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MRCOG PART 2 SBAs and EMQs

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infertility short assay

infertility short assay Posted by huaida A.

A 30 year old woman with her 35 year old partner have been referred to the fertility clinic because of a 2 year history of sub-fertility. The woman is found to have the polycystic ovary syndrome but there are no other abnormalities. (a) What will you tell the couple about the implications of this diagnosis? [8 marks]. (b ) Critically evaluate the treatment options to enable this couple achieve a pregnancy [12 marks].

ANSWER:A

I will tell them that the syndrome has short  term implications as well as long term implications

the short term implications include the sub fertility which result from unovulation ,increase risk of misscarriage,increase androgens level that may lead to hirsutism ,in addition to the problem of cycle irregularitiesand the central obisity

The long term implications include increase risk of developing both type 2 diabetes  and hypertention diseases  in .addition to increase risk of endometrial cancer due to unopposed oestrogen

B;;

Options include ,if pt is obese reducing wt will result in spontanouse ovulation and pregnancy,or she could be offer the option of ovulation induction using clomifene citrate with increasing risk of multiple pregnancy and ovarian hyperstimulation,

if not respond to clomiphene then pt can offer options of either being induced by  gonadotrophins( with increased risk of hyperstimulation and multiple pregnancy more than with comiphene citrate) or the second option  is that of laproscopic ovarian drilling.

Women with gynaecological malignancies should not be prescribed HRT. Is this statement justified? Posted by huaida A.

Itis known from studies that ostrogen stimulate breast cancer cell growth,  and those who dignosed with breast cancer while taking HRT ,they are in more advanced stage and have larg tumour,for this reason pt with breast cancer should not prescibed HRT and if completed their treat ment they should be assessed by oncologist and menopause clinic specialist,

and because oestrogen stimulate endometrial cancer  HRT shouldnot prescribed if pt not treaed ,but can be prescribed by gyneoncologist if pt completred her treatment

studies showed that HRTincreases the risk of ovarian cancer, so should not prescibed for apt with ovarian cancer

HRT will continue  to be prescribed as pt councelled about the risk and benifits`