Short case study

*sama mohamed, 25 years old housewife, P3+2 with one living, lives in al qusasine,
married for 5 years she is obese and her husband is smoker.

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*She presented to the patient clinic complaining of infertility for 2 years despite normal
unprotected intercourse.
*The patient was going well until she started searching for conception 2 years ago after
Subjective removal of progestin capsule. This is the first marriage for both she and her husband
Her husband semen analysis was normal.
She suffers from oligomennorhea of 2-year duration, stationary, acute, with no
increasing or decreasing factors, her menses occur once every 4 months with 3-day
duration and scanty amount (1pad per day), no intermenstrual spotting or discharge,
mild dysmenorrhea.
She suffers from gradual, progressive, hirsutism for 2-year duration. she noticed the
appearance of thick dark black hair in inner part of thigh, chin, midline of abdomen.
She sought medical advice over the past 2 years where an ultrasound was done and
revealed necklace appearance of ovaries and diagnosis was made as polycystic ovaries.
She took ovulation inducing drugs (Clomiphine citrate)2 tablets per day for 6 months
and monitoring of ovulation through folliculometry is done every cycle.
No UTI symptoms
Review of other systems is irrelevant.

Examination:
General examination revealed the following:
-Pulse rate: 80 beats\min

o
objective
-Temperature: 37.2ºC
-Blood pressure: 120\80
-Weight: 80 kg
-Height: 172 cm
Abdominal examination:
-examination show normal contour of the abdomen, there is no
enlargement of the abdomen, abdomen moves freely with the respiration.
-there is no tenderness, organomegaly or any visible abdominal swellings
and normal auscaltation
Pelvic examination: (bimanual)
-No abnormality in uterus shape and size or position
-No adnexal tenderness, fullness or masses.
Investigations:
 CBC: 10 hemoglobin
 Hormonal assay: TSH was normal
 LH: 7.7 mIU\ml
 FSH 3.2 MIU\ml ( inverted FSH\LH ratio)
 Ultrasound revealed follicles in the ovary the largest one was 15mm
 Polycystic ovary syndrome(PCO)

A
assesment

:Management 
Weight reduction )a

Pplan
Hormone therapy: cyclic gestagens for 10 days every cycle as
medroxy progesterone acetate 10 mg
Induction of ovulation )c
)b

By clomiphene citrate twice daily for 5 days

Human chorionic gonadotropins IM injection to facilitate rupture of
follicles
d) Insulin sensitizing drug : metformine 500mgper day orally