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Re: anovulationFrom: George M. Grunert (grunert@icsi.net)Sun Mar 22 20:42:00 1998
> A 25-year-old women in otherwise perfect health has menses fairly regularly > every 13-17 days. No ovulation symptoms. Not technically infertile yet, but 8 > months of unprotected intercourse without pregnancy. Physical exam completely > normal. LH, FSH, TSH, prolactin all normal. This patient either has anovulation or mid-cycle bleeding - most likely the former with her lack of ovulatory symptoms. A single ultrasound should suffice to rule out an anatomic lesion (polyp or myoma) which would produce bleeding. If your diagnosis is anovulation, why make her wait 4 months to 'prove' infertility if your diagnosis means her chances of pregnancy in those 4 months are zero? Lets put the gonads on the other foot: if I were seeing you and your wife, you had not started trying, you were azospermic, and there was a treatment for your azospermia, would I be justified in telling you to wait a year so you'll be 'officially' infertile? I'd tell her you have ruled out significant endocrinopathies and that her problem was a lack of communication between the brain, pituitary, and ovaries leading to anovulation. I'd go ahead and start her on clomiphene - if anovulation is the only factor, there's a 75% chance of pregnancy in the first three ovulatory cycles. Along the way you can get a sperm count and do her HSG. If she's not pregnant, finish her workup and look for additional factors.
-- George M. Grunert, M.D. Director ART Program, Woman's Hospital of Texas 7550 Fannin Houston, TX 77054 713-512-7851 fax 713-512-7853 grunert@icsi.net
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