Barbie is a 28 year old woman, who is being seen for fertility issues. She has been married to her husband, Ken, for 3 years. They have been trying, unsuccessfully, for the past 12 months to get pregnant. Physical exams reveals normal vital signs, a weight of 160 pounds, and some slight facial hair and mild acne. She is on medication to treat her acne that Barbie says she has been dealing with since her teenage years. Barbie also states that she “can’t seem to lose these 15 pounds she has put on” in the last few years and has just chalked it up to “married life”. Barbie states she does work out regularly and tries to eat a healthy diet, but admits to an occasional cheat meal. She complains of irregular periods, but states that this isn’t uncommon for her, especially when she has been stressed at work.
During her attempts to get pregnant, in the past 6 months, Barbie has used multiple over the counter ovulation kits, and states that her ovulation times “have been difficult to track” because they seem inconsistent. She provides a calendar that she uses to track her ovulation cycle. Based on her calendar, her ovulation cycles are anywhere from 25-38 days, and some months there is no ovulation at all. Barbie denies any family history of infertility, but her only sibling is her brother. She said that her mother has never mentioned any problems getting pregnant.
Surgical History: Tonsillectomy at age 10.
Medical History: She seen yearly for a physical and well woman exam. Barbie has a history of normal pap exams. The only medication she takes is for her acne.
Social History: Barbie doesn’t smoke and is an occasional social drinker.
Family History: Her mother denies any problems getting pregnant. Barbie’s only sibling is her brother.
To help aid in diagnosing the following lab tests are done: FSH, LH, HCG, TSH, Prolactin, 17-hydroxyprogesterone, testosterone, glucose, and insulin levels. She was also sent for a pelvic ultrasound to evaluate the ovaries. Her lab results reflected a negative urine and blood pregnancy test, normal 17-hydroxyprogesterone, as well as TSH. Her glucose and insulin levels were both elevated. Her LH and testosterone were elevated, but her FSH was normal. Her pelvic ultrasound showed polycystic ovaries.