1. Female Infertility and Assisted Reproduction Objectives: 1. Diagnosis of the cause of infertility 2. Choosing the most appropriate treatment Difficulty:

2. with 1ry Infertility of 2years Female factor: Amenorrhea from 6 months Male factor: semen analysis normal 24y 26y Family History: Father type II Diabetes Social History: non smoker, no alcohol, no drugs

3. Obstetrical-Gynaecological History: Menarche 15y Cycles: irregular (previous treatment with YAZ) No dysmenorrhea G0 P0 No hirsutism BMI=21.3 Status post 3 cycles with Clomiphene Citrate 50-100 mg= no ovulation Hysterosalpingo-contrast-sonography (HyCosy): both tubes patent

4. Which measures are best used for investigations of ovarian reserve? A.FSH, LH, E2, AMH between d 2-4 of the cycle with US for AFC B.FSH, LH, E2, AMH between d 10-14 of the cycle C. FSH, LH, E2 between d 21-23 of the cycle D. AMH between d 2-4 of the cycle

5. Which measures are best used for investigations of ovarian reserve? A.FSH, LH, E2, AMH between d 2-4 of the cycle with US for AFC B.FSH, LH, E2, AMH between d 10-14 of the cycle C. FSH, LH, E2 between d 21-23 of the cycle D. AMH between d 2-4 of the cycle

6. Results FSH 6.8 mIU/ml LH 1.2 mIU/ml E2 190 pmol/l AMH 184 pmol/l US AFC: > 12 follicles in both ovaries Endometrial thickness normal AMH 184 pmol/l Ovarian reserve

7. How do you estimate the level of the AMH? A.Low B.Very low C.Normal D.High

8. How do you estimate the level of the AMH? A.Low B.Very low C.Normal D.High AMH ≤ 5.4 pmol/l (low reserve) AMH ≥ 25 pmol/l (risk OHSS) NICE guideline 2013

9. What is the diagnosis in this patient? A.Premature ovarian insufficiency B.PCOS C.Unexplained infertility D.Oligomenorrhea for thyroid dysfunction

10. What is the diagnosis in this patient? A.Premature ovarian insufficiency B.PCOS C.Unexplained infertility D.Oligomenorrhea for thyroid dysfunction

11. Which treatment do you propose in this case? A.IVF B.ICSI C.Programmed intercourses with gonadotropin ovarian stimulation D. PGS

12. Which treatment do you propose in this case? A.IVF B.ICSI C.Programmed intercourses with gonadotropin ovarian stimulation D. PGS

13. What do we forget? …remember the family history: the father has a type II diabetes A.To perform an oral glucose tolerance test (OGTT) B.To perform a cholesterol test C.To perform a triglycerides test D.None of above

14. What do we forget? …remember the family history: the father has a type II diabetes A.To perform an oral glucose tolerance test (OGTT) B.To perform a cholesterol test C.To perfor a triglycerides test D.None of above

15. How do you stimulate the patient? A. Clomiphene citrate 50 mg B. FSH/HMG 25 U-37.5 U C. FSH/HMG 75 U D. FSH/HMG 150 U

16. How do you stimulate the patient? A. Clomiphene citrate 50 mg B. FSH/HMG 25 U-37.5 U C. FSH/HMG 75 U D. FSH/HMG 150 U

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27. 27 LH 59.4

28. 1973841

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