Case (23)

[Kassim]

Amino, a 27 year-old female come to your office complaining of long, painful, infrequent periods, and thinning hair. She had noticed excess hair growth in some part of her body.  Married when she was 19 years old, and been trying to have children since without any success.  Her menarche had been at the age of 13 and her periods had always been infrequent and irregular.  She had a family history of type 2 DM and was 1.62 m tall, weight is 73 kg.  She has a lot off pressure from her mother in-law because of her infertility; she is also worried because her husband is trying to get married. She wants to know what is wrong with her.
Physical examination was unremarkable.

What is the Diagnosis?

What investigation would you order (complete investigation to find out the cause of the infertility), which laboratory finding would confirm the diagnosis?

How would you treat this patient in the long time, knowing that the patient is trying to have children?

If she is not treated and continues to live like this, she is susceptible to develop what, and why?

What would you advice her to do?

[Diagnostic]

Diagnosis:
Polycystic Ovary Syndrome also known as clinically Stein-Leventhal syndrome

Investigation:
1- History (Clinical prediction is very important as they say: 4 Questions can diagnose PCOS with a sensitivity of 77%)
2- Hormonal assessments
3- The Gynecologic ultrasonography, specifically looking for ovarian cysts will confirm the diagnosis

Treatmen:
According to infertility problem I can start with clomiphene citrate and metformin which are the principal treatments used to help infertility, also diet adjustments and weight loss also increase rates of pregnancy.
if this didn't help surgery is usually the treatment option of last resort
then treat her hirsutism and restore regular menstruation.

If she left, she can develop endometrial cancer.

I will advice her not to worry about her condition.
Diagnostic

[Kassim]

Yes, that is the correct answer.
u r right u ultrasound will confirm the diagnosis. LH/FSH ratio 3to1 is more sensitive.
Regarding causes of infertility, it’s also important to include the husband, even though she has PCOS, it doesn’t mean he is fine, we have to do semen analysis.
We can also do a hysterosalpingogram (HSG) to looks at the inside of the uterus and the fallopian tubes area around them. HSG can show problems such as an injury or abnormal structure of the uterus or fallopian tubes, or a blockage that would prevent an egg moving through a fallopian tube to the uterus. A blockage also could prevent sperm from moving into a fallopian tube and joining.
Correct Colomiphene and Meformine are the principle, but if this doesn’t work, IUI will be the next step, if that fails after few cycles the last option will be IVF.

[Admin]

Case locked & 15 points goes to Diagnostic