Re: ovarian reserve and PCOS
From: ivan valencia (imvll@hotmail.com)
Sun Aug 31 22:16:27 2003
17 OH progesterone levels normal. However, just in case this patient
have CAH this would no explained the high Day 3 FSH value (Menstruation
was programmed with oral Provera) and it will not affect the controlled
ovarian stimulation for ICSI. Do you thing Avandia works as well as
metformin in terms of reproductive outcome? Would you recommend a Clomid
challenge test? Is the CCCT reliable in PCOS? Have you try letrozole
instead of clomid for ovarian reserve testing? Inhibin B will low FSH
levels.
I will appreciate your comments very much.
Ivan
imvll@hotmail.com
At Sat, 16 Aug 2003, Mark Perloe wrote:
>
>PCOS and diminished reserve would be independent conditions, although
>androgens drop as ovarian function diminishes. In the absence of PCO
>appearance, I would check a 17hyrdroxyprogesterone in the follicular phase
>to rule out adrenal hyperplasia. Observation at intervals may reveal
>increasing androgen levels suspicious of a tumor. An insulin glucose
>tolerance test may show relative hyperinsulinemia and merit diet and
>metformin treatment. Implantation may be reduced due to elevated androgens.
>SO that this would need to be normalized before oocyte donation is considered.
>
>At 11:39 PM 8/13/2003 -0500, you 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
>
>--
>Mark Perloe, M.D.
><http://www.ivf.com/>Georgia Reproductive Specialists
>IVF.com
>
>"no president since Herbert Hoover has actually lost jobs over the course
>of his term." Yet Bush has his eyes on that record.
><http://www.georgiaforwesleyclark.com>Draft General Wesley Clark, a
>necessary voice of common sense and moderation on the foreign policy front.
>
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