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Re: ovarian reserve and PCOS From: Rafael Haciski (haciski@earthlink.net) Thu Aug 14 20:05:31 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "Re: OBSERVATION VISITS" Previous message: Rafael Haciski: "Re: injection teaching nursing visits" In reply to: ivan valencia: "ovarian reserve and PCOS" Next in thread: Mark Perloe: "Re: ovarian reserve and PCOS" Your diagnosis is correct. But whether she has PCOS or not is really not that important (although technically speaking if she has signs of anovulation/oligo-ovulation and clinical or laboratory evidence of elevated androgens, then diagnosis of PCO applies - no further confirmation necessary). What is important is that she is not ovulating (or doing so irregularly) and she would need ovulation induction. Assuming they do not want donor insemination, sperm aspiration from the male and ICSI may indeed be the best route, however the question of early ovarian failure arises. When was the FSH obtained? Was this really CD 3? In irregularly bleeding woman (with 15 day interval sometimes) you may have picked a "bad" time for the testing. Could she have been caught by sheer luck during her own LH surge? That is best clarified by obtaining follow-up FSH, E2, and P4 levels 1 week later - if that was the midcycle surge, then P4 should be in the ovulatory range and FSH will come down, if not, FSH will still be high, and E2 low, and P4 anovulatory. I would opt for OCP suppression to regulate menses and suppress androgens, and then remeasure the FSH 3-4 days after the last active pill (or on the third day of ensuing menses). Lately I have also utilized inhibin B as an adjunct in helping with ovarian reserve. I do not use CCT, although that is an option as well (which I would also apply after OCP suppression of 1-2 months). And she will benefit from a little Synthroid. -- Rafael Haciski, MD FACOG Gynecology & Infertility Associates Baltimore, MD 410-825-0020 On Thursday, Aug 14, 2003, at 00:39 US/Eastern, ivan valencia wrote: > I have a case I want to share with you and I will appreciate some > comments. She is a latinamerican 34 years old lady who comes to the > office because of primary infertility of 6 years duration and very > irregular menstrual cycles (every 15, 30 and 60 days). Her partner had > a vasectomy (second marriage)and they are willing to have a PESA-ICSI > cycle. She have mild hirsutism and no acne complaints. BMI 26. > Vaginal > ultrasound and saline enhanced vaginal ultrasound normal. No PCO > ultrasound morphology. Ovaries normal size. Her day 3 labs are as > follows: > TSH 5,2 (normal less than 4) > Testosterone 130 (normal less than 60) > Prolactin 18 (normal less than 25) > Glucose tolerance challenge test normal. > FSH 16,5. Because this result was not expected we repeated it and came > 18.5 the same day. (normal less than 12). > Clinically we diagnosed PCOS and mild thyroid failure. However, the > elevated FSH levels suggest incipient ovarian failure. Now, the > irregular menstrual cycle is because PCOS or she is experiencing > premature ovarian failure? Would she benefit instead of oocyte > donation? > Are ovarian reserve testing realible in PCOS? > Your comments will be greatly appreciated. > Ivan Valencia MD > CEMEFES > Portete 600 y Abascal > Quito Ecuador > Next message: Garry E. Siegel, M.D.: "Re: OBSERVATION VISITS" Previous message: Rafael Haciski: "Re: injection teaching nursing visits" In reply to: ivan valencia: "ovarian reserve and PCOS" Next in thread: Mark Perloe: "Re: ovarian reserve and PCOS"

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