Social History and Ovulation Monitoring

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Questions and Answers

Which lifestyle factor is most likely to cause disruptions in GnRH and gonadotropin secretion?

Consistent hydration

Regular exercise

Adequate sleep

BMI greater than 25 (correct)

Which method is NOT indicative of ovulation monitoring?

Cervical mucus observation

Basal Body Temperature measurement

General lifestyle assessment (correct)

Regular menstrual cycle

What is the typical change in Basal Body Temperature (BBT) after ovulation?

Decrease by 0.5 - 1 C

Increase by 0.5 - 1 C (correct)

Fluctuates randomly

No change

Which examination finding may indicate hypoandrogenism in a male partner?

Gynecomastia Signup and view all the answers

What cervical mucus change is observed under the influence of estrogen?

Thin, clear, and stretchable Signup and view all the answers

Which surgical history is least likely to be relevant to male infertility investigations?

Endometriosis surgery Signup and view all the answers

Presence of which sign is most likely indicative of ovulation?

Mittelschmerz sign Signup and view all the answers

What would a bilateral absence of vas deferens likely indicate in a fertility investigation?

Cystic fibrosis Signup and view all the answers

What serum progesterone level indicates ovulation occurring 7 days after ovulation?

30 nmol/L Signup and view all the answers

Which of the following is a normal sperm motility percentage according to semen fluid analysis?

32% Signup and view all the answers

What is the minimum sperm concentration indicated for normal semen fluid analysis?

15 × 10^6/ml Signup and view all the answers

Which method is used to track follicular development and ovulation in the reproductive cycle?

Ultrasound Signup and view all the answers

What is one contraindication for hysterosalpingography?

Recent dilation and curettage Signup and view all the answers

Which parameter indicates the total sperm count is normal according to semen fluid analysis?

≥ 39 × 10^6/ml Signup and view all the answers

What is one complication associated with hysterosalpingography?

Vasovagal episode Signup and view all the answers

Which test can be employed to assess tubal patency as part of infertility evaluation?

Laparoscopy & dye hydrotubation Signup and view all the answers

What is the main goal of tubal disease treatment?

Restoring the normal anatomy of the tubes. Signup and view all the answers

Which procedure allows for the assessment of both tubal patency and uterine cavity conditions during the same session?

Hysterosalpingo-contrast sonography Signup and view all the answers

Which of the following describes a potential complication of laparoscopy and dye hydrotubation?

Bowel, bladder, or blood vessel injury. Signup and view all the answers

What is the commonest cause of ovulation disorder classified as Type II?

Polycystic ovary syndrome (PCOS). Signup and view all the answers

Which of these treatments targets hyperprolactinemia in patients with ovulation disorders?

Bromocriptine or cabergoline. Signup and view all the answers

What is a key lifestyle recommendation for patients attempting conception?

Achieve an optimum weight with a BMI of 20-25. Signup and view all the answers

What is the purpose of the post coital test in infertility evaluation?

To assess cervical mucus and sperm interaction. Signup and view all the answers

What is a potential outcome if the fallopian tubes are deemed beyond repair?

Consideration of in vitro fertilization. Signup and view all the answers

What is the ultrasound finding associated with moderate ovarian hyperstimulation syndrome (OHSS)?

Ovarian size 8 – 12 cm Signup and view all the answers

Which of the following is a clinical finding indicative of critical OHSS?

Tense ascites Signup and view all the answers

Which laboratory investigation is essential for assessing renal function in suspected cases of OHSS?

Serum electrolytes Signup and view all the answers

What management strategy is recommended for mild cases of OHSS?

Supportive monitoring Signup and view all the answers

In severe OHSS, which of the following clinical signs can be present?

Oliguria Signup and view all the answers

Which treatment is contraindicated in the management of OHSS due to potential renal impairment?

NSAIDs Signup and view all the answers

What is the threshold for WBC count in cases classified as critical OHSS?

WBC > 25,000 /ml Signup and view all the answers

What is a typical characteristic of severe OHSS as compared to mild cases?

Presence of clinical ascites Signup and view all the answers

What is the maximum daily dose of clomiphene prescribed during anti-estrogen treatment?

150 mg Signup and view all the answers

Which of the following is NOT a complication associated with stimulated intrauterine insemination?

Ectopic pregnancy Signup and view all the answers

What is the critical initial step in an in vitro fertilization (IVF) cycle?

Pituitary down-regulation Signup and view all the answers

What is the main purpose of hCG in the IVF process?

To trigger ovulation Signup and view all the answers

Which condition is an indication for intracytoplasmic sperm injection (ICSI)?

