QuestionQUESTION: Hello-
I am having some issues getting pregnant and I had some labwork completed and I am hoping you can help me interpret my results. My glucose/Hemoglobin A1c are within normal limits, my cholesterol is elevated at 231, LDL 152, HDl 52. I am aware of what that means however I am confused about what TSH elevation at 4.78 means. Does this mean I have hypothyroidism? Free T4 is 1.25, SHBG is low at 36.5. What does that mean? Is it possible PCOS? I tried looking this up online and am comfused by various info. I am in no way asking you to diagnose me since I am aware you are not a physician but any assistance you can give would be helpful.
Also I am 5'4" and 190 lbs. If I have to do IVF (my husband is being tested for motility issues) how much weight would I need to lose?
Thanks.
ANSWER: Hello Tara from the U.S.,
Your TSH is not elevated, but if it were, it would indicate that you had hypothyroidism (decreased thyroid function). SBHG is of no consequence.
In order to make the diagnosis of PCOS, you have to have hormone testing done, specifically, FSH an LH, done on cycle day # 2, and an ultrasound. In addition, it is basically a "clinical" diagnosis, which means that the diagnosis can be given based on a patient's presentation including irregular cycles, hirsuitism, increased follicular count on ultrasound and increased response to fertility stimulation.
By, the way, I AM a Physician and specializes in Infertility.
You are technically overweight based on your BMI, which is 32.61. You should have a BMI of less than 25 and preferably close to 20. That means you weight should be no more than 120 lbs. Weight loss is not an absolute in terms of IVF is concerned. You don't necessarily NEED to lose weight but a loss would be good for your health. I counsel my patients to lose weight because they will have to gain weight for their pregnancy, which will make they even more overweight if they start from a high number rather than a lower number.
I hope this helps and answers your questions,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf
---------- FOLLOW-UP ----------
QUESTION: Hello-
I apologize I am aware that you are a physician. I had written the same email to someone who interpretted lab results who was not a physician and I forgot to take that line out. They did not really answer my questions so I thought I would ask you. Thank you for your response. It was helpful. I am 33 years old and I was on the birth control pill since age 19 and I just stopped taking it about a year ago. I have had problems with irregularity since I stopped taking the pill. My cycles for this past year were as follows:
May 5/10 (estimating this date)
June 6/10 (32 day cycle)
July 7/18 (39 day cycle)
Aug 8/15 (29 day cycle)
Sept 9/12 (29 day cycle)
Oct 10/16 (35 day cycle)
Nov-none
Dec 12/7- spotting (53 day cycle)
My periods are very heavy and often include severe cramps and clotting. I am not sure if I am ovulating. How can I tell? Is there any sort of test for this? I am not sure if I am going to be put on Clomid or not. My husband has motility issues. Is IVF our only option and will that work if I have issues with ovulation? Any assistance you can recommend would be greatly appreciated. Thanks!
AnswerHello Again,
Apology accepted, but I just wanted you to know where my expertise was to validate my answer.
Looking at your menstrual schedule for the past year, except for November, you were very regular. Periods are considered regular if they are within +/- 7 days. Something happened in November, but I can't say what. Is it possible that you had some type of lifestyle change that month? Maybe got pregnant? Moved? Increased stress?
I cannot advise if IVF is your only option or not without more extensive testing i.e. a basic infertility testing. However, if your husband's semen analysis is indeed real bad, then IVF may be the best option in order to overcome the sperm problem. He might need to have the sperm injected into the eggs, which is a procedure called ICSI and IVF is the only way to get eggs.
If you have severe menstrual cramping, it may be a sign of a pelvic disease called endometriosis. This is a cause of infertility in 20% of infertile women. A laparoscopy would need to be done in order to make this diagnosis. In some cases, IVF is the treatment of choice if the endometriosis is severe.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf
