What are the high-yield topics in reproductive health that I should focus on for the USMLE (United States Medical Licensing Examination) Step 1?

High-Yield Reproductive Health Flashcards for USMLE Step 1

The most effective way to prepare for reproductive health questions on USMLE Step 1 is through comprehensive flashcards covering pathophysiology, pharmacology, and clinical correlations with mnemonics for rapid recall. 1

Male Reproductive System

Spermatogenesis

• Stages: Spermatogonia → Primary spermatocyte → Secondary spermatocyte → Spermatid → Spermatozoa
• Mnemonic: "Some People Study To Succeed" (Spermatogonia, Primary, Secondary, Spermatid, Spermatozoa)
• Time: Complete process takes ~74 days
• Hormonal control: FSH stimulates Sertoli cells; LH stimulates Leydig cells to produce testosterone

Male Infertility Evaluation

• Normal semen parameters:
  • Volume: 1.5-5.0 mL
  • pH: >7.2
  • Sperm concentration: >20 million/mL
  • Total sperm count: >40 million per ejaculate
  • Motility: >50%
  • Forward progression: >2 (scale 0-4)
  • Morphology: varies between criteria 1
• Mnemonic for causes: "VINDICATE" (Vascular - varicocele, Infectious - orchitis/epididymitis, Neoplastic - testicular cancer, Degenerative, Intoxication - alcohol/drugs, Congenital - Klinefelter's, Autoimmune, Traumatic, Endocrine - hypogonadism)

Varicocele

• Most common correctable cause of male infertility
• 90% occur on left side due to left testicular vein drainage into left renal vein
• "Bag of worms" on palpation
• Treatment indicated when associated with abnormal semen parameters 1

Female Reproductive System

Menstrual Cycle

• Phases: Menstrual → Proliferative (Follicular) → Secretory (Luteal)
• Mnemonic: "Menstruation Produces Secretions"
• Hormones: FSH/Estrogen dominate follicular phase; LH/Progesterone dominate luteal phase
• Mnemonic for hormones: "For Females, Estrogen Levels Peak Before Ovulation" (FSH, Estrogen, LH, Progesterone)

Ovulation

• Occurs on day 14 of a 28-day cycle
• Signs: Mittelschmerz, increased basal body temperature, cervical mucus changes (becomes clear, stretchy - "spinnbarkeit")
• Mnemonic: "OVUM" (On the 14th day, Vaginal mucus changes, Uterine tubes capture egg, Mittelschmerz pain) 2

Female Infertility

• Definition: Failure to conceive after 12 months of regular unprotected intercourse
• Earlier evaluation: After 6 months if woman >35 years, history of oligo-amenorrhea, suspected uterine/tubal disease, endometriosis, or male subfertility 2
• Mnemonic for causes: "OVARIES" (Ovulatory dysfunction, Vascular issues, Age-related decline, Reproductive tract abnormalities, Immunologic factors, Endocrine disorders, Systemic diseases)

Contraception

Hormonal Contraceptives

• Combined OCPs: Contain estrogen + progestin
• Mechanism: Inhibit ovulation, thicken cervical mucus, thin endometrium
• Effectiveness: 91% with typical use, 99% with perfect use
• Contraindications: "ACHES" mnemonic - Abdominal pain, Chest pain, Headaches (severe), Eye problems, Severe leg pain 3

Non-hormonal Methods

• Copper IUD: >99% effective, lasts 10+ years
• Barrier methods: Male condom (82% typical use), Female condom (79% typical use)
• Fertility awareness: 76-88% typical use
• Mnemonic for effectiveness: "LARC is a STAR" (Long-Acting Reversible Contraceptives are Superior To All Remaining methods) 2

Sexually Transmitted Infections

Chlamydia

• Most common bacterial STI in the US
• Presentation: Often asymptomatic; can cause urethritis, cervicitis
• Complications: PID, infertility, Reiter's syndrome
• Treatment: Azithromycin or doxycycline
• Mnemonic: "CHLAMYDIA" (Causes Harmful Lasting Affects Making Your Daughters Infertile Always)

Gonorrhea

• Presentation: Purulent discharge, dysuria; often asymptomatic in women
• Complications: PID, epididymitis, disseminated infection
• Treatment: Ceftriaxone + azithromycin (due to resistance concerns)
• Mnemonic: "GC DRIP" (Gonococci Cause Discharge, Redness, Inflammation, Pain)

Syphilis

• Stages: Primary (chancre), Secondary (rash, condylomata lata), Latent, Tertiary
• Mnemonic for progression: "Some People Have Syphilis Longer Than Others" (Spirochete, Primary, Secondary, Latent, Tertiary)
• Treatment: Penicillin G (all stages)

Reproductive Endocrinology

Hypothalamic-Pituitary-Gonadal Axis

• GnRH → Anterior pituitary → FSH/LH → Gonads → Sex hormones
• Mnemonic: "Gonads Need Releasing Hormones For Lasting Sexual Health"
• Negative feedback: Testosterone inhibits GnRH/LH in males; Estrogen/Progesterone inhibit GnRH/FSH/LH in females

Polycystic Ovary Syndrome (PCOS)

