A 28 years old lady, height 5 feet, weight - 70 kg has been trying to conceive for the last on and a half years. She has a 32-33 days' menstrual cycle. Husband's semen analysis, follicular study and HSG reports are normal. Ultrasound of pelvis reveals evidence of polycystic ovaries with normal sized one ovary and other of 11 cc. She has been put on Tab Metformin 500 mg three times a day and Chirocyst by another Gynaecologist. She gives H/O partial seizures and is on Tab Orcabezapine. The patient uses Ovulation predictor kit to time intercourse. She used it on 14th and 16th day of the present cycle. The menstrual period got overdue by 6 days, yesterday. The patient used the Ovulation predictor kit and the result was positive. Today, she had a normal period. This is the first time that she had a delayed period. The query is, can ovulation predictor kit show positive result just one day prior to the onset of the menstrual period? Do the drugs she is taking interfere with LH levels?
Then, Ovulation predictor test kit would not show positive result on 16th day of cycle. It was again positive one day before the onset of delayed period.
From a neurological perspective, excess hormones like Prolactin from a silent pituitary microadenoma are a common cause of disturbances in conception this women age group, advise to do a MRI scan to rule out any anormalies, and do a complete endocrinology panel review with a specialist....in addition to the measures they were currently taking
Dear James,
The patient's Serum Prolactin levels are normal. Then, why do we need to do MRI scan?
Prolactin levels in women vary in amount at different times of the menstrual period, that the endocrinology panel is normal is a good finding, the MRI scan may not be necessary, its just a diagnostic test to rule out any pituitary microadenoma, but again the gynaecology measures taken are more important
Metformin use was reported to increase menstrual cyclicity, improve ovulation, and reduce circulating androgen levels. Why was patient started on metformin? Was a case of type 2 diabetes mellitus or polycystic ovary syndrome?
Dear Alice,
The patient was put on Metformin by some other Gynaecologist. Hence, I can't comment on that. The patient has not reported for consultation again.
The specialty of the prescriber and age of the patient suggests possible PCOS in which case I would incline to link metformin to the unexpected changes noticed. Drug use is in that case appropriate and expected to contribute positively in the overall context
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