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Tuesday, May 1, 2012

Quiz Case
Infertility Centre

A 32 yrs. old healthy looking, actively working for women development lady visits Infertility Centre with complaints of missed period for about three months. She also complained of no issue with eight years of married life. She does not have any significant medical history. In the menstrual history, she got her menses at the age of sixteen. Since then, the cycle is irregular which comes at the interval of 40 days to 10 months period. During menses she has very scanty flow for about four days. She often has abdominal discomfort during flow period. She has two sisters who were not married. She does not smoke nor drinks.
Her husband 33 yrs old, physically active & has one elder brother who has two children. He drinks alcohol only during weekend but does not smoke.
 Physical examination of the lady: General look fair; weight = 48kg; height = 5'2''; B.P. 110/70mmHg. She had normal female type hair growth, normal breasts & female type voice. Pelvic examination showed normal vulva & vagina. Per speculum examination showed the cervix was normal size but little pale. On per manual examination, uterus  anteverted, normal sized, adnexae free. Thus she was found to be a physically a normal lady.
Hemogram: HB = 10.8; TC = 7000; N = 68 ; L = 20; E = 7 ; M = 5 ; ESR = 16 mm/hr
Urinanalysis: Nothing significant
Hormone profile on D2: FSH = 43.1mIU/ml; LH = 6.4 mIU/ml; Prolactin = 112.9; Estradiol = 16.6 pg/ml; TSH = 2.0 mIU/ml
Her HSG showed patent both fallopian tubes.
Basal ultrasound with transvaginal probe showed both ovaries with immature follicles. The uterus was slightly small in size with midline endometrium.
This lady was treated only for two cycles for conception. She has a healthy baby boy & is living very happy life. 
Can anyone outline the treatment for her conception?