)may use donor oocytes and/or sperm
4)if woman over 40yo and no success in 3 cycles, donor oocytes are recommended

Front 71

Adjunctive use of meds in ART (2)

Back 71

1)progesterone assists in sustaining endometrium
2)superovulation to stim multiple follicle development: follitropins w/ or w/o hCG/LH and GnRH antagonists

Front 72

ART place in therapy (2)

Back 72

1)1st line for severe male infertility and female infertility due to severe tubal disease, cervial factors, or endometriosis
2)last line for ovulatory dysfxn infertility in women

Front 73

Brand name of hMG (urinary human menopausal gonadotropin--follitropin)

Back 73

Repronex
Menopur

Front 74

Brand name of HP-FSH (Purified FSH)

Back 74

Bravelle

Front 75

Recombinant FSH brand name

Back 75

Gonal-f
Follistim

Front 76

Recombinant hCG brand name

Back 76

Ovidrel

Front 77

IM Infertility drugs (2)

Back 77

1)hMG
2)hCG (human chorionic gonadotropin)

Front 78

SC infertility drugs (3)

Back 78

1)Bravelle (HP-FSH)
2)Gonal-f/Follistim (Recombinant FSH)
3)recombo hCG (Ovidrel)

Front 79

Prevetion of OHSS (3)

Back 79

1)limiting # of recruited follicles
2)aspirating some of the follicles b4 ovulation
3)withhold hCG until estradiol levels decrease

Front 80

OHSS (Ovarian Hyperstimulation Syndrome)
a)occurs from...
b)occurance is correlated to... (4)

Back 80

a)excessive response to FSH/LH causing production of a large # of follicles (over 20) and the resulting rise in estrogen production

b1)# of follicles recruited
b2)estradiol level
b3)use of hCG as a trigger
b4)greatest incidence associated w/ higher follitropin doses

Front 81

Complications of OHSS (7)

Back 81

1)multiple gestation
2)miscarriage
3)prematurity
4)low birth wt
5)placental abruption
6)GDM
7)LIFE THREATENING (potentially)

Front 82

Infertility is defined as the inability to conceive after freq. contraception free intercourse for...

Back 82

1yr

Front 83

most common cause of infertility in female is...

Back 83

ovulatory dysfxn

Front 84

What is a criterion for earlier eval and tx of infertility

Back 84

female has hx of oligomenorrhea

Front 85

Name a product that can impair male sperm production

Back 85

weed

Front 86

1st line pharmacologic for a woman w/ infertility dysfxn

Back 86

clomiphene

Front 87

This acts like LH to stim ovulation and may be used adjunctively w/ clomiphene and gonadotropin therapy

Back 87

hCG

Front 88

Fertility treatments LEAST likely to result in multiple births of 3 or more kids

Back 88

clomiphene

Front 89

Which gonadotropin formulation is most effect in tx of infertility

Back 89

NONE all have similar efficacy

Front 90

Dx of PCOS is determined by 3 criteria

Back 90

1)oligo-ovulation
2)hyperandorgenism
3)ruling out other etiologies

Front 91

Best lab test to assess for insulin resistance in a woman w/ FCOS

Back 91

fasting glc-insulin ratio

Front 92

In PCOS the most commonly occuring clinical sign of hyperandogenism is...

Back 92

hirsutism

Front 93

In POCS obese and insulin resistant first line is...

Back 93

metformin

Front 94

role of bilateral ovarian wedge resection in tx of infertility in women w/ PCOS

Back 94

last-line tx option once pharm tx has failed

Front 95

Correct statement regarding use of fertility meds in POCS (as compared to general public)

Back 95

there is higher risk of OHSS

Front 96

If pt has had a DVT what to give for hirsutism?

Back 96

sprinolactone