24 year old married obese girl with this classical finding on USG. patient is planning a child. lets discuss management and diagnosis

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It is typical polycystic ovaries to diagnose PCOD. Find out other criterias like oligomenorrhea / clinical , biochemical signs of hyperandrogenimi. Advise TFT , Prolactin levels , weight reduction & life style modifications. Also look for insulin resistance features like acanthosis nigra, abnormal GTT, Metformin 500mgs. BD . Tab. Clomifen citrate ( minimum endogenous oestrogens essential ) of fails Tab Letrozol 2.5 mg.bd from day 3 to 7 with clomifen.Gonadotropins can be used to induce ovulation , in clomifen resistance cases with proper , close monitor to prevent side effects of hormones. Most imp is rule out other causes of infertility. Very last think of ovarian drilling.

Typical case of PCOD. Do day 2 LH,FSH,S.prolactin. TSH. Fbs,s.insulin. Adv lifestyle modifications. Wt loss Counsel regarding diet. Start tab krimson 35 of for 6 months cyclically. Tab metphormin 500 mg bd Myoinositol : chiro inositol combination sachets daily once. If pesistent pcod after medical treatment, then go for laproscopic puncturing along with Hysteroscopic viewing of uterus. Endometrial tissue for TB PCR.to be done. Induction can be done with tab.clomiphene 100 mg OD. For 5 days from 2 nd day to 7 the day of period. Follicular study from 10 the day on alt days.if follicle is mature 18 mm × 20 mm. Inj huchog 10000 for trigger. Tab progetrone support s.od for15 days. If still resistant induction with gonadotropin s

A case of pcod, to be treated before inducing ovulation. Oc pills for 2 months along with metformin 500 mg bd. Later induce ovulation with clomiphene alone or along with gonadotrophins, follicular study. Advise wt reduction , exercise, b complex , vitamin e supplements

Typical findings of PCOS. Needs LSM Yoga Wt reduction Put her on Krimson or Ginnete 35 for 6 cycles. Then put on Inositol Clomiphene citrate 50 mg 1st cycle then increas dose as per findings. Sos Pcos drilling with hysteroscopy.

Necklace pattern confirms pcod. Hyperandroginism and hypothyroidism to be r/o. Then you can proceed with management. Pt counseling is crucial as she becomes anxious with failed cycles

polycystic ovaries.... need lap puncture

Take proper history regarding family history of DM malignancies TIA stroke DVT Also past history of Deranged sugars hypothyroidism Migraines LIVER DS TIA STROKE DVT THROMBOPHILIAS Menstrual history regarding any irregularities in cycle flow dietary history to be taken On examination BMI to be calculated Look for signs of sugar intolerance with hyperandrogenimia Clinical breast examination to be done rule out galactorrhea Thyroid to be evaluated Get her investigations done ABO RH CBC HIV HBS AG HCV VDRL HPLC RUBELLA IGG VARICELLA ZOSTER IGG LFT RFT FBS PPBS HBA1C FASTING INSULIN PP INSULIN DHEAS FREE AND TOTAL TESTOSTERONE DAY TWO LH FSH E2 Counsel her for lifestyle modification Dietary advises Exercises Lose weight Tell her about timed intercourse Also sensitise her about risks of DM metabolic syndrome endometrial cancer

She is a case of polycystic ovaries....If she has oligomenorrhea n needs correction for that you can put her on ocps...If she needs treatment for infertility ,,she needs induction with clomiphene ...If she is not ovularing with clomiphene...You can increase the dose till 150 mg...If clomiphene resistance is seen you can start her on letrazole.....If that's not working....You can go for gonadotropin s...You can also add metformin 500 mg bd or myo_chiroinositol powder bd ....Anyhow weight reduction is a must

induction with clomephene citrate and do follicular study. if circulatory, try 6cycles of OI, and metformin or myoinositol along with.

This is a case of PCOD, planning a child as soon as possible, even through ovulation induction by clomiphene citrate

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