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Re: REI:Pregnancy and Premature Ovarian FailureFrom: George M. Grunert (grunert@pop-server.icsi.net)Thu Apr 30 12:21:23 1998
> 31y/o G1P1001 hispanic female with a history of premature ovarian failure > who transferred care to me at 23 weeks gestation and went on to deliver a > viable female infant 12/97. Of note is the fact that the patient had a > diagnosis of Premature Ovarian Failure prior to her conceiving in 2/97. > Reviewing her old records (I will apologize ahead of time if her history > sounds disjointed because I am getting my info from her old records and > what the patient remembers.) revealed that she had been infertile since > 1993. She had been on clomid (up to 200mg) and after she had an FSH > 34.9 on 2/9/96; and an FSH 81.8 and LH 48.2 on 7/22/96, the clomid was > stopped and the patient was placed on Estrace (unopposed) for her hot > flashes. Because of irregular bleeding the patient stopped all > medications and somehow conceived in 2/97. > > Now she comes back to me complaining of hot flashes and FSH •.5miu/ml. > She wants to get pregnant and wants to know her chances of conceiving > again. > > Questions: How do I advise this patient? > Do I just treat her with Prempro? > > In Seibel's 2nd Edition of, "Infertility A Comprehensive Text," in > Chapter 4, page 64, (written by Shalom Bar-Ami, PhD), He writes, > "Sometimes estrogen treatment for several days followed by gonadotropin > treatment causes gonadal activity to resume at least temporarily, > although the diagnosis is still ovarian failure." (No references given) > > Does anyone know of such a "recipe" that works? This is always worth a try, but she's already making her own FSH by the ton. Chances are she conceived with her last living oocyte, but she could always have another one in there. Lightning does occasionally strike twice. PremPro, PremPhase, or estradiol+progesterone for HRT would all be fine.
-- George M. Grunert, M.D. Director, Assisted Reproduction Program Obststrical and Gynecological Associates 7550 Fannin Houston, Texas 77054 713-512-7851 fax 713-512-7853 grunert@icsi.net
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