Reproduction 401: What every ob/gyn needs to know

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Fertility evaluation/treatments, menopausal transition and common endocrine disorders are three areas of reproduction that all ob/gyns should be well versed in, according to a course dubbed “Reproduction 401” at the 2019 American College of Obstetricians and Gynecologists (ACOG) annual clinical and scientific meeting in Nashville.

“These are important topics that patients expect their ob/gyn to be cognizant about, both pregnancy-related and non-pregnancy-related,” said moderator Christos Coutifaris, MD, PhD, a professor of ob/gyn at the University of Pennsylvania in Philadelphia. “For example, thyroid disease in women is fairly common. Our specialty needs to know how to identify and approach the disease-whether the patient is interested in pregnancy or not interested in pregnancy.” 

For fertility, patients ask about their likelihood of achieving a pregnancy, the timetable and influence of age.

“From a medical point of view, it would be ideal to have screening methods to evaluate ovarian reserve of women as they age, and therefore to be able to give them feedback as to how many fertile years they have left,” Dr. Coutifaris told Contemporary OB/GYN. “With women nowadays postponing childbearing, this is particularly important. Unfortunately, such testing does not exist. Nevertheless, the community and the lay press promote approaches and tests that claim to be able to predict the reproductive potential for women as they age.”

Dr. Coutifaris said it is important for ob/gyns to know what reproductive predictors are available and their limitations. Meanwhile, the patient’s general health and hormonal conditions that may impact the chances of becoming pregnant need to be addressed. 

As women approach menopause, numerous changes occur in their physiology, and their medical management starts changing. “These women require guidance and sometimes therapy for abnormal bleeding or hot flashes, for instance,” said Dr. Coutifaris, immediate past president of the American Society for Reproductive Medicine (ASRM), which collaborated with ACOG on the reproductive course. 

“If women have no menopausal complaints, there are still issues to be addressed, like cardiovascular health and bone health, so there is a smoother transition into menopause,” Dr. Coutifaris said.

A woman of advanced reproductive age may also have an interest in achieving a pregnancy. “Is that an appropriate expectation?” he said.

A number of common endocrine conditions affect women, which an ob/gyn can identify and potentially manage initially before referring a patient to a subspecialist. 

“One of the most prevalent is thyroid dysfunction, with hypothyroidism being the most common, often occurring after the delivery of a child,” said Dr. Coutifaris, the presenter on endocrine disorders. “Frequently, the patient first becomes hyperthyroid, but in time becomes hypothyroid, a condition which affects many organ systems, including her reproductive system, and leads to decreased energy levels, fatigue, weakness, weight gain and other daily life-affecting symptoms.”

However, the signs and symptoms of thyroid dysfunction are frequently so slow-developing and subtle that a blood test is required to pinpoint and treat.

For non-pregnant women, the guidelines recommend using hormone therapy to replenish thyroid hormone levels to their appropriate levels, followed by periodic monitoring. 

But for pregnancy, the guidelines are more stringent as to the amount of thyroid replacement. “During pregnancy, demands for thyroid hormones increase dramatically,” Dr. Coutifaris said. “Hence, close monitoring and adjustment of the treatment doses are necessary for good outcomes for both the mother and her baby.” 

Disclosures:

Dr. Coutifaris reports no relevant financial disclosures.