Question

Progression

Chart View

Lab Results

 L.B.                                                                      J.B.

Progesterone low                                             Testosterone Normal

Estradiol normal                                                LH normal

FSH normal                                                         TSH norm

TSH normal                                                         Seminal parameters normal

Pelvic ultrasound normal



J.B.'s semen analysis reveals no apparent problem. L.B. appears to be ovulating normally. BBT charting captures a change in temperature, and ovulation testing reveals an LH surge. The provider suspects L.B. may have a luteal phase defect because her progesterone levels are low after ovulation. The provider decides to order an hysterosalpingogram (HSG) for LB.

1. How will you describe a HSG to the couple?
2. You tell L.B. that it is important for her to call the office when her menstrual cycle starts

so the HSG can be scheduled between days 7 and 10 of her cycle. It is important they                             abstain from sex between the first day of her cycle until after the test. L.B. asks why. What do you tell her?

The HSG was normal, with no blockage to the fallopian tubes. The provider speaks with the couple about starting L.B. on clomiphene (Clomid) and progesterone vaginal suppositories, starting 2 days after ovulation.

3. What is the expected outcome associated with each of these medications?
4. You determine that L. B. understands your teaching about clomiphene therapy.

  (Select all that apply;)

1. “I do not need to use the LH testing kits anymore.”
2. “There is a higher risk of my having twins, or more.”
3. “I will take this medicine orally for 5 days each month.”
4. “I may experience some flushing and breast tenderness.”
5. “My husband will need to learn to give me daily injections.”

Answer 1

1. Hysterosalpingography

Hysterosalpingography, also known as uterosalpingography, is a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. This means it is a special x-ray using dye to look at the womb and Fallopian tubes.

2. The patients to abstain from intercourse until after vaginal spotting or discharge stops, usually 1 to 2 days after the HSG.

3. Clomid is an oral fertility-enhancing medication for patients with ovulatory problems (such as failure to ovulate or inconsistent ovulation). Clomid is offered to patients who have no known medical condition hindering ovulation and to patients whose medical treatment by itself fails to stimulate ovulation. Some terms for ovulation dysfunction are PCOS (polycystic ovary syndrome), anovulation, irregular ovulation, luteal phase deficiency, and progesterone deficiency.

Progesterone injections, pills, or suppositories. They may be used after ovulation to help the lining of your uterus grow.

4. While taking the clomiphene patient may take the medicine orally for 5 days in each month and the patient may experience flushing and breast tenderness as a side effects

So these statements are correct

1. “I will take this medicine orally for 5 days each month.”
2. “I may experience some flushing and breast tenderness.”