TREATMENT OF INFERTILITY
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What is the general approach to treatment of infertility A stepwise approach, from least to most invasive (and expensive) It may start with use of clomiphene citrate to induction with gonadotropins, and then to in vitro fertilization (IVF) For patients with anovulation, the goal is monofollicular development with ovulation For patients over 35 and those with unexplained infertility, the goal may be 2 4 follicles, with ovarian stimulation Smoking and alcohol cessation, decrease in caffeine consumption,
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What modifications in lifestyle habits may improve fertility
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Section II: Topics in Gynecology
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increased frequency of coitus Maintaining a healthy weight and diet not only helps with conception but predicts a healthier pregnancy What is clomiphene citrate and in which patients is it used It is a selective estrogen receptor modulator (SERM) that ultimately increases gonadotropin release It is the agent of choice for women less than 36 years of age and in normogonadotrophic normoestrogenic anovulation It has been effective in inducing ovulation for 60 85% of anovulatory women Subcutaneous injection of hMG, specifically FSH, is used in women who have failed with clomiphene and in women with hypothalamic amonorrhea with hypopituitarism Pulsatile administration of GnRH stimulates endogenous production of FSH and LH
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When is induction with human menopausal gonadotropins (hMG) indicated
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How is follicle development and ovulation induced in women in hypogonadotropic hypogonadal anovulation with normal pituitary function What agent should be used in women who have anovulation because of hyperprolactinemia Do these induction agents have an associated risk for ovarian cancer and breast cancer
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Dopamine agonists such as bromocriptine or cabergoline Although historical evidence may indicate an association between clomiphene use and ovarian cancer, more recent well-controlled studies do not support the concept of increased risk However, it is recommended that induction with clomiphene be limited to 12 cycles There has been no reported risk between fertility drugs and breast cancer It consists of collecting a specimen of ejaculated sperm, followed by washing and concentration of the sperm The concentrated sperm is then injected directly into the upper uterine cavity using a small catheter through the cervix The pregnancy rate is 4 6% per cycle when used alone It is frequently used in combination with ovulation induction to achieve pregnancy rates of 5 15%
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What is intrauterine insemination (IUI)
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7: Reproductive Endocrinology and Infertility
ASSISTED REPRODUCTIVE TECHNOLOGIES
What are the different modalities of assisted reproductive technologies (ARTs) 1 In vitro fertilization-embryo transfer (IVF-ET) 2 Intracytoplasmic sperm injection (ICSI) 3 Gamete intra-fallopian tube transfer (GIFT) 4 Zygote intra-fallopian tube transfer (ZIFT) 5 Oocyte donation IVF-ET: The female s ovary is hyperstimulated by daily FSH injections Multiple mature eggs are collected by a transvaginal procedure and combined with sperm in the laboratory to allow fertilization to occur After fertilization selected embryos are placed in the female s uterus to allow development Pregnancy is achieved 28% of the time and 82% result in one or more births ICSI: This procedure combines the technique of IVF and involves taking a single sperm from the male partner and injecting it directly into the cytoplasm of the egg in the laboratory It is commonly used as treatment for male infertility factor Overall fertilization rate is 60%
What is the mechanism of each of the following technologies and their success rate of pregnancy
What is osteoporosis A disorder of the skeleton that involves low bone mass and microarchitectural disruption, both of which lead to skeletal fragility and increased fracture risk Over 30% of women over 50 years have radiographic evidence of osteoporosis; over 44 million men and women are currently diagnosed with osteoporosis in the United States
What is the prevalence of osteoporosis
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Section II: Topics in Gynecology
Who does osteoporosis affect
Predominately thin, postmenopausal women and more often Caucasian and Asian women Women have a lower peak bone mass and have accelerated bone loss after menopause At age 30 35 Bone loss, which is a result of a mismatch between bone resorption and bone formation Most is a result of either age-related or menopauserelated bone loss Often with hip fracture, a vertebral compression fracture (leading to kyphosis), or a wrist fracture after minimal trauma Osteomalacia Hyperparathyroidism Multiple myeloma Pathological fracture secondary to metastatic cancer
Why does osteoporosis affect women more than men When does bone mass peak What is the pathogenesis of osteoporosis