ABOG Reproductive Endocrinology and Infertility flashcards

41 cards. Read the term and the definition here. The deck at the top of this page is optional.

GnRH pulse frequency effects

Rapid pulses favor LH secretion while slower pulses favor FSH; pulsatile administration preserves gonadotropin function, whereas continuous exposure downregulates receptors.

Estradiol positive feedback

Sustained high estradiol from the dominant follicle triggers the midcycle LH surge, which induces ovulation about 24-36 hours later.

Inhibin B role

Secreted by small antral follicles, inhibin B selectively suppresses pituitary FSH secretion and reflects ovarian reserve and follicular activity.

Hyperprolactinemia mechanism

Elevated prolactin suppresses GnRH pulsatility, causing hypogonadotropic hypogonadism, amenorrhea, and galactorrhea; treated with dopamine agonists.

PCOS Rotterdam criteria

Diagnosis requires two of three findings: oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound.

WHO anovulation types

Type I is hypothalamic, Type II is normogonadotropic (including PCOS), Type III is ovarian insufficiency, and Type IV is other causes.

Primary ovarian insufficiency definition

Amenorrhea with elevated FSH above 40 mIU/mL occurring before age 40, reflecting loss of ovarian follicular function.

Progesterone challenge test

Administering progestin and observing withdrawal bleeding confirms an estrogenized endometrium and a patent outflow tract.

Ovarian reserve markers

Anti-Müllerian hormone and day 3 FSH with estradiol estimate remaining follicular pool; AMH varies less across the cycle.

OHSS prevention strategy

In high responders, use a GnRH antagonist protocol with GnRH agonist trigger and freeze-all embryos to reduce ovarian hyperstimulation syndrome risk.

ICSI indications

Intracytoplasmic sperm injection is used for severe male factor infertility, prior fertilization failure, and when preimplantation genetic testing is planned.

Infertility definition

Failure to conceive after 12 months of regular unprotected intercourse, with earlier evaluation advised for women aged 35 or older.

Azoospermia classification

Obstructive azoospermia shows normal testicular volume and normal FSH, while nonobstructive azoospermia typically shows small testes and elevated FSH.

Klinefelter syndrome fertility

47,XXY causes nonobstructive azoospermia with small firm testes and elevated FSH; micro-TESE may retrieve sperm in some cases.

Varicocele significance

Varicocele is the most common correctable cause of male infertility; surgical repair may improve semen parameters in selected patients.

Semen volume reference limit

The WHO 2021 lower reference limit for semen volume is 1.4 mL, with total sperm concentration and motility thresholds also specified.

Antiphospholipid syndrome treatment

In recurrent pregnancy loss, antiphospholipid syndrome is treated with low-dose aspirin plus prophylactic heparin to improve pregnancy outcomes.

Methotrexate contraindications

Methotrexate is contraindicated when an intrauterine pregnancy is present, during breastfeeding, and with significant renal or hepatic disease.

Recurrent pregnancy loss definition

Conventionally defined as two or more (or three or more, depending on guideline) consecutive pregnancy losses, prompting evaluation for causes.

Early pregnancy loss management

Options are expectant, medical with misoprostol, or surgical with suction dilation and curettage, chosen based on stability and patient preference.

Menopause diagnosis

Menopause is diagnosed clinically after 12 months of amenorrhea in a woman over 40; laboratory FSH testing is not required.

Hormone therapy endometrial protection

Women with a uterus receiving systemic estrogen require a progestogen to prevent endometrial hyperplasia and carcinoma.

Transdermal estrogen advantage

Transdermal estrogen avoids first-pass hepatic metabolism, resulting in lower venous thromboembolism risk than oral estrogen.

Genitourinary syndrome of menopause

Vaginal dryness, dyspareunia, and urinary symptoms respond to local vaginal estrogen, which has minimal systemic absorption.

MRKH syndrome

Mayer-Rokitansky-Küster-Hauser syndrome is 46,XX Müllerian agenesis with primary amenorrhea, normal ovaries, and a shortened blind vagina.

Androgen insensitivity syndrome

46,XY complete androgen insensitivity presents with female phenotype, absent uterus, blind vaginal pouch, testes, and elevated testosterone.

Imperforate hymen presentation

Presents in puberty with cyclic pelvic pain, amenorrhea, and a bulging membrane; treatment is surgical hymenotomy.

PGT types

PGT-A screens for aneuploidy, PGT-M tests monogenic disorders, and PGT-SR detects structural chromosomal rearrangements.

Trophectoderm biopsy

Preimplantation genetic testing typically uses trophectoderm biopsy at the blastocyst stage, sampling cells that form the placenta.

Balanced translocation impact

Carriers produce unbalanced gametes, increasing risk of miscarriage and offspring with congenital anomalies; PGT-SR can be offered.

Emergency contraception options

The copper IUD is the most effective emergency method; levonorgestrel and ulipristal acetate are oral alternatives with time-dependent efficacy.

CHC contraindications

Combined hormonal contraception is contraindicated with migraine with aura, smoking over age 35, and prior venous thromboembolism.

Bacterial vaginosis findings

Diagnosis is supported by clue cells, a fishy odor with the amine whiff test, thin discharge, and vaginal pH above 4.5.

Ovarian tissue cryopreservation

Cryopreservation of ovarian cortex is an option for prepubertal girls and patients needing urgent gonadotoxic therapy without stimulation delay.

GnRH agonist ovarian protection

Cotreatment with a GnRH agonist during chemotherapy may reduce gonadotoxicity by suppressing ovarian activity, though evidence is debated.

Ovarian transposition

Surgically moving the ovaries out of the radiation field protects them from pelvic irradiation during cancer treatment.

Hydrosalpinx management

Salpingectomy or proximal tubal occlusion before IVF improves implantation and live birth rates by removing embryotoxic fluid.

Endometrioma cystectomy caution

Excision of endometriomas should minimize removal of ovarian cortex, as surgery can reduce ovarian reserve.

Informed consent in ART

Consent must disclose risks, alternatives, success rates, costs, and disposition options for embryos and gametes.

Embryo disposition options

Patients may direct embryos to transfer, research donation, donation to another person, or discard, per prior written consent.

Plan-do-study-act cycle

A quality improvement method that tests small changes iteratively, measuring outcomes and refining interventions to improve care.