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Re: Infertility Patient**Attention Repro Endos**From: Laurie Lovely (llovely@med.unc.edu)Fri Oct 31 16:03:50 1997
At Wed, 29 Oct 1997, Garry E. Siegel, M.D. wrote:
>Long history of infertility with records, This is an interesting case that points out that there is an underlying fertility rate in these patients (something we know but often forget).
>Her cycles are 24 to 25 days, previously 28 days, and her mother had Worrisome, as you know.
>1. With the 2nd period after this event resolves, she'll do an FSH, LH, Okay. I would add estradiol (if it's elevated, it can lower FSH and falsely reassure you as to ovarian function). Also, she's 38; why wait for two periods?
>2. If these are within reason (ie the FSH isn't too high, such as 12 or This depends on your assay. (Leeco, IMX, Abbott). We use Abbott and levels >18 are abnormal. Also, would she still want to try to get pregnant, no matter what her chances as indicated by FSH and/or Clomid challenge test screening?
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) okay.
>3. After the above, if all is "go", that her husband have a Semen Or S.A. first. could be abnormal, even if they just were pregnant. And if it's really abnormal and her best chances are ICSI vs. donor sperm, do they want to continue? If it is, and they don't, you save her the HSG expense, pain, small risk of infection.
>4. That she get an appointment with the local Repro guy after the above Yeah cool. Sounds like this couple have a lot of decisions to make, as they will likely be COH/IUI candidates vs. IVF candidates. I will be interested to hear what the "real" RE folks on this list think.
-- Laurie Lovely, MD RE fellow, UNC-Chapel Hill
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