Luteal support in reproduction—Pretest (optional)

The editors of Sexuality, Reproduction & Menopause would like insight into your current knowledge of luteal support in reproduction. Your answers to these questions are anonymous and are not linked to your name or CME posttest score.

1) The luteal-placental shift for progesterone production in pregnancy occurs at approximately what gestational age (weeks from last menstrual period)?

12710416

2) Which of the following formulations of progesterone was shown to prevent miscarriage as described in a recent Cochrane review?

vaginal capsulesintramuscularvaginal insertsoralnone of the above

3) Endometrial biopsy should be performed for women with polycystic ovarian syndrome in order to detect:

Out-of-phase endometriumLeukocyte infiltrationEndometrial hyperplasia or cancerStromal edemaBasal vacuolation

4) Progesterone is typically preferred over hCG for luteal phase support of IVF cycles because:

Clinical pregnancy rates are higher with progesteroneLive birth rates are higher with progesteroneThe incidence of ovarian hyperstimulation syndrome is lower with progesteronePatients prefer vaginal administration of progesterone over injections of hCGhCG is not FDA-approved for luteal phase support

5) Acceptable formulations for luteal phase support of IVF cycles include:

Intramuscular progesterone, vaginal progesterone inserts or vaginal progesterone gelIntramuscular progesterone onlyVaginal progesterone inserts onlyVaginal progesterone gel onlyOral progesterone

6) A 26-year-old G2 P1 woman is seen in the emergency room with a history of 6 weeks of amenorrhea. She complains of severe right lower quadrant pain, nausea, vomiting, dizziness, and rectal pressure. A urine hCG is positive. Pelvic ultrasound reveals peritoneal fluid in the cul de sac, an intrauterine gestational sac with fetal heart motion, a 9 cm right ovarian cyst without Doppler demonstrated blood flow, and a normal-sized left ovary. She is taken to laparoscopy for a possible torsion of her right ovary. Just before anesthesia induction, she requests everything possible be done to save the pregnancy. During pregnancy, the major source of progesterone at 6 weeks gestation is:

PlacentaYolk sacCorpus luteumFetal adrenal

7) Following the case study in the question above, findings at the time of surgery show a right ovarian torsion and the ovary is untwisted on its pedicle. The ovarian tissue turns from pale gray to pink in color. Your next step would be to administer:

EstradiolhCGProgesteroneGlucocorticoidTerbutaline

8) A 29-year-old G0 is seen for intermittent vaginal bleeding and spotting for 3 weeks. She is obese, has irregular menstrual cycles, and complains of acne and increased facial hair. Her last previous spontaneous menses was 8 months ago. Urine hCG is negative. Pelvic ultrasound reveals an endometrial thickness of 22 mm with bilateral enlarged multicystic ovaries. The next best step in the management of the above patient is:

Progestin challengeBirth control pillsDepo-medroxyprogesterone acetateEndometrial biopsyMetformin

9) For the obese patient desiring contraception (with the same findings as in the previous question), which therapy reduces the incidence of endometrial hyperplasia and offers the best contraception?

Long-cycle birth control pillsDepo-medroxyprogesterone acetateProgestin-only pillContraceptive patchCombination birth control pills

10) A 37-year-old G0 is undergoing an IVF treatment cycle with a regimen of leuprolide, rFSH, and progesterone luteal phase supplementation. She is accepting of the treatment regimen but wants to know why the progesterone medication is necessary given that she has more than 10 follicles during the retrieval. Relative progesterone deficiency may occur in IVF cycles because of:

FSH-only stimulationPoor ovarian response to hCG triggerAnesthesia for oocyte retrievalPituitary down-regulation by GnRH analogsStress associated with IVF procedures