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Infertility Patient**Attention Repro Endos**From: Garry E. Siegel, M.D. (garrys@mindspring.com)Wed Oct 29 21:09:23 1997
38 YO P 0013 (3 adopted), longstanding patient who was first seen in 1990 for an annual exam. Long history of infertility with records, worked up elsewhere by RE, with a normal SA, normal HSG, normal ovulatory function. 1984 scope (op note) suggested endo, and laparotomy was done with biopsies of one ovary and mesosalpinx, both negative for endo. Subsequently went to Pergonal, didn't conceive, and never opted for IVF. Low and behold, she just came in spotting, and had an abnormal pregnancy which resolved spontaneously with a peak HCG of 244, and a progesterone of less than 5. No location was ever deteremined. She now wishes to reassess her situation, and based on an evaluation, she may pursue a pregnancy again. Her cycles are 24 to 25 days, previously 28 days, and her mother had menopause by 40. I have suggested the following plan; what do ya'll think? 1. With the 2nd period after this event resolves, she'll do an FSH, LH, TSH and Prolactin on day 3. 2. If these are within reason (ie the FSH isn't too high, such as 12 or 15 or what?), proceed to an HSG since she a) might have had a recent tubal pregnancy, and b)her tubes haven't been assessed in years , and c) her tubes haven't been assessed since her laparotomy. 3. After the above, if all is "go", that her husband have a Semen Analysis. 4. That she get an appointment with the local Repro guy after the above is in. Thanks
-- Garry E. Siegel, M.D., FACOG Private Practice Roswell, Ga.
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