Y2 OCaPE: ESR 6 – infertility clinic

The inability to conceive after 2 years of regular intercourse (2)

What is meant by the term fecundity?

Reproductive capacity (2)

In the blood test, HbA1c is measured.

 What is HbA1c a measure of and what does this result suggest?

HbA1c is a measure of the glycation of haemoglobin over the last three months

HbA1c > 6.5% means the patient has diabetes.

A high HbA1c, indicates constantly high levels of blood glucose. (3)

You are quite concerned over Boberta’s blood tests results, so decide to take an ultrasound scan.

Can you describe what you see?

Ultrasound of the ovaries

High number of follicles/cysts (2)

Based on the blood tests and the ultrasound scan, what is the most likely diagnosis?

Polycystic Ovarian Syndrome (PCOS) (2)

The elevated HbA1c indicates Boberta has diabetes mellitus. Can you explain how type two diabetes can lead to the development of and the symptoms of PCOS?

Type 2 Diabetes can lead to an increased level of insulin in the blood (initially due to resistance) 

Insulin causes increased androgen production by binding to insulin/insulin-like growth factor-1 receptors in the ovaries.

Additionally, hyperinsulinaemia decreases the amount of SHBG (sex hormone binding globulin) produced by the liver. 

This results in less androgens being bound, and therefore and increase in free androgen concentration 

Hyperandrogenism in females can lead to ovarian follices/cysts,  male pattern hair growth, acne, hair loss and infertility. (5 marks)

Name two risk factors that put patients at risk for PCOS

TWO FROM:

-Obesity

-Diabetes

-Genetic Background

(2)

What treatment could you offer Boberta so she can have a baby?

Metformin

Clomifene – Selective oestrogen receptor modulator (SERM) – used to encourage ovulation 

IVF (2)