Oligomenorrhea in 30 y/o female

31 yrs old patient secondary infertility want to concieve . her reports she brought along. hsg normsl nd even husband semen analysis. what further advises nd steps be taken in this case for her conception ?

POLYCYSTIC OVARIAN SYNDROME Signs and symptoms The major features of PCOS include menstrual dysfunction, anovulation, and signs of hyperandrogenism. Other signs and symptoms of PCOS may include the following: ■ Hirsutism ■ Infertility ■ Obesity and metabolic syndrome ■ Diabetes ■ Obstructive sleep apnea Diagnosis On examination, findings in women with PCOS may include the following: ■ Virilizing signs ■ Acanthosis nigricans ■ Hypertension ■ Enlarged ovaries: May or may not be present; evaluate for an ovarian mass. Testing Baseline screening laboratory studies for women suspected of having PCOS may include the following: ■ Thyroid function tests [4] (eg, TSH, free thyroxine) -■ Serum prolactin level [4] ■ Total and free testosterone levels ■ Free androgen index [4] ■ Serum hCG level ■ Cosyntropin stimulation test ■ Serum 17-hydroxyprogesterone (17-OHPG) level ■ Urinary free cortisol (UFC) and creatinine levels ■ Low-dose dexamethasone suppression test ■ Serum insulin-like growth factor (IGF)–1 level Other tests used in the evaluation of PCOS include the following: ■ Androstenedione level ■ FSH and LH levels ■ GnRH stimulation testing ■ Glucose level ■ Insulin level ■ Lipid panel Imaging tests The following imaging studies may be used in the evaluation of PCOS: ■ Ovarian ultrasonography, preferably using transvaginal approach ■ Pelvic CT scan or MRI to visualize the adrenals and ovaries Management Lifestyle modifications are considered first-line treatment for women with PCOS. Such changes include the following ... ■ Diet ■ Exercise ■ Weight loss Pharmacotherapy Pharmacologic treatments are reserved for so-called metabolic derangements, such as anovulation, hirsutism, and menstrual irregularities. First-line medical therapy usually consists of an oral contraceptive to induce regular menses. If symptoms such as hirsutism are not sufficiently alleviated, an androgen-blocking agent may be added. First-line treatment for ovulation induction when fertility is desired are letrozole or clomiphene citrate. ■ Medications used in the management of PCOS include the following: ■ Oral contraceptive agents (eg, ethinyl estradiol, medroxyprogesterone) ■《Antiandrogens (eg, spironolactone, leuprolide, finasteride) ■ Hypoglycemic agents (eg, metformin, insulin) ■ Selective estrogen receptor modulators (eg, clomiphene citrate) ■ Topical hair-removal agents (eg, eflornithine) ■ Topical acne agents (eg, benzoyl peroxide, tretinoin topical cream (0.02–0.1%)/gel (0.01–0.1%)/solution (0.05%), adapalene topical cream (0.1%)/gel (0.1%, 0.3%)/solution (0.1%), erythromycin topical 2%, clindamycin topical 1%, sodium sulfacetamide topical 10%) Surgery Surgical management of PCOS is aimed mainly at restoring ovulation. Various laparoscopic methods include the following: ■ Electrocautery ■ Laser drilling ■ Multiple biopsy

POLYCYSTIC OVARIAN SYNDROME /PCOD is a chronic anovulatory endocrine disorder. * it is the commonest cause of anovulatory infertility. ROTHERDAM CRITERIA : for diagnosing pcod. requires two out of three criteria for diagnosing pcod. -oligo/anovulation = oligomenorrhoea /amenorrhoea. -clinical (acne, hirsutism, alopecia ) or biochemical signs of hyperandrogenism. -Polycystic ovaries. classic triad of pcod are -oligomenorrhoea. -hirsutism. -obesity. INVESTIGATIONS : * fsh, lh, prl, testosterone, tft, fbs, ppbs. * for hyperandrogenism dheas, androstenedione ,SHBG. * ultrasound. CLINICAL EXAMINATION : * BMI. see for acne, hirsutism, alopecia, acanthosis nigricans. MNEMONIC FOR PCOD. CHICAGO C Cystic ovaries. H Hirsutism , Hyperandrogenism. I Infertility, Insulin resistance. C Cortical stromal fibrosis. A Amenorrhoea, Acne. G Genetic predisposition, Gestational diabetes. O Obesity, oligomenorrhoea. ROLE OF METFORMIN IN PCOD. Metformin is a insulin sensitising drug. -improves insulin resistance. -restores normal cycle and ovulation. -promotes ovulation. -protects against first trimester miscarriage. -reduces GDM and fetal macrosomia. ROLE OF MYO INOSITOL IN PCOD. -insulin sensitiser. -improves the binding of insulin to the receptors on the cell wall. -improves the ovarian response to gonadotrophins. MANAGEMENT : *life style modifications. *diet and exercise effective in restoring ovulatory cycles and achieving pregnancy. * COCP ,METFORMIN. * myo inositol. *ovulation induction. * laparoscopic ovarian diathermy. * IVF if all measures fail.

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

29 year female....married with h/o irregular menses....diagonesed with p.c.o.d since 4 year difficulty in conceive ..kindly suggest best treatment.