Keywords:

  • 36 yo woman
  • married 5 years
  • had oral contraceptives 2 years ago
    • already discontinued fro 2 years
  • infertility
  • menstrual cycles regular and normal length
  • not taking other regular medications
  • not smoking
  • no chronic diseases
  • STD –ve
  • male partner no sexual dysfunction
  • Semen analysis normal
  • Prolactin & TSH levels normal
  • endometrial biopsy normal (rule out cancer)
  • has a risk factor for pelvic adhesive disease
    • due to history of myomectomy for uterine fibroids
  • Gonadotropins administration & uterine insemination were tried
    • after 2 cycles, patient became pregnant

Hypothesis

  • Leiomyoma
  • Decreased sperm count/abnormal sperm/bad semen quality
  • post testicular obstruction
  • structural/congenital abnormalities
  • Cervical mucus plug

Final hypothesis

  • Risk of pelvic adhesive disease due to myomectomy for uterine fibroids

Extra learning issues:

Hysterosalpingography

  • radiologic procedure to investigate shape of uterine cavity & the shape and patency of the fallopian tube
  • done during follicular phase of the cycle
  • radiologic dye injected into uterine cavity

Pipelle sampling

  • Take sample during luteal phase
  • Insert pipelle through cervix, pass up to the fundus, withdraw white fluid, rotate and move device around. place sample on histology plate.
  • Indication:
    • abnormal bleeding
    • anovulation
    • obesity
    • postmenopausal bleeding

Contraception

  • Combined OCP (oestrogen & progesterone)
  • Mifepristone (antiprogesterone)
  • Ormeloxifene (selective oestrogen receptor modulator)
  • Intrauterine device
    • inert & copper-based devices
    • hormonal intrauterine device

Pro-ovulating agents

  • Progesterone
  • Gonadotropin-releasing hormone (GnRH) agonist
  • GnRH antagonist
    • prevent release of LH, FSH
  • Clomid
    • FSH receptor modulator
  • Human menopausal gonadotropin
    • LH & FSH
  • Aromatase inhibitor

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