ABOG Reproductive Endocrinology and Infertility common mistakes
ABOG Reproductive Endocrinology and Infertility · Understand the traps and how to avoid them.
When a stem describes a woman with amenorrhea, the candidate jumps straight to a single diagnosis (e.g., PCOS) without first excluding pregnancy and then working through the compartments (TSH, prolactin, FSH/LH, estrogen) in order.
Pattern recognition from familiar vignettes overrides the systematic endocrine workup; candidates want to demonstrate knowledge of the named syndrome rather than demonstrate a safe diagnostic sequence.
What to do instead
Before answering any amenorrhea question, write the sequence: pregnancy test, TSH, prolactin, then FSH/estradiol to localize the defect (hypothalamic-pituitary-ovarian). Then match the stem's data to the compartment that fits.
Selecting a treatment for anovulation without first checking whether the patient has been screened for the contraindications specific to that agent (e.g., starting clomiphene without addressing BMI, or starting metformin as monotherapy for a patient who wants ovulation induction).
Candidates memorize drug-diagnosis pairs rather than drug-patient-fit criteria, so they answer the pharmacology question that was asked instead of the safety question that was implied.
What to do instead
For each ovulation induction option, rehearse a one-line eligibility screen (clomiphene: BMI, visual symptoms, ovarian reserve; letrozole: preferred first-line in PCOS per current evidence; metformin: adjunct, not first-line monotherapy for conception). Apply the screen to the stem before choosing.
Ordering a full infertility workup (HSG, laparoscopy, genetic panels) on a couple who has not yet met the duration or age criteria for infertility evaluation, or omitting semen analysis from the initial workup of a couple where the female partner has been fully evaluated.
Candidates equate thoroughness with correctness and fear missing a diagnosis, and they reflexively center the evaluation on the female patient because most of the exam content is gynecologic.
What to do instead
Anchor to the definition: infertility evaluation begins after 12 months of unprotected intercourse, or 6 months if age 35 or older, or immediately with known risk factors. Semen analysis is part of the initial evaluation of every couple, always.
Interpreting a semen analysis against the wrong reference threshold or treating a single abnormal parameter as diagnostic without planning a repeat analysis and a targeted evaluation.
Candidates conflate older WHO cutoffs with current ones and treat a lab value as a diagnosis rather than as a screening test with high biological variability.
What to do instead
Memorize the current WHO lower reference limits as a set (concentration, total motility, progressive motility, morphology) and state explicitly that an abnormal result warrants a repeat analysis at least a few weeks later plus history, exam, and endocrine testing when indicated.
Attributing recurrent pregnancy loss to a single cause and stopping, or ordering an exhaustive panel (thrombophilia, karyotype, uterine anomaly workup) after a first miscarriage rather than after the defined threshold.
Candidates want to find the answer and stop, and they over-apply the RPL label to any patient with more than one loss without checking the definition and whether the losses were documented intrauterine clinical pregnancies.
What to do instead
State the definition first (two or more clinical pregnancy losses, not necessarily consecutive, per current ASRM guidance), then list the evaluation in order: parental karyotype, uterine cavity assessment, antiphospholipid antibody testing. Reserve inherited thrombophilia testing for specific contexts.
Prescribing menopausal hormone therapy without individualizing by time since menopause, route, and the patient's specific risk profile, or reflexively withholding HT from a symptomatic woman because of misapplied WHI conclusions.
Candidates remember the WHI headline rather than the subgroup and age-stratified findings, and they apply a population-average result to an individual patient.
What to do instead
Frame every HT question around three variables: age/time since menopause, symptom severity, and risk (VTE, breast cancer, cardiovascular). Use the 'timing hypothesis' for recently menopausal women and choose transdermal estrogen when VTE or triglyceride risk matters.
Managing an adolescent with primary amenorrhea or pelvic pain by treating symptoms (e.g., prescribing oral contraceptives for dysmenorrhea) without first evaluating for obstructive müllerian anomalies or considering the differential by presence or absence of breast development and uterus.
Candidates carry adult management patterns into adolescent presentations and skip the anatomic/developmental differential that is unique to this age group.
What to do instead
Use a two-axis framework: breast development (estrogen present or absent) and uterus present or absent on imaging. That grid localizes the problem to gonadal, outflow tract, or hypothalamic causes before any treatment is chosen.
Recommending PGT-A as a way to improve live birth rates for all IVF patients, or conflating PGT-A, PGT-M, and PGT-SR indications when answering a genetics question.
Candidates hear 'genetic testing' and select the most familiar test rather than matching the specific test to the specific indication.
What to do instead
Build a three-row table: PGT-M for known monogenic disease, PGT-SR for known structural rearrangements, PGT-A for aneuploidy screening. Know that PGT-A has not been shown to improve cumulative live birth rates across all patients and is not a universal recommendation.
Choosing a contraceptive method based on efficacy alone without screening for the specific contraindications in the current US MEC framework (e.g., estrogen-containing methods in a patient with migraine with aura, or in the early postpartum period).
Candidates rank methods by effectiveness and forget that the exam frequently tests the safety screen, particularly for conditions that are common and easy to overlook.
What to do instead
For every contraception question, run the MEC category check on the conditions named in the stem (migraine with aura, postpartum timing, VTE history, smoking age, hypertension). If a category 3 or 4 condition is present, exclude the method and name the safer alternative.
Answering a fertility preservation question by selecting a technique without addressing urgency and the patient's specific gonadotoxicity exposure, or counseling a prepubertal patient with an adult oocyte cryopreservation plan.
Candidates focus on the technology (oocyte vitrification, ovarian tissue cryopreservation) rather than on the clinical timeline and developmental stage that determine which technology is even feasible.
What to do instead
For each case, state the time available before treatment, the patient's pubertal status, and whether the cancer is hormone-sensitive. That triad selects the option: urgent and prepubertal points to ovarian tissue cryopreservation; hormone-sensitive breast cancer argues against ovarian stimulation without letrozole co-treatment.