Master the board step 3

Master the Boards: USMLE Step 3
Unexplained Infertility
The semen analysis is normal, ovulation is confirmed, and patent oviducts
are noted. No treatment is indicated, and approximately 60 percent of patients
with unexplained infertility will achieve a spontaneous pregnancy within the
next 3 years.
In Vitro Fertilization
1. Eggs are aspirated from the ovarian follicles using an ultrasound-guided
transvaginal approach.
2. They are fertilized with sperm in the laboratory, resulting in the formation
of embryos.
3. Multiple embryos are transferred into the uterine cavity with a cumulative
pregnancy rate of 55 percent after 4 IVF cycles.
Gestational Trophoblastic Disease (GTN)
This is an abnormal proliferation of placental tissue involving both the cytotrophoblast
and/or syncytiotrophoblast. It can be either benign or malignant.
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GTN is most common in Taiwan and the Philippines. Other risk factors are
maternal age extremes (< 20 years old, > 35 years old) and folate deficiency.
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The most common symptom is bleeding < 16 weeks gestation and passage
of vesicles from the vagina. Other symptoms of a molar pregnancy include
hypertension, hyperthyroidism, and hyperemesis gravidarum and no fetal
heart tones appreciated.
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The most common signs are fundus larger than dates, absence of fetal
heart tones, bilateral cystic enlargements of the ovary (theca-lutein cysts).
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The most common site of distant metastasis is the lungs.
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