TEALE FENNING

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

1. Varicocele is the second most common cause of male factor subfertility and surgical treatment improves pregnancy rates
2. Clomiphene citrate is appropriate treatment for WHO class III ovulatory dysfunction
3. Pulsatile GnRH is the treatment of choice for women with Kalman syndrome who want to concieve
4. women with 2 episodes of PID have almost 50% risk of tubal factor subfertility
5. Women with endometriosis are likely to have similar success rates with IVF as with those without endom.
6 Inhibin levels and ovarian biopsy are usefull investigations for ovarian reserves
7.Ovulation occurs in up to 80% of women taking clomiphene with a pregnancy rate per cycle 20-25%
8. multi-fetal reduction to twins carry outcomes as good as unreduced twin pregnancy
9. The results of semen analysis and ovulation confirmation should be known before doing a HSG
10. Tubal factor subfertility secondary to sterilization should be treated by tubal re-anastomosis and not IVF

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

Loads? 10 questions in one topic.. If i play like this Im never going to enter the century club..

mridulaben · Posted: Thu Jan 25, 2007 11:11 am Post subject:

. Varicocele is the second most common cause of male factor subfertility and surgical treatment improves pregnancy rates - FALSE
Surgery improves the count definately, but pregnancy rates r not improved,. Regarding second common cause am not sure, has not mentioned as such.
2. Clomiphene citrate is appropriate treatment for WHO class III ovulatory dysfunction - FALSE, it is ovarian failure, Ovum donation.
3. Pulsatile GnRH is the treatment of choice for women with Kalman syndrome who want to concieve - TRUE, as hypogonadotropic hypogonadism
4. women with 2 episodes of PID have almost 50% risk of tubal factor subfertility - FALSE, too high
5. Women with endometriosis are likely to have similar success rates with IVF as with those without endom.- TRUE
6 Inhibin levels and ovarian biopsy are usefull investigations for ovarian reserves - FALSE, INHIBIN yes, but not biopsy
7.Ovulation occurs in up to 80% of women taking clomiphene with a pregnancy rate per cycle 20-25% - FALSE, 40%
8. multi-fetal reduction to twins carry outcomes as good as unreduced twin pregnancy FALSE ????
9. The results of semen analysis and ovulation confirmation should be known before doing a HSG TRUE, Primary I/V
10. Tubal factor subfertility secondary to sterilization should be treated by tubal re-anastomosis and not IVF- ??,preferably yes, Should be makes it FALSE

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

[quote="mridulaben"]. 5. Women with endometriosis are likely to have similar success rates with IVF as with those without endom.- TRUE

Endometriosis lower the success rate.

EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

1. Varicocele is the second most common cause of male factor subfertility and surgical treatment improves pregnancy rates -- FALSE

Men should not be offered surgery for varicoceles as a form of fertility treatment because it does not improve pregnancy rates. NICE GUIDELINE

2. Clomiphene citrate is appropriate treatment for WHO class III ovulatory dysfunction -- FALSE

WHO class II not 3.

3. Pulsatile GnRH is the treatment of choice for women with Kalman syndrome who want to concieve -- TRUE

NICE recomendation for Class I ovulation disorder

4. women with 2 episodes of PID have almost 50% risk of tubal factor subfertility -- TRUE

1 episode 25 %, 2 episodes 50%, 3 episodes 75%

(i don't remember where i got these values from, but this is what i thought at first look at the Q)
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

5. Women with endometriosis are likely to have similar success rates with IVF as with those without endom. -- FALSE

Women with minimal or mild endometriosis who undergo laparoscopy should be offered surgical ablation or resection of endometriosis plus laparoscopic adhesiolysis because this improves the chance of pregnancy.
Women with ovarian endometriomas should be offered laparoscopic cystectomy because this improves the chance of pregnancy.
Women with moderate or severe endometriosis should be offered surgical treatment because it improves the chance of pregnancy.

