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Infertility Q

Discussion in 'Step I' started by pezzang, Apr 23, 2007.

  1. pezzang

    pezzang Senior Member 10+ Year Member

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    May 12, 2005
    If a patient gets overweight, shows excessive hair (no tumors) and can't get pregnant. What would be the cause of the presentations (infertility and hirsutism)? Which hormone in menstrual cycle should we test? Any help would be appreciated!:)
     
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  3. UCLAstudent

    UCLAstudent I'm a luck dragon! 10+ Year Member

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    PCOS --- do a pelvic ultrasound and measure blood levels of LH/androgens
     
  4. Idiopathic

    Idiopathic Newly Minted Lifetime Donor Classifieds Approved 10+ Year Member

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    Should be increased ratio of LH:FSH
     
  5. buddindoc

    buddindoc Senior Member 7+ Year Member

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    Kerala,India or PA,USA
    pcos.
    inc LH
    & i remember something about inc chances of berry aneurysm(dunno for sure):oops:
    As far as i know no treatment yet...other than wt loss ocp yada..yada
     
  6. blz

    blz Senior Member 10+ Year Member

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    you're confusing it with pckd which has a higher inc of berry aneurysms.
     
  7. buddindoc

    buddindoc Senior Member 7+ Year Member

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    Kerala,India or PA,USA
    :laugh: right on:laugh:
    blz is the MAN!!!
     
  8. UCLAstudent

    UCLAstudent I'm a luck dragon! 10+ Year Member

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    There are actually a good number of treatments. Clomiphene, metformin, and gonadotropins work for infertility. Spironolactone decreases male skin/hair effects like hirsutism and acne. Exercise and weight loss improve insulin resistance and facilitate normal ovulation. Birth control pills decrease male effects as well as restore normal menstruation.
     
  9. pezzang

    pezzang Senior Member 10+ Year Member

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    May 12, 2005
    How does the increased LH:FSH disable ovulation? Is it because aromatase is saturated to convert androgen to estrogen so more androgen is left behind causing hirtuism? When inc LH:FSH do you mean increased LH AND decreased FSH? Also how would insulin (weight loss) help gain her period back?
     
  10. blz

    blz Senior Member 10+ Year Member

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    constantly elevated LH levels eliminate the LH surge that results in ovulation. Weight loss isn't going to help with the anovulation. It's to increase her insulin sensitivty.
     
  11. pezzang

    pezzang Senior Member 10+ Year Member

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    May 12, 2005
    What about excess hair? is it due to accumulation of excessive androgen not being able to become converted to estrogen?
    -How could one distinguish this androgen from ovary and DHEA from adrenal cortex?
    -when we take a sample of LH and androgen, how freuqently and when do we take samples?
     
  12. blz

    blz Senior Member 10+ Year Member

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    The pathophysiology of PCOS is very complex and a lot of it is unknown. It is a mixture of hyperinsulinemia, increased testosterone and increased LH. Really, all you got to know are it's clinical presentation and laboratory findings.
     
  13. pezzang

    pezzang Senior Member 10+ Year Member

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    May 12, 2005
    So if I am a physician in OB/GYN and a patient with any infertility problems comes in, what is the first critical question that I should ask to determine fertility problem with the patient?
     
  14. joe6102

    joe6102 by the power of grayskull 5+ Year Member

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    Mar 31, 2005
    socal
    This is not a joke - make sure they are having sex correctly.
     
  15. BRUINMD

    BRUINMD New Member

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    Jun 2, 2006
    Maybe a demonstration will work?:D
     
  16. pezzang

    pezzang Senior Member 10+ Year Member

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    May 12, 2005
    make sense...:) any others?!
     
  17. pezzang

    pezzang Senior Member 10+ Year Member

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    May 12, 2005
    Any help would be greatly appreciated!
     
  18. monalisa83

    monalisa83 Junior Member 5+ Year Member

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    Jun 14, 2004
    First of all Infertility is diagnosed when pregnancy does not occur after 1 year of unprotected intercourse. I got this info from medscape if you want to read it :http://www.medscape.com/viewarticle/520088_4
    Tests:
    If the cycles are regular :early follicular phase FSH and estradiol levels to determine the FSH/estradiol ratio; measurement of inhibin B or anti-Müllerian hormone levels; or the early follicular phase antral follicle count are options Dynamic tests evaluate the ovaries during clomiphene citrate (CC) challenge or during gonadotropin-releasing hormone agonist (GnRHa) or gonadotropin stimulation.
    When the cycles are irregular, other hormonal measurements -- such as testosterone, dehydroepiandrosterone sulfate (DHEAS), 17-OH progesterone, cortisol, prolactin (PRL) -- as well as thyroid function tests and dynamic evaluation of pituitary function may be necessary for the infertility work-up. If the results of any of these tests are considered abnormal, conducting imaging studies (eg, MRI, CT, thyroid scan) may be the appropriate step.

    The above was from one source, so Im not sure if it represents the general rules. Of course you also want to do a semen analysis in the male and of course make sure they are actually having "intercourse".
     
  19. Idiopathic

    Idiopathic Newly Minted Lifetime Donor Classifieds Approved 10+ Year Member

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    PCOS is more a clinical diagnosis than a lab one. You will also have to consider cushing's, metabolic syndrome and thyroid abnormalities. Rx of choice for symptomatic relief is OCP. Obviously this wont help if you are trying to get pregnant.
     

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