The smart way to learn. The smart way to teach.

MRCOG PART 2 SBAs and EMQs

Course PAID
notes336
EMQ1502
SBA2115
Do you realy want to delete this discussion?
Forum >>

Essay about sub-fertility

Essay about sub-fertility Posted by Farkhanda A.
(a)
I will inform the couple about the diagnosis and also reassure them that it is not an uncommon condition. Its incidence is about 20%.
It has immediate and long term effects on women?s\' life. It causes anovulation due to multiple follicles grow, but no one grows enough to release egg. In this way it is responsible for anovulatory infertility. Due to decrease production of sex hormone binding globulin by liver and increase conversion of oestrogen, androgens levels become high which are responsible for acne, deepening of voice and abnormal hairs distribution on face and body.
Pcos also causes increased resistance to insulin and disturbance in carbohydrate metabolism which is the reason for obesity.
It cause derangement in lipids and ultimately hyperlipidaemia.

Long term implications; pcos causes type 2 NIDDM , due to oligomenorric menstrual cycles, increased exposure of oestrogen to endometrium, risk of hyperplasia and cancer of endometrium.
There is an increased risk of coronary heart disease due to the imbalance of lipids.
(b)
General advice about decreasing BMI. It can help in resumption of regular periods and ovulation.
Medical treatment.
Clomifen Citrate for ovulation induction. It is associated with multiple pregnancy, so follical monitoring by ultrasound is needed to avoid this complication. It is used for 12 months with a 6 monthly increase in dose with a blood test for progesterone level to check ovulation. It is associated with nausea, vomiting, blurring of vision, hair loss and constipation.
Gonadotrophin releasing hormone analogue is another option for ovulation induction, but they are associated with multiple pregnancy, ovarian hyperstimulation and other side effects of hypooestrogen.
Surgical treatments include:-
Ovarian wedge resection which is not associated with multiple pregnancy, ovarian hyperstimulation but it can cause damage to the ovaries and adhesion formation. There are risks of anaesthesia and laparoscopy.
More recent in practice is laparoscopically ovarian drilling. There are 4 points to diathermised by using 40 watts for 4 seconds. It is not associated with multiple pregnancy, OHSS. It lowers the androgens level, is more successful in achieving pregnancy in 6-12 months after the procedure. It put patients in extra risk of anaesthesia and laparoscopy.
The last option is IVF (in vitro fertilisation). All this information should be documented and backed up by giving information leaflets.