• Diagnostic criteria (Rotterdam): Need 2 of 3:
  1. Oligo/anovulation
  2. Clinical/biochemical hyperandrogenism
  3. Polycystic ovaries on ultrasound
• Mnemonic: "PCOS" (Periods rare, Cysts on ovaries, Obesity common, Signs of androgen excess)
• Treatment: Weight loss, OCPs, metformin, anti-androgens

Pregnancy

Early Pregnancy

• hCG: Doubles every 48-72 hours in normal pregnancy
• Implantation: 6-12 days after fertilization
• Ultrasound milestones: Gestational sac (5 weeks), Yolk sac (5.5 weeks), Fetal pole (6 weeks), Cardiac activity (6-7 weeks)
• Mnemonic: "FETUS" (Five weeks - sac, Extra week - yolk sac, Two more days - pole, Ultrasound shows heartbeat at seven weeks)

Preconception Care

• Folic acid: 400-800 mcg daily to prevent neural tube defects
• Immunizations: Update as needed, especially rubella, varicella
• Chronic disease management: Optimize control of diabetes, hypertension, thyroid disease
• Mnemonic: "FOLIC" (Folic acid, Optimize health, Limit toxins, Immunize, Control chronic conditions) 2

Reproductive Pathology

Testicular Tumors

• Seminoma: Most common, radiosensitive, excellent prognosis
• Embryonal carcinoma: Aggressive, produces AFP and hCG
• Choriocarcinoma: Very aggressive, produces hCG
• Teratoma: Contains elements from all three germ layers
• Mnemonic: "Some Embryos Create Terrible Yolk sacs" (Seminoma, Embryonal carcinoma, Choriocarcinoma, Teratoma, Yolk sac tumor)

Ovarian Tumors

• Epithelial: Most common (70%), includes serous, mucinous, endometrioid, clear cell
• Germ cell: Teratomas, dysgerminomas, yolk sac tumors
• Sex cord-stromal: Granulosa-theca cell, Sertoli-Leydig cell
• Mnemonic: "Every Good Student Earns Success" (Epithelial, Germ cell, Sex cord-stromal)

Breast Pathology

• Fibrocystic changes: Most common benign breast condition
• Fibroadenoma: Most common benign tumor in women <30
• Ductal carcinoma: Most common malignant tumor (80%)
• Risk factors: "HER BREAST" (Hormone exposure, Early menarche, Radiation, BRCA mutations, Race, Environmental factors, Age, Sex, Tissue density)

Pharmacology

Estrogens

• Mechanism: Bind estrogen receptors, promote female secondary sex characteristics
• Uses: OCPs, hormone replacement therapy
• Side effects: "ESTROGEN" (Endometrial hyperplasia, Stroke risk, Thromboembolism, Retention of fluid, Obesity risk, Gallstones, Elevated BP, Nausea) 3

Progestins

• Mechanism: Bind progesterone receptors, oppose estrogen effects on endometrium
• Uses: OCPs, emergency contraception, abnormal uterine bleeding
• Side effects: "PROGESTINS" (Period changes, Retention of fluid, Oily skin/acne, Glucose intolerance, Emotional changes, Spotting, Tenderness of breasts, Increased appetite, Nausea, Sleepiness)

Selective Estrogen Receptor Modulators (SERMs)

• Examples: Tamoxifen, raloxifene, clomiphene
• Effects: Mixed agonist/antagonist effects depending on tissue
• Mnemonic: "SERM" (Selective Effects on Reproductive Modulators)
• Tamoxifen: Antagonist in breast, agonist in endometrium (↑ cancer risk)
• Raloxifene: Antagonist in breast and endometrium, agonist in bone
• Clomiphene: Antagonist at hypothalamus → ↑ FSH/LH → induces ovulation

Clinical Correlations

Amenorrhea

• Primary: No menses by age 16 or by age 14 with no secondary sexual characteristics
• Secondary: Absence of menses for >3 cycles or 6 months in previously menstruating woman
• Mnemonic for causes: "PERIODS" (Pregnancy, Endocrine disorders, Reproductive tract abnormalities, Iatrogenic, Ovarian failure, Dysfunction of hypothalamic-pituitary axis, Stress/weight loss)

Preeclampsia

• Diagnostic criteria: Hypertension (≥140/90) after 20 weeks + proteinuria or end-organ damage
• Risk factors: "PREECLAMPSIA" (Primigravida, Renal disease, Extreme ages, Ethnicity (African American), Chronic hypertension, Lupus/autoimmune, Antiphospholipid syndrome, Multiple gestation, Preexisting diabetes, Severe obesity, Infertility treatment, Angiogenic factors imbalance)

Ectopic Pregnancy

• Risk factors: "ECTOPIC" (Endometriosis, Chlamydia/PID, Tubal surgery, Operations (pelvic), Previous ectopic, IUD, Congenital abnormalities)
• Classic triad: Abdominal pain, amenorrhea, vaginal bleeding
• Diagnosis: Transvaginal ultrasound + quantitative hCG
• Treatment: Methotrexate (if stable) or surgery

Remember to focus on these high-yield topics and use the mnemonics to quickly recall information during your USMLE Step 1 exam. Good luck with your studies!