A 34-year-old nulligravid woman comes to clinic complaining of difficulty getting pregnant for the past 15 months. The woman reports that her menses have always been irregular. The woman has a BMI of 31 and hirsutism on physical exam. What is the most likely cause of infertility in this patient?

6 Likes

LikeAnswersShare

PCOS.. also known as STEIN LEVINTHAL SYNDROME. Rotterdam criteria.. In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met, in the absence of other entities that might cause these findings:- oligoovulation and/or anovulation excess androgen activity polycystic ovaries (by gynecologic ultrasound) The Rotterdam definition is wider, including many more women, the most notable ones being women without androgen excess. Signs & Symptoms:- Common signs and symptoms of PCOS include the following:- Menstrual disorders:- PCOS mostly produces oligomenorrhea (fewer than nine menstrual periods in a year) or amenorrhea (no menstrual periods for three or more consecutive months), but other types of menstrual disorders may also occur. Infertility:- This generally results directly from chronic anovulation (lack of ovulation). High levels of masculinizing hormones:- Known as hyperandrogenism, the most common signs are acne and hirsutism (male pattern of hair growth, such as on the chin or chest), but it may produce hypermenorrhea (heavy and prolonged menstrual periods), androgenic alopecia (increased hair thinning or diffuse hair loss), or other symptoms. Approximately three-quarters of women with PCOS (by the diagnostic criteria of NIH/NICHD 1990) have evidence of hyperandrogenemia. Metabolic syndrome:- This appears as a tendency towards central obesity and other symptoms associated with insulin resistance. Serum insulin, insulin resistance, and homocysteine levels are higher in women with PCOS.

Thankyou so much sir
1

View 3 other replies

Infertility and Hirsutism fulfill 2/3 criteria of Rotterdam and also BMI is raised above 30, so she is obese. This is likely a case of Polycystic Ovarian Syndrome(PCOS), in which LH is persistently high so ovulation does not occur and hence anovulatory infertility.

Dear Singh, I really appreciate your spirit & knowledge as a medical student itself, My hearty congratulations dear. God bless you abundantly. All the best to you in all your endeavours in your life. Hope to see you one of the best doctors in the country in the future. Amazing answer at UG Level.
1

Infertility,irregular menstrual cycles,hirsuitism,BMI..31, all these point towards Polycystic Ovarian disease. Investigate for hirsutism...LG,FSH,Dheas,17OHProgesterone, For infertility....also do,Throid profile,AMH,S.prolactin. To regularize her cycles give Krimson 35 for 3 cycles.then go for ovulation induction if other factors are normal..

Thankyou ma'am
0

View 1 other reply

Pt. fits into pcos.with so much of hirsutism investigate for late onset congenital adrenal hyperplasia and other adrenal causes.do s.17OH progesterone and DHEAS

Thankyou ma'am
0

Good afternoon. Polycystic ovary syndrome (PCOS) is a hormone imbalance that can cause irregular periods, excess hair (hirsutism), and acne.

Rule out stein levels syndrome and also testosterone level

I agree with Dr.Viral Patel,explained in detail.

Thanks Dr Parveen.
0

PCOS is the most likely cause.

Polycystic ovarian syndrome

Pcos-cause of infertility

Load more answers

Cases that would interest you