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Re: Infertility Patient**Attention Repro Endos** From: Ricardo Savaris (savaris@orion.ufrgs.br) Thu Oct 30 05:48:03 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dr Naimish Patel: "Re: Infertility Patient**Attention Repro Endos**" Previous message: sohi@italob.fmed.uba.ar: "ergotamine" Maybe in reply to: Garry E. Siegel, M.D.: "Infertility Patient**Attention Repro Endos**" Next in thread: Dr Naimish Patel: "Re: Infertility Patient**Attention Repro Endos**" 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. >1. With the 2nd period after this event resolves, she'll do an FSH, LH, >TSH and Prolactin on day 3. Ask for PRL (pool) , dont need LH >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. TRy FSH challenge test. FSH on the 3rd and 10th day of the cycle, Clomiphene 100 mg from the the 5th til 9th day of the cycle, if the added result is higher than 25, it is ovarian failure. Dont waste time, ask for HSG directly, and check the slides personaly for tubal phymosis. Add to your investigation Chlamydia, P4 on day LH+ 4, 6, 8 (normal > 20) or a End. Biopsy on day 27 to check normal endometrial development. 3. After the above, if all is "go", that her husband have a Semen Analysis. Not necessarily, she already conceived from him, but if you want to ask for SA, ask it now. You should ask everything that it is important for your patient right now. If she has patent tubes and normal ovarian function, scan to check for no dominant follicle on the ovary, try to induce with CLOMIPHENE 100 mg from day 3-7, plus HMG on day 9, scan on day 10, if follicle >= 18 mm hCG and try IUI 24h and 40h after hCG -- Ricardo Savaris, MD, TEGO, MSc Porto Alegre, Brazil 55 51 3301354 Next message: Dr Naimish Patel: "Re: Infertility Patient**Attention Repro Endos**" Previous message: sohi@italob.fmed.uba.ar: "ergotamine" Maybe in reply to: Garry E. Siegel, M.D.: "Infertility Patient**Attention Repro Endos**" Next in thread: Dr Naimish Patel: "Re: Infertility Patient**Attention Repro Endos**"

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