EBCOG P1 – ESHRE Guideline – Day 1

A Combined oral contraceptive pill
B Progesterone
C Transdermal estradiol plus cyclic oral progestin
D GnRH analogs
E Metformin
F Clomiphene citrate
G FSH
H Dopaminergic drugs
I Vitamin E
J Estrogen adult dose
K Estrogen low dose4

1 A 15-year-old girl presents at the gynaecological endocrine clinic complaining of primary amenorrhea. Clinical examination shows no secondary sexual characteristics. Laboratory investigation shows serum FSH 75 IU/L, LH 40 IU/L and estradiol 10 pg/ml. Her karyotype is 45XO.

 

2. A 22-year-old single woman with oligomenorrhea attends the endocrine outpatient clinic. Her menstrual periods appear every 3-4 months. Her BMI is 32 kg/m2, while her hormonal profile shows serum FSH 6.7 IU/L, LH 9.5 IU/L, prolactin 20 ng/ml and testosterone 1.4 ng/ml (normal equal or less than1.2 ng/ml). Further laboratory investigation shows glucose intolerance.

3. A 19-year-old woman has been referred to the gynaecological endocrine outpatient clinic because of 12 months secondary amenorrhea. Over the last 15 months she lost 18 kg and her BMI is now 17 kg/m2. Her weight has not increased despite an effort for nutritional interventions. Her serum FSH is 4.3 IU/L, LH 2.1 IU/L and estradiol 15 pg/ml. She is in good mood and understands that her amenorrhea is possibly related to the loss of weight.

A In vitro fertilisation (IVF)
B Intracytoplasmic sperm injection (ICSI)
C Testicular biopsy and ICSI
D Antibiotics treatment
E Varicocelectomy
F Salpingectomy followed by ICSI
G Sperm donation
H Adoption
I FSH/HCG for the husband followed by IVF
J Intrauterine insemination (IUI)

For each one of the following scenarios select the most appropriate treatment from the list of options. Each option may be used once, more than once, or not at all.

Scenario 1. A 34-year-old woman with primary infertility of 3 years duration has been referred to the infertility clinic. Her past medical history is not significant. She has regular menstrual periods and the hysterosalpingogram shows bilateral tubal blockage. Her husband’s semen analysis shows sperm count of 1.5 million/ml with 5% motility and 2% normal morphology. His serum FSH is 9.6 IU/L.

Scenario 2. A 29-year-old woman presents complaining of primary infertility of 2 years duration. She has regular menstrual periods, while her past medical history is not significant. Her hysterosalpingogram shows patent tubes. Her husband is 30 years old and his semen analysis shows persistently low count almost azoospermia. His serum FSH is 2.3 IU/L.

Scenario 3. A 38-year-old woman presents with primary infertility of 3 years duration. She has regular cycles and on hysterosalpingogram patent tubes. Her husband is 40 years old. His past medical history is not significant. However, there are moderate semen abnormalities that are characterized as idiopathic (sperm count from 13 to 15 million/ml, motility 30%). In his semen, a number of leucocytes are identified.

A Abdominal examination

B Abdominal ultrasound scan

C Barium enema

D Colonoscopy

E CT scan of pelvis

F Diagnostic laparoscopy

G Diagnostic laparoscopy and peritoneal biopsy

H Endoanal ultrasound

I Endometrial biopsy

J Endometrial cytokine levels

K MRI of pelvis

L Rectal examination

M Serum CA125

N Transperineal ultrasound scan

O Transvaginal ultrasound scan

P Vaginal examination

For each of the following clinical scenarios, what is the most appropriate management option from the list above? Each option may be used once, more than once or not at all

1 A 35-year-old woman presents to the gynaecology clinic with pelvic pain and dysmenorrhoea. A pelvic examination demonstrates tenderness and fullness in the right iliac fossa. Which test should be used to diagnose or exclude an ovarian endometrioma?

 

2. A 24-year-old woman, virgo intacta, presents to the gynaecology clinic with abdominal and pelvic pain, dysmenorrhoea and dyschezia. What is the most appropriate initial assessment for the diagnosis of endometriosis?

3. A woman with a previous diagnosis of pelvic endometriosis presents to the clinic with cylical rectal bleeding. Vaginal and rectal examinations are inconclusive. What is the most appropriate initial assessment to identify or exclude rectal endometriosis?