Severe oligoasthenoteratozoospermia Signup and view all the answers

In which scenario is ovarian hyperstimulation syndrome most likely a risk?

Following multiple IVF treatment cycles Signup and view all the answers

What is a key indication for using IVF in a patient?

Severe tubal disease Signup and view all the answers

Which of the following options accurately describes a step in the typical IVF-embryo transfer cycle?

Conducting fertilization after oocyte collection Signup and view all the answers

Study Notes

Body Mass Index (BMI) impacts GnRH and gonadotropin secretion; values over 25 or under 17 are concerning.
Smoking and alcohol consumption affect reproductive health and hormone levels.

Ovulation Monitoring

Regular menstruation indicates ovulation; the presence of Mittelschmerz (mid-cycle pain) suggests ovulation.
Symptoms associated with ovulation include breast tenderness, acne, mood changes, and dysmenorrhea.
Basal Body Temperature (BBT) rises by 0.5 - 1°C after ovulation; daily measurement during periovulatory phase is essential.
Estrogen influences cervical mucus changes; mucus becomes thin, clear, and stretchable.

Physical Examination

General assessment includes height, weight, BMI, fat and hair distribution, and signs of acanthosis nigricans, acne, and galactorrhea.
Abdominal examination checks for masses or tenderness.
Pelvic examination assesses the vulva, vagina for infections, cervix for polyps, and evaluates uterine size, shape, and mobility.
A PAP smear is performed if indicated.

Male Partner History

Includes type of infertility, previous relationships, fertility investigations, and treatments.
Medical history examines STDs, testicular issues, smoking, and alcohol abuse.
Surgical history checks for hernia repairs, injuries, or any procedures like vasectomy.
Occupational history investigates exposure to toxins.
Sexual history covers puberty onset, ejaculation problems, libido, and understanding of fertile periods.
General examination notes height, weight, BMI, presence of hypoandrogenism or gynecomastia.
Groin check for hernias or masses; genital examination for testicular position, size, and epididymal health.

Ovulation Tests

Semen analysis measures volume (≥1.5 ml), pH (7.2-7.8), sperm concentration (≥15×10^6/ml), total sperm count (≥39×10^6/ml), and motility (≥32%).
Serum progesterone levels checked mid-luteal phase; levels >30 nmol/L indicate ovulation.
Ovulation predictor kits detect mid-cycle LH surge in urine.
Ultrasound tracks follicular development and ovulation.
Endometrial biopsy on day 25 can confirm ovulation.

Tubal Patency Tests

Hysterosalpingography (HSG) evaluates the uterus and fallopian tubes via X-ray; performed during the follicular phase, contraindicated during menstruation.
Laparoscopy with dye hydrotubation for direct visualization and assessment of pelvic pathology.
Hysterosalpingo-contrast sonography assesses uterine cavity and tubal patency as an outpatient procedure.

Assessment of Uterine Cavity

Hysteroscopy identifies and treats uterine anomalies, fibroids, and adhesions.

Treatment of Tubal Disease

Restoring normal anatomy is crucial; surgical interventions may include lysis of adhesions or tuboplasty.
In cases of irreparable damage, in vitro fertilization (IVF) should be considered.

General Management Strategies

Lifestyle changes advised, including achieving a BMI of 20-25 and taking folic acid for neural tube defect prevention.
Ovulation disorders treated based on type:
- Type I: Gain weight, gonadotrophins, or dopamine agonists for hyperprolactinemia.
- Type II (PCOS): Weight reduction, anti-estrogens (clomiphene) for ovulation induction.
- Type III: Ova donation.

Assisted Reproductive Techniques

Intrauterine insemination (IUI) involves placing sperm into the uterine cavity to optimize chances of conception.
Indications for IUI include mild male factor infertility, ejaculatory issues, and unexplained infertility.
IVF involves surgical retrieval of oocytes and fertilization; indications include severe endometriosis and tubal disease.
Intracytoplasmic sperm injection (ICSI) directly injects sperm into the egg, typically for severe male factor infertility.

Ovarian Hyperstimulation Syndrome (OHSS)

Classified by severity: mild (abdominal bloating), moderate (ascites), severe (clinical ascites), and critical (renal failure).
Management ranges from supportive care for mild cases to hospitalization and monitoring for severe cases, with pain relief strategies and avoidance of certain medications.

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Description

This quiz explores the impact of social history factors such as lifestyle, eating habits, and substance consumption on ovulation and hormonal secretion. Key concepts include BMI effects on GnRH and gonadotropin levels, signs of ovulation, and the role of Basal Body Temperature in monitoring ovulation.