11 . Carrie and Bob have been attempting to conceive for the last year. They hav

Question

11. Carrie and Bob have been attempting to conceive for the last year. They have consulted a fertility specialist, who conducted lab and diagnostic tests. The lab results are as follows:

Carrie

LH (serum)

                  Follicular = 15 mIU/mL

                  Mid-cycle = 80 mIU/mL

Progesterone (serum)

                  Before ovulation (follicular) = 0.5 ng/mL

                  After ovulation (luteal) = 4 ng/mL (within normal range)

FSH (serum)

                  Pre- and post-ovulation = 12 mIU/mL

                  Mid-cycle = 30 mIU/mL

What do these test results indicate about Carrie’s monthly hormonal (both uterine and ovarian) cycle? Be sure to include a description of the 28-day hormonal female cycle events at the ovaries and uterus as coordinated by the hypothalamus and adenohypophysis.

What aspects of her reproductive status remain uncertain? Provide examples of potential future follow-up clinical diagnostic procedures.

Bob

Semen Analysis

Volume: 3.0 mL

Sperm count: 10 million/mL

Sperm motility: 65%

Abnormal sperm: 20%

What do these tests indicate about Bob’s reproductive status?

What else remains uncertain about his reproductive status?

What are some treatment options available to this couple? Be specific.

Explanation / Answer

Carrie has an increased level of LH, whose normal range in follicular phase is 1.9 to 12.5 IU/L and mid cycle is 8.7 to 76.3 IU/L. Also, the FSH levels are higher. Higher than normal FSH levels are indicative of poor ovarian reserves which, in other words are also known as declining ovarian reserve or premature ovarian aging. When this condition occurs, the female may have impaired development of eggs or impaired recruitment of eggs or very few eggs left in the ovaries.

Also, the progesterone levels are low, the normal range for progesterone are 1.9 to 12.5 IU/L in the follicular phase and   0.5 to 16.9 IU/L in the luteal phase. Low progesterone levels can be difficult for the women to get pregnant.

Bob

The spe-rm count of bob is very low . The normal range is spe-rm count per ml should be  40 million to 300 million. If the counts are below 10 million, they are said to be poor count and if counts are of approximately 20 million /ml, are acceptable, provided motility and morphology are normal, with an abnormal sperm count of 20%. With such low spe-rm counts, there are almost nil chances of conceiving.

For both Carrie and bob, the fertility issues are high as bob has a very low spermatid count and Carrie has poor or premature ovarian ageing. IVF is the most common treatment for infertility.

For women : Clomiphene injections to release eggs and metformin

For men : hormone injections for insemination ; spe-rm retrieval

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