••• Chapter 54^ Infertility^541
❍ What is the treatment of infertile women with hyperprolactinemia and anovulation?
Bromocriptine 2.5 to 7.5 mg daily or cabergoline 0.25 to 1 mg twice a week.
❍ When should prolactin levels be retested after beginning dopamine agonist therapy?
4 weeks after initiating therapy or changing the dosage.
❍ What imaging study is used for the diagnosis of a prolactinoma?
MRI of the sella turcica.
❍ What percentage of women will ovulate after establishment of euprolactinemia?
80%.
❍ What BMI is associated with an increased risk of ovulatory infertility?
❍ What is the mechanism by which anorexia nervosa causes anovulation?
Hypothalamic amenorrhea, decreased follicle stimulating hormone (FSH) and luteinizing hormone (LH) with
apulsatile or low-amplitude, low-frequency pulsatile hormone secretion.
❍ The most common ovarian causes of anovulation are?
Ovarian failure and polycystic ovary syndrome (PCOS).
❍ How can you test for ovulation in women with regular menses?
(1) Progesterone level 1 week before expected onset of menses.
(2) Basal body temperature (BBT) increase occurs 24 hours after ovulation, useful for establishing a pattern.
(3) LH predictor kits predict ovulation within 24 to 48 hours from the time of the surge, best if use kit with first
morning void when urine is most concentrated, testing is then repeated late afternoon/early evening, good
timing for intercourse or intrauterine insemination (IUI), and false-positive tests occur in 7% of cycles.
(4) Serial transvaginal ultrasound (TVUS) provides the most reliable estimate for detecting when ovulation occurs.
(5) Endometrial biopsy (EMB)-anovulatory women are always in the proliferative phase, secretory endometrium
implies ovulation in the absence of exogenous progesterone/synthetic progestin, also important in patients with
irregular menses to rule out hyperplasia and to diagnose endometritis.
❍ What is a luteinized follicle?
An unruptured follicle, ovulatory women trying to conceive should be advised to limit nonsteroidal anti-
inflammatory drug (NSAID) use to the menstrual phase of the cycle due to suspected interference with normal
ovulation; NSAIDs predispose patients to a luteinized or unruptured follicle.
❍ What is clomiphene citrate (CC)?
A nonsteroidal estrogen agonist/antagonist.