CC May 2016 Initial infertility evaluation for women

echoecho's version from 2016-08-24 03:25


Question Answer
Define infertility?unprotected heterosexual intercourse for a year without pregnancy
In women > 35 years of age, many recommend an infertility evaluation after ____ months due to decreased fecundity related to advancing age?6
Infertility is very common among couples in the US,a ffecting up to ____% of the population?15
What % of cases of infertility are due to male factors?What % are due to female factors? What % are due to idiopathic factors?40; 40; 20
Of the causes of female infertility, what % account for ovulation disorders? tubal factors? endometriosis? other factors?40; 30; 15;15
Inital evlauation of a women presenting with infertility focuses on what?1)detailed hx (general, gynecolic and obstetric) 2) careful physical exam
The hx provides important information regarding past _____?fertility
Other symptoms provide clues to underlying disorders should be considered, list these?1) weight gain and hirsuitism suggest PCOS 2) galactorrhea suggests prolactinoma
List comorbid conditions that affect fertility?1) thyroid disorders 2) diabetes
What does a hx of pelvic infections suggest as a cause of infertility?tubal cause
What conditions may indicate endometriosis?1) dysmenorrhea 2) dyspareuia
What should physical exam focus on?1) findings suggestive of secondary causes of anovulation (galactorrhea, hirsuitism)
What findings on pelvic exam may identify causes of infertility?1) tenderness on bimanual exam may suggest endometriosis or infection 2) tubal or ovarian enlargement suggests hydrosalpinx or PCOS respectively
Why is determining the ovulatory status usually thefirst step in evaluation of female infertility?because ovulation disorders account for 40% of all cases of female infertility
Compare ovulatory vs anovulatory cycles as to cycle length and bleeding pattern?1) ovulatory cycles (predictable cycle length and bleeding pattern) 2) anovulatory cycles (unpredictable cycle length and bleeding pattern)
Compare ovulatory vs anovulatory cycles as to PMS?1) ovulatory cycles (presence of PMS symptoms such as breast tenderness, dysmenorrhea) 2) anovulatory cycles (absence of PMS symptoms or breast tenderness)
Compare ovulatory vs anovulatory cycles as to basal body temperature curve?1) ovulatory cycle (biphasic basal body temperature curve or positive LH surge test) 2) anovulatory cycles (monophasic or triphasic basal body temperature curve)
Compare ovulatory vs anovulatory cycles as to cervical mucus?1) ovulatory cycle (change in cervical mucus) 2) anovulatory cycle (no predictable change in cervical mucus)
Compare ovulatory vs anovulatory cycles as to other signs?1) positive Mittelschmerz 2) positive LH predictor kit
List 4 recommended methods to evaluate ovulatory status? Which of the 4 is preferred?1) luteal phase progesterone level (preferred) 2) Luteinizing hormone (LH) predictor kits 3) endometrial biopsy 4)transvaginal US
Regarding the luteal phase progesterone level test, this provides a good measure of what when drawn at the correct time in the menstrual cycle, what is the correct time?1) ovulatory function 2) seven days prior to anticipatory menses
Regarding luteal phase progesterone level, what level indicates ovulation has occurred? If a women has prolonged, irregular cycles, the test should be done based on presumed _____ cycle, but may need to be repeated weekly until the next cycle starts?1) > 3-5 ng/ml 2) next
Regarding the luteinizing hormone (LH) predictor kits, are these found OTC? What do they measure? They provide indirect evidence of what?1) yes 2) measure urinary LH levels (the surge usually occurs 24-36 hours prior to ovulation) 3) ovulation and predict the time of highest fertility
Regarding an endometrial biopsy, this is performed in what phase of the cycle? Looking for what on the biopsy? Used in those patient where ______ pathology is of concern?1) luteal phase 2) secretory endometrium 2) endometrium
Regarding the transvaginal US, this is performed to look for what regarding the follicles? True or false, this is reserved as a first-line test?1) looks for size and number of follicles 2) false (reserved as a second-line test)
In the past, basal body temperature (BBT) was the primary means of assessing ovulation. However it no longer considered the best test. What does the NICE guidlines recommend?BBT monitoring is NOT recommended
*** Measuring a ____ level is recommended for women with ovulatory disorders? When is testing of thyroid function recommended?1) prolactin 2) when symptoms of thyroid dysfunction are present
Anovulation is classified into 3 groups, name them?1) Group 1 is characterized by hypothalamic-pituitary failure. Percentage is 10%. Hormone status is hypogonadotropic, hypoesterogenic. Examples are exercise-or stress related amenorrhea, anorexia nervosa, Kallman's syndrome) 2) Group II (dysfunction of the axis. Percentage is 85%. Hormone status is normogonadotropic, normoestrogenic. Examples are PCOS, thyroid abnormalities, prolactinoma) 3) Group III (primary ovarian dysfunction. Percentage is 5%. Hormone status is hypergonadotropic, hypoestrogenic. Example is primary ovarian failure)
If a women gives a hx of oligo- or amenorrhea and has characteristics that suggest group I anovulation (low body weight, high levels of exercisei), what would be the results of a FSH and estradiol test?1) FSH may be low or perhaps normal 2) estradiol may be low
Regarding PCOS, how is it diagnosed? What are the s/s?1) clinical dx 2) menstrual irregularity, clinical evidence of hyperandrogenism (hirsuitism) 3) exclusion of other causes
Many women with PCOS, also have _______ syndrome?metabolic
What 2 abnormalities also fall in the group 2 annovulation group?thyroid and prolactin abnormalities
Primary ovarian dysfunction (group III) is defined as what?cessation of menses prior to age 40 y.o.
What are the s/s of primary ovarian dysfunction?1) hot flashes 2) night sweats
What are the lab results of FSH and estradiol in primary ovarian dysfunction (group III)?1) HIGH FSH 2) low estradiol
The second most common cause of infertility is an anatomic abnormality, list examples of this?1) septate uterus 2) tubal occlusion due to PID 3) ectopic pregnancy 4) pelvic surgery 5) endometriosis
What radiologic procedure is recommended for women with infertily and NO identified comorbiditis (like endometriosis, hx of pelvice surgery or PID)?hysterosalpingogram (HSG)
Describe what a HSG hysterosalpingogram is?it is a radiologic procedure where dye is injected into the uterus allowing delineation of the anatomy of the uterus and fallopian tubes
Does HSG visualize the outer contours of the pelvic organs?no
What procedure is useful for identifying uterine abnormalities, though it does NOT visualize the tubes?sonohysterogram
What is Sonohysterogram?saline infused into the uterine cavity to r/o uterine abnormalities
What is the appropriateness criteria for using HCG to r/o tubal occlusion? to r/o endometriosis?9/9; 7/9
What is the appropriateness criteria ofr transvaginal US and MRI of the pelvis w/ or w/o contrast?8/9
*** For women with comorbidities, NICE guidelines state that ________ with dye should be offered so that tubal and other pelvic pathology can be assessed simultaneously?laparoscopy
Is CT recommended a part of an infertility evaluation?no
*** SUMMARY = Define infertility?unprotected heterosexual intercourse for a year without pregnancy
*** SUMAMRY = 40% of cases of infertility are due to male factors, 20% are idiopathic. What % are due to female factors?40%
*** SUMMARY = Of the causes of female infertility, what % are due to ovulation disorders, tubal factors, endometriosis, other factors?40%; 30%; 15%; 15%
*** SUMMARY = What is the first step in infertility evaluation?determining ovulatory status