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11 Cards in this Set

  • Front
  • Back
% of reproductive age women who will get endometriosis:

What % of pelvic pain and infertility patients have endometriosis?

Pain results from:
3-10%

5-20% pelvic pain, 20-40% infertility

stimulation of implants from E/P, fribrous peritoneum prevents blood from escaping, pain from inflammation, pressure, adhesions, relationship to nerves
Major S/S of endometriosis:

PE findings:

Imaging study to better evaluate adenomyosis:
may be asymptomatic
chronic pelvic pain, dysmenorrhea, mentrual pain, dyspareunia, infertility

often normal
tender cul-de-sac, uterosacral ligament tenderness, fixed/retroverted uterus, adnexal masses

MRI
Gold standard of eval:

Relationship of pain to size of masses:

Classic appearance of endometriosis:

non-classical appearance:

50% of endometriomas are located where?
laparoscopy w/ biopsy/confirmatory histo

no correlation

red spots, dark blue, black, brown, "powder burns", cystic

clear vesicles, white/yellow spots, nodules, "pockets"

ovaries
Non-surgical tx:
What should you be careful of?
Pain meds?
Effect of OCP's?

Effect of Danazol?
avoid, be careful of narcotic use
use NSAID's, PG inhibitors
use continuous OCP's - 6-12 mo., no placebos - can result in decidual changes in tissue, but is NOT curative

inhibits gonadotropin release at hypothal - no FSH/LH surge, hypoestrogenic effect - prevents endometrial growth
What is leuprolide?

Why do you need to limit its use?

Conservative surgical tx?
GnRH agonist - continuous administration suppresses gonadotropin release

limit 6 months - hypoestrogenic effects - add norethindrone, can extend use to 1 year

lyse adhesions, remove all endometriomas - restore anatomy, laparoscopically
When should you use definitive surgical management?
severe disease, S/S
complete child bearing
failed conservative management
Define infertility:

% US couples affected:

Three circumstances to check after 6 months:

Two major etiologies:
inability to achieve pregnancy after 12 months of unprotected sex

10-20%

advanced age, irregular cycles, high risk populations

sperm disorders, ovulation disorders
Pertinent male PE findings:

female PE findings:

Normal ranges for sperm eval:
penis deformities, testicular descent, testicular size (mass)?, vericocele, hydrocele

thyroidmegaly, mass; abd/pelvic mass/tenderness, uterine immobility, enlargement, uterosacral nodules, tenderness, cervical abnormalities

count - >20 million/mL
motility - >50%
morphology - >60% normal
Explain the luteal phase defect:

gold standard for dx:

Reasonable initial screening test:
insufficient progesterone effect on uterine lining

endometrial biopsy, >2 day difference between dating by pathology and time of ovulation

hysterosalpingogram
Basic workup guidelines:

When should you jump to the HSG/laparoscopy?

What drug can initiate ovulation?

Effect of metformin?

ASRM guidelines for ART:
don't over test, W/U can usually be done over 2-4 cycles, time tests appropriately

After normal sperm counts/ovulation

Clomid - clomiphene citrate

increases ovulation rate

no more than 2 embryos tx'ed in patients <35 y/o
4 types of ART:
IVF - in vitro
GIFT - gamete intrafallopian tx
ZIFT - zygote intrafallopian tx
ICSI - intracytoplasmis sperm injection