Question

A 25-year-old cis-female presents to your office for her medical condition. She indicates that her menarche had occurred at an age of twelve years but never established a completely regular cycle (1-2 missed cycles/year). She began birth control pill use at age 19. After discontinuing the use of birth control pills (an estrogen/progesterone combination) three years ago, her cycles became even less regular, declining to 6-7 menses/year. She has had no menstrual flow over the past five months. The remainder of her history was unremarkable. The patient and her husband have been interested in having children for more than two years. A recent fertility work-up on her husband found him to be normal. Examination: She is a bit obese with excess body fat around the waist. She does have high blood sugar, but is not diabetic and has high cholesterol. Her husband claims she snores very loudly and teases her about sleep apnea, but she has not been through a sleep study to confirm obstructive sleep apnea. She had a distinct darkening of hair above the upper lip and several dark chin hairs and admitted to an increase in acne on both face and back over the past year but denied any change in facial hair during that period. Pubic and axillary hair appeared normal. A pelvic examination discloses no abnormalities except for a borderline clitoral enlargement. She has noticed no increase in skin pigmentation and has no striae. One ovary was palpable. Her muscle mass is normal, as is the rest of the physical examination. Hormone Levels: - hCG - normal range for non-pregnant - Thyroxine - normal - Testosterone - elevated - Androstenedione - elevated - DHEAS (Dehydroepiandrosterone sulfate-DHEAS is a male sex hormone-androgen) - elevated - Prolactin - normal - Cortisol - normal - ACTH - normal What are the different phases of a menstrual cycle? How do hormone levels change during the different phases? Describe follicular development. What do the hormone levels tell you about the patient? What is hCG, how and when is it produced, and why? A transvaginal ultrasound was performed and found more than 12 follicles/ovary and an ovarian volume of >10cc. What is the normal range of primordial (antral) follicles/ovaries? What is your potential diagnosis? Can this couple conceive? What are the hormonal changes during pregnancy, and when do they occur (fertilization to birth)? Describe the fertilization process.

A 25-year-old cis-female presents to your office for her medical condition. She indicates that her menarche had occurred at an age of twelve years but never established a completely regular cycle (1-2 missed cycles/year). She began birth control pill use at age 19. After discontinuing the use of birth control pills (an estrogen/progesterone combination) three years ago, her cycles became even less regular, declining to 6-7 menses/year. She has had no menstrual flow over the past five months. The remainder of her history was unremarkable. The patient and her husband have been interested in having children for more than two years. A recent fertility work-up on her husband found him to be normal.

Examination:
She is a bit obese with excess body fat around the waist. She does have high blood sugar, but is not diabetic and has high cholesterol. Her husband claims she snores very loudly and teases her about sleep apnea, but she has not been through a sleep study to confirm obstructive sleep apnea. She had a distinct darkening of hair above the upper lip and several dark chin hairs and admitted to an increase in acne on both face and back over the past year but denied any change in facial hair during that period. Pubic and axillary hair appeared normal. A pelvic examination discloses no abnormalities except for a borderline clitoral enlargement. She has noticed no increase in skin pigmentation and has no striae. One ovary was palpable. Her muscle mass is normal, as is the rest of the physical examination.

Hormone Levels:
- hCG - normal range for non-pregnant
- Thyroxine - normal
- Testosterone - elevated
- Androstenedione - elevated
- DHEAS (Dehydroepiandrosterone sulfate-DHEAS is a male sex hormone-androgen) - elevated
- Prolactin - normal
- Cortisol - normal
- ACTH - normal

What are the different phases of a menstrual cycle? How do hormone levels change during the different phases? Describe follicular development.

What do the hormone levels tell you about the patient? What is hCG, how and when is it produced, and why?

A transvaginal ultrasound was performed and found more than 12 follicles/ovary and an ovarian volume of >10cc. What is the normal range of primordial (antral) follicles/ovaries? What is your potential diagnosis?

Can this couple conceive? What are the hormonal changes during pregnancy, and when do they occur (fertilization to birth)? Describe the fertilization process.

Added by Nicole A.

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