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



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


Endocannabiods regulate multiple endocrine system including HPO axis.

Intrauterine life has an impact


Anovulation with PCOS

Group 2 Anovulation

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


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.