6 Inhibin levels and ovarian biopsy are usefull investigations for ovarian reserves -- FALSE (as mcq includes both inhibin and biopsy, it's true for inhibin, false for biopsy)

one will not like to destroy the ovary with a biopsy especially if it's reserve is in question.

acceptable tests are --
-Day 3 FSH and estradiol (E2) test
-Clomiphene challenge test
-Ovarian response to stimulation with injectable gonadotropins (FSH)
-Response to stimulation and antral follicle counts
-embryo quality at IVF

inhibin B level estimation is still debatable. It is suggested that inhibin B provides a more direct measure of the mass of follicles potentially available for recruitment. low levels of Inhibin B suggest poor ovarian reserve.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

7. Ovulation occurs in up to 80% of women taking clomiphene with a pregnancy rate per cycle 20-25% -- TRUE

'In properly selected patients, 80% can be expected to ovulate, and 40% become pregnant,' according to Speroff, Clinical Gynecologic Endocrinology and Infertility.
Approximately 75% of pregnancies that do occur on clomiphene do so in the first three treatment cycles.

The percentage of pregnancies per ovulation cycle is 20 to 25%. Almost 5% of the pregnancies are multiple pregnancies (almost all twins). the pregnancy rate per ovulatory cycle approaches the normal rate of 20 to 25%.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

8. multi-fetal reduction to twins carry outcomes as good as unreduced twin pregnancy -- TRUE

CA Melgar, DL Rosenfeld, K Rawlinson, and M Greenberg . Perinatal outcome after multifetal reduction to twins compared with nonreduced multiple gestations. Obstetrics & Gynecology 1991;78:763-767. The American College of Obstetricians and Gynecologists.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

9. The results of semen analysis and ovulation confirmation should be known before doing a HSG -- TRUE

is this not what we do in the clinic regularly?

the HSG bit threw me a bit. if you had said lap + dye, it would have been a straight True. with the HSG, could be a false as it is not as invasive.

logistically speaking in absence of comorbidities one could do all three simultaneously. that would save time.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

10. Tubal factor subfertility secondary to sterilization should be treated by tubal re-anastomosis and not IVF --

can't answer this in T / F
The alternative to tubal sterilization reversal is IVF. The benefit of IVF is that it is immediate and there is no waiting period to try out the reversal to see if it works. This is a very important consideration for a woman over age 35. IVF may also be preferable when there are other factors that may cause infertility.
With sterilization reversal there is a chance of ectopic pregnancy. This chance is reduced with IVF. However, with IVF there is an increased chance of multiple births (twins or more). For some, sterilization reversal may allow for an additional pregnancy at a later time, but then for others, one pregnancy may be all that is desired and contraception must be used.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

4. women with 2 episodes of PID have almost 50% risk of tubal factor subfertility --FALSE

hi,

i've changed my answer ..... it is false..

1 episode 13 %.
2 episodes 35 %
3 episodes 75 %

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

You've gone to your StratOG obviously!!

Nick Raine-Fenning · Posted: Thu Jan 25, 2007 7:44 pm Post subject:

Very interesting questions wolverine - nice work

Some good reasoned answers there as well Smile

I think we have agreed on most except ...

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

I think that Nick's remarks concludes this topic. I would never dare to challenge him, especially in his area..
But Well Done everybody you all scored more than 7/10! I would have scored maximum 2 before I had read the subject...

Nick Raine-Fenning · Posted: Thu Jan 25, 2007 8:02 pm Post subject:

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

no nick,

can't be Shocked

. i know i knew those initial figures and they still ring true in my head, but have read the stratog since and the new figures are from there.

what do i go with now??? Question

_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

good job i did then! You would have lost a mark! Wink

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

Don't forget that the area that Nick lives and works is the National Champion of chlamydia! Hurraaayy!! So his figures might be a bit overestimated. I would go with the RCOG publication ones

Nick Raine-Fenning · Posted: Thu Jan 25, 2007 8:13 pm Post subject: