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Re: ovarian reserve and PCOS From: ivan valencia (imvll@hotmail.com) Sun Aug 31 22:04:57 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: ivan valencia: "Re: ovarian reserve and PCOS" Previous message: DR.BELAL HOSSAIN: "Nigerian money" In reply to: Steve & Eryl Raymond: "Re: ovarian reserve and PCOS" Next in thread: Rafael Haciski: "Re: ovarian reserve and PCOS" The lady I presented is oligomemorreic and sometimes amenorreic, clearly anovulatory. Presents mild hirsutism and a testosterone level 2 DS above the normal value, clearly Hiperandrogenemia. Anovulation is defined as less than 6-8 cycles per year. In America is not usually neccesary to have PCO ultrasound morphology for making the diagnosis. LH/FSH ratio is not need to be present because it is not sensitive as many PCOS patients have normal ratios. 17OH progesterone normal. No indication for Cushing syndrome testing (no striae, no hypertension, no obesity). She is going to have a controlled ovarian stimulation for ICSI anyway so using Clomid or tamoxifen will not help me predict if she is going to be cancelled because of low response. Day 3 FSH levels greater than 10 and specially above 15 are associated with a great chance to cancel the cycle and a low pregnancy rate during ART. At Thu, 14 Aug 2003, Steve & Eryl Raymond wrote: > >You would find it helpful to do a day 21 progesterone with LH and FSH. > If she has an anovulatory PRG and the LH is greater than the FSH by a >factor of 2:1 or more then you can start thinking about PCO, but nothing >else that you have posted is really indicative of PCO. On day 3 her FSH >would be elevated as it is still within the menstruation. In the end >you may find it easier to give her Clomiphene or Tamoxifen and see what >her response is on a day 21 Progesterone. >Steve > >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 >> >-- >S.H. Raymond FRCOG >Principal Specialist >Department of Obstetrics & Gynaecology >Empangeni Hospital >Private Bag X20005 >Empangeni >SOUTH AFRICA 3880 > >Phone: (+27)-35-9028560 >Fax: (+27)-35-7922596 > >"The greatest derangement of the mind is to believe in something because one wishes it to be so". René Dubos 1876. > Next message: ivan valencia: "Re: ovarian reserve and PCOS" Previous message: DR.BELAL HOSSAIN: "Nigerian money" In reply to: Steve & Eryl Raymond: "Re: ovarian reserve and PCOS" Next in thread: Rafael Haciski: "Re: ovarian reserve and PCOS"

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