5 - ovulation disorders

Question 1

what is done pre-treatment for infertility?

Answer 1

• stabilise weight
• lifestyle (smoking & alcohol)
• folic acid 5mg daily
• check prescribed drugs
• cervical smear
• rubella immune
• semen analysis

Question 2

what are the 4 types of ovulation disorders by FIGO classification?

Answer 2

type 1 = hypothalamic (low LH & FSH)
type 2 = pituitary (low LH & FSH)
type 3 = ovarian (high LH & FSH)
type 4 = PCOS

HyPO-P

Question 3

what is management of each FIGO problem (4 classes)?

Answer 3

(lifestyle for all!)

1. pulsatile GnRH (pump worn continuously) or gonadotrophin daily injections - hypothalamic
2. clomifene or citrate (anti-oestrogen triggering feedback, they try stimulate ovulation). If these unresponsive try metformin (reduces insulin resistance & androgens so can restore menstruation/ovulation). if all fails then FSH injections - pituitary
3. HRT or egg donation (premature ovarian insufficiency) - ovarian
4. just symptomatic relief - PCOS

Question 4

what is progesterone challenge test?

Answer 4

when you give progesterone to induce period

• if no bleeding = low oestrogen levels and uterine/endometrial abnormality

normally oestrogen produced before ovulation and causes growth & thickening of endometrium, after ovulation progesterone produced and does similar thing. when progestserone drops, the endometrial lining is shed causing period. if oestrogen levels not sufficient then endometrial lining won’t grow thick enough so when progesterone given and then drops then no period as not thick enough lining to shed. so low estrogen causes no bleeding in the progesterone challenge test because there is insufficient endometrial development to respond to progesterone withdrawal, preventing menstruation.

Question 5

what can cause premature ovarian insufficiency? (ovaries not working properly)

Answer 5

• menopause before 40
• genetic thing like turner syndrome (46XO)
• autoimmune ovarian failure
• bilateral oophrectomy
• pelvic radiotherapy or chemo

Question 6

what are the criteria for diagnosis of PCOS?

Answer 6

1. amenorrhea
2. polycystic ovaries (US)- 12-20 2-9mm follicles, increased ovarian volume
3. clinical or biochemical signs of hyperandrogenism (acne, hirsutism)

Question 7

what are some risks of ovulation induction?

Answer 7

ovarian hyperstimulation, multiple pregnancy, theoretical risk of ovarian cancer

Question 8

why is more pregnancies potentially bad?

Answer 8

= more complications

• hyperemesis
• anaemia
• higher risk of hypertension/pre-eclampsia, gestational diabetes
• delivery problems
• postnatal depression & stress
• increased still birth or miscarraige or premature (loads of problems like disability, IQ, speech problems)