542 Obstetrics and Gynecology Board Review •••
❍ What is the initial dose of CC?
50 mg for 5 days starting on day 3, 4, or 5 of the cycle.
50% of women will ovulate at the 50-mg dose.
❍ How is ovulation induction with gonadotropins performed?
Start FSH or LH/FSH at 75 IU or 150 IU daily starting day 2 or 3 of a cycle. Measure estradiol at day 6 or 7 and
if adequate (500–1500 pg/mL) perform TVUS until diameter of largest follicle is 16 to 18 mm. Then administer
5000 to 10,000 IU of human chorionic gonadotropin (hCG) and around the time of intercourse or insemination.
❍ Who should be evaluated for diminished ovarian reserve (DOR)?
Infertile women over 35 years of age, women who have a family history of early menopause, women with a history
of ovarian surgery or chemotherapy/radiation treatment, or women who are smoker or have a long history of
smoking.
❍ What causes an elevation in FSH?
Decreasing feedback inhibition from a shrinking follicular pool.
❍ What does an elevated FSH result in?
As FSH levels rise, the follicular phase shortens because FSH stimulates a more rapid follicular development and
estradiol levels rise earlier in the cycle.
❍ What is the menopausal transition?
Marked by onset of irregular cycles, average age is 46 but ranges between 34 and 54; when this occurs, menopause
can be expected in 5 to 6 years.
❍ What is DOR?
Currently, there is no accepted definition of DOR; however, ovarian reserve tests screen for those at risk of lower
than expected fertility potential.
❍ Are screening tests^ diagnostic for DOR?
No. They are used to identify women more likely to have a poor response to gonadotropin stimulation.
Testing should be limited to women at risk of DOR to maximize positive predictive value (PPV) and maximize
specificity to avoid false-positive test results that would categorize a woman with normal ovarian reserve as
having DOR.
❍ What is the most effective treatment of DOR?
In vitro fertilization (IVF) with donor egg.