Patient A, aged 35, came to me after being told she had PCOS by a local Reproductive Endocrinologist at one of the large Cleveland area hospitals. She had already taken a couple of cycles of Letrozole/Femara, with no appreciable response, and was headed to IUI next.
Her body type might have led one to believe this, yet there were no diagnostic labs to back that diagnosis up? Unimpressed with the efforts of her RE doctor, she thought she might take a chance to see what I might offer?
I learned that she suffered from chronic headaches of unknown origin, and other than her struggle to concieve there was not much to go on for diagnositic purposes? At least, not until the lab results came in!
Surprises abounded, and not the good kind.
Since diagnosis is what determines course of treatment, it is always the starting point for any patient coming for treatment to my clinic.
The outcome of her diagnostic lab work revealed that Patient A had NORMAL ovarian reserve and NOT PCOS as her doctor had assumed. (AMH/Ovarian reserve is typically elevated in PCOS).
She DID have low functioning thyroid, too low for fertility purposes, AND elevated prolactin levels. Further testing with an MRI ordered by Dr Mulligan in response to elevated the elevated prolactin, revealed that there was a pituitary tumor! That was causing the elevated prolactin AND the chronic headaches, and of course, contribting to infertility.
Doctor Mulligan put her one medication for shrinking the tumor, and another for correcting the thyroid.
Six months later, she returned to my care to try to concieve naturally.
Upon my request, Patient A carefully charted her morning temperatures throughout her cycle.
Her BBT charts that led me to believe she had endometriosis, so even though cramps at period were reported as mild, I encouraged a Receptiva biopsy endo test.
In my practice, I utilize many fertility tracking methods, but the one I prefer the most is simple BBT thermometer graphing.
Over the years I have developed a skill of graph interpretation that gives me an actual visual blueprint of diagnostics. SO many things can be deciphered utilizing simple BBT charting.
BBT charting is MUCH better and cheaper than any fertility monitor on the market, though I do utilize Inito and and Mira for patients unable to comply with BBT guidleines.
At this point the patient felt overwhelmed with the idea that there could be even more obstacles than the tumor in her head she had just been through, but she agreed to do the Receptiva biopsy test for endometriosis.
I had strongly recommended the Receptiva biopsy over a laparocopy for diagnosis, because of experience with previous patients seeking diagnosis. Receptiva accuracy of diagnosis is 96%, but many doctors don't favor it because they do not make as much money utilizing it for diagnostic purposes.
Receptiva biopsy testing is, the in my opinion, the BEST way to rule out endometriosis.
At this point, facing an endometriosis related diagnosis, I presented her with two possible paths: endometrisis surgery, or IVF with hormonal suppression in between retriaval and transfer.
Patient A chose surgery.
The doctor who had performed the Receptiva test performed her surgery. What she found is called adenomyosis, the lining of the uterus had been infiltrated with endometriosis.
This is very dire situation in terms of fertility potential, and interferes with the immune system and endometrial receptivity (implantation). When fertility is not the object, hysterectomy is generally considered the solution.