Subspecialty Topics
Core concepts
Subspecialty content spans reproductive endocrinology and infertility, urogynecology, gynecologic oncology, maternal-fetal medicine, and minimally invasive surgery. In infertility, know the basic evaluation (ovulation assessment, tubal patency, semen analysis) and the indications for clomiphene, letrozole, and gonadotropins, plus the risks of ovarian hyperstimulation. In urogynecology, understand pelvic organ prolapse quantification, stress vs. urge incontinence, and initial management (pelvic floor therapy, pessary, surgery). Oncology topics include hereditary cancer syndromes (BRCA, Lynch) and their surveillance implications. MFM content overlaps with obstetrics but emphasizes genetics, multifetal gestation, and medical complications of pregnancy. Minimally invasive surgery questions focus on patient selection, complication recognition, and energy-device safety.
Traps
Distractors often misassign first-line therapy: pelvic floor muscle training before surgery for stress incontinence; lifestyle and bladder training before anticholinergics for urge incontinence. In infertility, beware of treating a male factor with intrauterine insemination alone when IVF is indicated. In oncology, do not confuse screening with diagnostic testing, and remember that BRCA status changes management and surveillance. Regarding surgery, recognize that conversion to laparotomy is a judgment call, not a failure.
Worked example / rule of thumb
A 33-year-old with 12 months of unprotected intercourse and regular cycles has a normal pelvic exam. The evaluation begins with a semen analysis, ovulation documentation, and assessment of tubal patency before any ovulation induction. Rule of thumb: evaluate both partners before treating one - the male factor is present in roughly half of infertile couples and is the cheapest test to obtain first.