Womens Health Elective PCOS/Infertility

Case 1
AB is a 30 yowf who presents to the clinic with complaints of irregular
periods. She states that her periods have been very irregular since
puberty, but it hasnt bothered her until now. She is attempting to use
a home ovulation kit in order to assess the best time to get pregnant,
but she is unable to determine her cycle length because of the
irregular nature of her periods. Her current medications include
hydrochlorothiazide 25 mg po qd and atorvastatin 40 mg po QHS.
You gather the following information from the visit:
PE:
Thick, dark upper lip hair - states that she has to wax frequently
Acne Severe acne on her face and back, has had since puberty and
has tried several medications/OTC items without success.
Height: 61 inches
130/85

Weight: 210 lbs

BMI: 39.7

BP

1. Which lab values would you need to consider when assessing the
possibility of PCOS in this patient?
A. Serum testosterone, LH and FSH, random glucose level
B. Serum testosterone, LH and FSH, and fasting
glucose level
C. Serum testosterone, serum estradiol, fasting glucose level
D. Serum testosterone, LH and FSH, progesterone
2. Which of the following treatment options would be the best choice
for this patients PCOS? Keep patient treatment goals in mind and
select all that apply.
A. Metformin
B. Elfornithine
C. Lifestyle Changes + clomiphene
D. Spironolactone
E. Oral contraceptives
3. True or False: If the patient stated that her symptoms (irregular
period, acne, hair growth) started within the past month rather than at
the onset of puberty, PCOS would still be the suspected cause.
A. True
B. False

A.
B.
C.
D.

4. Identify the correct statement regarding the pathophysiology behind

PCOS and infertility
Low LH inhibits follicle development
Low FSH inhibits follicle development
Too little estradiol decreases the release of FSH
High progesterone increases the frequency of menses
Case 2
Patient BC is a 30 yowf. She and her husband have been trying to have
a child for the past year and a half. Her husband has one child from a
previous marriage and she does not have any children of her own. She
has had an irregular period since puberty and has dark patches on her
neck and behind the knees. She presents to the clinic for an
evaluation.
PMH:
PCOS (x9 years diagnosis), hyperlipidemia, migraine headaches
Vitals:
BP 145/90
PE:
Dark and thick hair on neck and chinwaxes frequently
Dark patches on skin behind the knees
Height 5 2, Weight 250lbs
SH:
Married x 2 years, no children of her own, one stepchild
Lost job two years ago and has struggled to find work since, has
issues with income
Smoker PPD for almost 2 years (attributes to stress of job
loss/financial situation
Irregular period since puberty (age 13)
Medication List:
Atorvastatin 40 mg po QD
Sumatriptan 50 mg po at onset of headache as needed
5. After assessing the above information, would you conclude that the
couple is suffering from infertility? If so, which type?
A. Yes, primary infertility
B. Yes, secondary infertility
C. No, the issue is not infertility
6. Before she starts medication, BC is interested in trying some nonpharmacologic strategies to help her issue. Which of the following
would you suggest for her?
A. Management of high blood pressure

B. Weight loss
C. Stress management
D. Smoking cessation
BC returns to the clinic 6 months later. She has lost 25 pounds and has
quit smoking. She states that despite her lifestyle changes, she is still
having issues getting pregnant. The physician at the clinic decides to
start her on clomiphene to assist ovulation.
7. The physician tells you he remembers that clomiphene helps to
induce ovulation, but cant remember the mechanism. He also cant
remember the normal dose. Before he writes the prescription, what do
you tell him?
A. 1 tablet by mouth daily for 1 month; improves endometrium
quality for better implantation after ovulation
B. 2 tablets by mouth on days 5 9 of cycle to increase LH in order
to induce ovulation
C. 1 tablet by mouth on days 5-9 of cycle for enhancement
of follicle maturation and ovulation
D. 1 tablet by mouth on days 10-15 of cycle for enhancement of
follicle maturation and ovulation
8. BC is concerned about the potential side effects of this new
prescription. Which of the following side effects is most likely to occur
with clomiphene use?
A. Anemia
B. Vasomotor symptoms
C. Breakthrough bleeding
D. Weight gain
9. BC completed 4 cycles of clomiphene over her past 4 menstrual
cycles, but still has not had success in conceiving. Which of the
following is the best next step in therapy?
A. Continue on clomiphene
B. Switch to metformin
C. Switch to letrozole
D. Add hCG