Friday, 23 January 2009

Reproductive Medicine

Learning points from regional teaching
Hypothalamus-GnRH that acts on anterior pitutitary
Pitutitary FSH/LH act on granulosa
Ovary granulosa cells secretes inhibin

3types of oestrogen :17b estradiol oestriol oestrone


Oestrogen helps in development of secondary sexual charecteristics and preserves bone density.

Ovary's dimension 4*1.5*1.5 cm

PCOS

2003 ESHRE/ASRM

USS-ovarian volume >10ml
2-12 mm cysts 10 or more

Polygenic disorder of steroid biosynthesis or insulin metabolism.

LH acts theca cell

2 cell theory

SHBG reduced by androgen & insulin.SHBG produced in liver .

Free androgen index =total testerone*100/SHBG. Normal <4.5

Impact of Obesity insulin resistance and increase in insulin like growth factors

Leptin

Endocannabiods regulate multiple endocrine system including HPO axis.

Intrauterine life has an impact


Follistatin

Anovulation with PCOS

Group 2 Anovulation


Consensus on infertility treatments ESRE
1-preconceptual-weight loss
2-ovulation induction
Multiple pregnancy clomiphene 10%
Hyperstimulation



Clomiphene

Tamoxifen less trials

Clomiphene + Dexamethasone is one option
Metformin Doses 500. mg or 850 mg bd
ESRE only indicated glucose intolerance or type 2 DM


Gonadotropins cumulative success rate 40-50%

1-2% severe OHSS. Possible tx

Rotterdam crieteria


Ovarian adhesion

Laparoscopic diathermy free of risk multiple
Pregnancy , no ovarian HSS


LOMNI new technique.