27 yrs c/o primary infertility with frequent menses(17 to18 days) with TSH 9.20 nd Serum AMH 2.2 please suggest expert opinion

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PCOS by USG Primary hypothyroidism by elevated TSH Correction of hypothyroidism Tt PCOS with tab ginnete or Krimson 35 6_7 cycles. LSM Wt reduction (must be fat as PCOS +hypothyroidism) Meanwhile check for tubal patency. Husband's semen analysis Follicular induction with CC 50 mg to start with after 6_7 cycles of Krimson. Follicular study. Start metformin 500 mg bd to 1000 along with other medicines,it will give wonderful results.

Wt of patient is 53kg nd fasting serum insulin is 3.06.irregular cycles are from last two months before that follicular study was normal.. Husbands seman analysis reports are normal
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[3/9, 11:50 AM] : Thyroid function is measure base of the TSH range of TSH blood test. The normal thyroid levels for TSH used to be from 0.5 to 5.0. After clinical studies, in 2003, the TSH range has been revised to 0.3 - 3.0 as normal TSH levels. If you are trying to conceive, a normal level of TSH for conception should be lower than 2, that is what many reproductive endocrinologists prefer to see. Hypothyroidism is present when elevated TSH levels are present. Normal Thyroid Levels for T4 Total T4 levels should be approximately 4.5 to 12.5. A low T4 level with High TSH indicates hypothyroidism. Free T4 normal range is approximately 0.7 to 2.0. If the value is low, it indicates f hypothyroidism. Normal Thyroid Levels for T3 Total T3 levels should be approximately 80 to 220. Hypothyroidism is suspected when values are less than 80, while hyperthyroidism if over 220. Free T3 levels should be approximately 2.3 to 4.2. When values are less than 2.3, hypothyroidism is most likely. [3/9, 11:53 AM] : Normal Thyroid Levels During Pregnancy During a normal pregnancy, the thyroid TSH levels should be as follow. These value apply to those that do not present autoimmune antibodies and have sufficient levels of iodine. Normal TSH Levels during the first three months of pregnancy: 0.24 - 2.99. Normal TSH Levels during the second trimester of pregnancy: 0.46-2.95. Normal TSH Levels during the last three months of pregnancy: 0.43 - 2.78. [3/9, 11:54 AM] : The following are potential factors that prevent normal thyroid levels: 1. Exposure to enviromental toxins like chemicals, heavy metals, pesticides, electromagnetic radiation. Mercury fillings and drinking chlorinate and fluorinated water. Bromide/bromine present in food products like baked goods, can negatively affect the thyroid gland. An increase in plasma bromine, in fact, can cause an increase of TSH probably by inhibiting thyroid gland activity. 2. Genetic predisposition. 3. Mineral deficiency like iron, selenium, zinc, iodine, copper, calcium, magnesium, manganese, etc... 4. Autoimmune disorders. 5. High levels of stress. 6. Infections. 7. Adrenal insufficiency. 8. Estrogen dominance. 9. High levels of prolactin. 10. Diet high in refined grains, soy, alcohol, coffee, and hydrogenated oils. [3/9, 11:56 AM] : Women who suffer fromunderactive thyroid symptomsexperience heavy bleeding during menses, anovulatory cycles, fairly long cycles. In women where the levels of serum prolactin are high, as a result of low thyroid function ,symptoms of amenorrhea can be present. [3/9, 11:57 AM] : Hyperthyroidism Hyperthyroidism seems to affect fertility in causing frequent miscarriages even in normal menstrual cycles. Overactive thyroid symptoms are usually present when low TSH levels are present. The diagnosis of hyperthyroidism is made my measuring serum Thyroxine. What Is Euthryoid This is a medical term used to indicate that normal TSH levels are present but the woman is experiencing symptoms of thyroid disorder. This is also related to unexplained infertility cases. [3/9, 11:58 AM] : The natural thyroid diet e-book is a good way to start. This easy to follow program was developed by Louise O'Connor, a leading high profile Naturopath from Australia that is considered an authority on natural thyroid health. Reading these information can change your life by giving you vibrant health, energy and increase your chances of conceiving.

So correct hypothyroidism by diet and medicine it will definite help in correction of infertility.start tranexemic acid temporarily for heavy menses during period.
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As TSH is raised a case of hypothyroidism. Need to control hypothyroidism. Take endocrinologist opinion. Tab. Tranexamic acid to stop bleeding. Weight reduction

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