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Re: anovulationFrom: Shankar Periasamy (shankar@pc.jaring.my)Mon Mar 23 09:00:39 1998
>A 25-year-old women....... >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.
>Questions:
>1) Assume that 4 more months go by like this, without pregnancy, so that we're There is no fixed rule that one has to wait for 12 months to be diagnosed as subfertile. Even 6 months is good enough, provided the age of the female partner taken into consideration. For eg a 36 yr old female seeking treatment for infertility after 6 months of unprotected coitus and unable to conceive. It has to be flexible. The couples could be evaluated and the active treatment may be defered.
>2) When the patient asks "*Why* do I not ovulate?", what would be your It is easy to say "idiopathic". But with the help of molecular genetics, many unexplained cases could be explained. For eg premature ovarian failure, delayed puberty, etc are shown to exhibit defective FSH-receptor hormone gene defects. (Ref Aittomoki and Layman)
> Would this be enough to diagnose anovulation as the cause, or would you Serum progesterone assay, Em Bx for ovultory/anovultory cycles. HSG for evaluation of tubes and the uterus.
>I'd go ahead and start her on clomiphene - if anovulation is the only It depends on what technique is planned to hepl her conceive. If ovulation induction + timed SI, or ovulation induction + IUI, then clomiphene citrate should suffice. If ART is planned CC would not be of much help. Think in terms hMG or FSH-HP. (after evaluating the tubes!)
>......over-diagnosis and over-treatment with its consequent risk of multiple Basic evaluation could be done, but defer treating the couple. Shankar
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