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