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MRCOG PART 2 SBAs and EMQs

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EMQ1480
SBA2068
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EMQ quiry

EMQ quiry Posted by Dr. Umme  H.
Dear Paul,
I am confused about the following questions:

A 34 year old woman with her 35 year old partner has been referred to the infertility clinic because of 2 years of primary infertility. The woman has a regular and normal 28 day cycle, her BMI is 26 and she has no other symptoms. Investigations have shown normal LH = 3.5mIU/ml, FHS = 5.0mIU/ml, Thyroid function tests, prolactin and day 21 progesterone concentration confirms ovulatory cycles. Her partner?s semen analysis is normal. Hystero-salpingogram confirms bilateral patent fallopian tubes.
The correct ans is IVF, the explanation says, IUI is appropriate but given the age (34 y), IVF should be dicussed. the question asks about the \" single most appropriate initial mx\"..

On the other hand, the following question asking the same \"single most appropriate initial mx\"..for--

A 37 year old woman with her 45 year old partner has been referred to the infertility clinic because of 2 years of primary infertility. The woman has an irregular menstrual cycle every 2-4 months and her partner?s semen analysis shows a volume of 3ml, concentration of 30,million/ml and motility of 60%. The woman?s BMI is 26 and there is no significant past medical history. Investigations have confirmed a diagnosis of polycystic ovary syndrome which has not responded to treatment with clomephene citrate over 6 months.

the answer is laparoscopic ovarian drilling.
Could you please explain why the option of IVF is not appropriate for the 37 yr PCO woman?
Thanks