Q & A : November 14, 2007

Hello,
   I am very confused, and maybe you can help. Here is my story, it is short compared to most but still no one seems to agree on the problem. I delivered a healthy baby girl in 2004 at age 26. At 29, I got pregnant again in March, but lost the baby in April. Both times I got pregnant immediately, the first month of trying. I have now been trying again for 6 months. I have regular periods, like clockwork, grab a pad in the morning before I even start kinda regular (29-30days). They did a vaginal ultra sound to check on a small, tiny fibroid i have, there are no more, and it is small... too small to cause problems. At this time the meanie, yucky, ultra sound lady tells me my ovaries are the size of a post menopausal women, and that I most likely have POF, and to start thinking about adoption. I thought I would puke on the table. Now, they are wanting me to go through a battery of tests, calling this "being aggressive" and have ordered all the bloodwork and even the HSG. Now, I am only 30 years old, and everything I've read about POF presents with missed periods... Anyway, my question is, do you think these tests are necessary? Does it matter in the least that I have regular periods? Or that I got pregnant on my own 6 months ago? Why is everyone talking about "being aggressive"?
-Tara in KS

Dear Tara,
    I don't know your entire story of course, but based on what you provide, I would agree that your instincts are correct that there may be some overreaction here. If I read you correctly, you are 30, got pregnant very easily and delivered a healthy girl. Then you got pregnant again immediately upon trying at age 29, but sadly, lost the pregnancy in the first trimester. Now, it had been six months and no pregnancy. Based on this information alone, it would be hard-pressed to say that you have any problem at all. There's nothing abnormal about having one miscarriage. There is nothing abnormal about six months passing without getting pregnant.
    Again, according to your email, your doctors are telling you that they are very concerned because your ovaries are small on ultrasound. You don't provide any measurements saying just how small they are, but still, if you got pregnant on your own six months ago and are having regular periods, I don't see the need yet to get "aggressive". The blood test you are talking about is probably a FSH level. That's not an unreasonable thing to get because it's inexpensive and easy to do. The HSG, on the other hand, is more expensive and invasive. It also puzzles me why they would get an HSG to address a suspicion of POF. POF is an ovarian problem. HSG's give information about the uterus and tubes, not the ovaries. In any case, my best advice is to have a quality discussion with your doctors. They might have some additional information that you are not providing here. I really hope you get pregnant on your own again, and soon. Good luck!!

Comments

[Tara]

Dear Dr. Lee,
The reference to small ovaries was due to the overzealous comment from the ultrasound tech. The doctor agreed they were small, but did not think it was POF because of my regular periods. My doctor wanted the HSG to make sure I had no blockage. It has been done now, no blockage. I had an FSH level taken on day 21 and it was 10. I also had a progesterone that was 12.4 one week later. My doctor thinks this proves ovulation has occured, but from what I read these levels are low or borderline average... The doctor is talking about placing me on clomid now. Do you think this is a good next move? Or is this move premature?
-Tara