Mgr university bsc nursing adult health previous question paper with answers
Premature ovarian failure (POF) by istan
1. PINAR ÖZCAN,MD, PHD, Associate Professor
ACIBADEM UNİVERSİTY MEDİCAL FACULTY
ACIBADEM MASLAK HOSPİTAL
DEPARTMENT OF OBSTETRİC&GYNECOLOGY
DİVİSİON OF REPRODUCTİVE ENDOCRİNOLOGY AND INFERTİLİTY
2. Ovarian reserve
the functional potential of the
ovary and reflects the number and
quality of the remaining follicles
and oocytes in both ovaries at a
given age
7. Primary ovarian insufficiency (POI), a clinical
syndrome, is defined by the exhaustion of the
functional potential of ovaries prior to 40
years of age.
POI is characterized by menstrual
disturbance (oligomenorrhea or amenorrhea),
with raised gonadotrophins, low estradiol
and low anti Mullerian hormone (AMH) levels
ESHRE Guideline, Hum Reprod 2016
8. The overall presumption regarding the
prevalence of POF is that occurs in 1–2% of
the general population
10. The diagnosis POI is based on the presence of
menstrual disturbance and biochemical
confirmation.
Although proper diagnostic accuracy in POI is
lacking, the GDG recommends the following
diagnostic criteria:
(i) oligo/amenorrhea for at least 4
months,
(ii) an elevated FSH level >25 IU/l on two
occasions >4 weeks apart
ESHRE Guideline, Hum Reprod 2016
18. Four of the following theoretical risks, infection of the endometriomas, follicular fluid
contamination with the endometrioma content, higher risk of pregnancy complications and
cancer development later in life. The first three conditions do not justify surgery because these
events are uncommon and the number of women needed to be treated would be exceedingly
high and would not justify the costs and risks of the intervention. The possibility of developing
ovarian cancer later in life is more troublesome because it is a life-threatening condition, this
risk can be effectively prevented by postponing surgery until after the IVF programme is
concluded or when women have definitely satisfied their reproductive wishes. The available
evidence on the risks of conservative management does not support systematic surgery before
IVF in women with small ovarian endometriomas.
Somigliana E, Human Reprod Update, 2015
19. Santilli P, Hum Reprod 2016
The objectives of these proposed strategies are: (i) first, to
avoid unnecessary surgical procedures, and especially
those contributing to damage ovarian reserve; and (ii)
second to perform ‘the endometriosis surgery’ at the
appropriate time. Ideally, patients should undergo surgical
treatment only once in their ‘endometriosis life’. In
particular, use of hormonal medical treatment in patients
with no immediate desire to conceive (with or without
infertility) allows delaying the surgical intervention at the
best time. Similarly, the place of ART in the treatment
sequence should be carefully considered. Currently, ART is
too often proposed at the end of the ‘infertility story’ after
several surgical procedures, especially for OMA
management. A main objective for the future would be to
identify those patients for whom there are benefits to
perform ART first, before the surgery.
21. There is no screening test that can be used alone
to accurately measure the residual pool of
primordial follicles and predict a woman’s
reproductive lifespan.
26. HRT is indicated for the treatment of symptoms of low
estrogen in women with POI
Women should be advised that HRT may have a role in
primary prevention of diseases of the cardiovascular system
and for bone protection
17-bestradiol is preferred to ethinyl estradiol or conjugated
equine estrogens for estrogen replacement
Women should be informed that whilst there may be
advantages to micronized natural progesterone, the strongest
evidence of endometrial protection is for oral cyclical
combined treatment
ESHRE Guideline, Hum Reprod 2016
40. Fetility preservation
Group for UTD guideline
Coordinator : Dr. L. Cem Demirel
Dr. Pınar Özcan
Dr. Volkan Turan
Dr. Enis Özkaya
Dr. Nuray Bozkurt
Dr. L. Cem Demirel
41. POI has widespread consequences for general
health and fertility
To investigate for the causes of POI
Assessment of risk for POI
Fertility preservation options
HRT is indicated for the treatment of symptoms of
low estrogen in women with POI at least until the
average age of menopause
Women should be advised that HRT may have a role
in primary prevention of diseases of the
cardiovascular system and for bone protection
