Abnormal Uterine Bleeding

Lab Work

Blood Tests for Infertility

If you are unable to become pregnant after one year of unprotected intercourse, or six months of unprotected intercourse if you are a woman over 35, you and your partner should have a full physical and medical evaluation. Several blood tests are available to determine if you, your partner, or both of you have a problem that is causing infertility.

FSH

Follicle-stimulating hormone (FSH) helps control a woman’s menstrual cycle and the production of eggs. In men, it regulates the production and transportation of sperm. For women, a FSH test is done on the third day of the menstrual cycle and is used to evaluate egg supply. For men, the test is used to determine sperm count.

Estradiol

Estradiol is an important form of estrogen. An estradiol test is used to measure a woman’s ovarian function and to evaluate the quality of the eggs. Like FSH, it is done on the third day of a woman’s menstrual cycle.

Luteinizing Hormone Level

In women, luteinizing hormone (LH) is linked to ovarian hormone production and egg maturation. In men, it stimulates the hormone testosterone which affects sperm production. An LH test is used to measure a woman’s ovarian reserve (egg supply) and a man’s sperm count. It is done during a woman’s menstrual cycle to see if she is ovulating

Serum Progesterone

Progesterone is a female hormone produced by the ovaries during ovulation. It causes the endometrial lining of the uterus to get thicker, making it receptive for a fertilized egg. A serum progesterone test is used to determine if ovulation is occurring. Since progesterone levels increase towards the end of a woman’s cycle, the test is done during the luteal phase of the menstrual cycle (just before her period starts).

Prolactin

The hormone prolactin is made by the pituitary gland and causes milk production. In women, a prolactin test is done to find out why they are not menstruating, or why they are having infertility problems or abnormal nipple discharge. The test is done in men when there is a lack of sexual desire, difficulty getting an erection, or if there might be a problem with the pituitary gland.

Androgen

Testosterone is probably the most well-known androgen and it affects the sexual functioning of both men and women. In men, an androgen test is used to find the cause of a low sex drive, the inability to get an erection, or infertility. In women, it is used to determine the cause of irregular periods or a low sex drive.

INITIAL APPROACH — Both partners of an infertile couple should be evaluated for factors that could be impairing fertility. The infertility specialist then uses this information to counsel the couple about the possible etiologies of their infertility and to offer a treatment plan targeted to their specific needs.

It is important to remember that the couple may have multiple factors contributing to their infertility; therefore, a complete initial diagnostic evaluation should be performed to detect the most common causes of infertility, if present. When applicable, evaluation of both partners is performed concurrently .

The recognition, evaluation, and treatment of infertility are stressful for most couples . The clinician should not ignore the couple’s emotional state, which may include depression, anger, anxiety, and marital discord. Information should be supportive and informative.
History and physical examination — Findings on history and physical examination may suggest the cause of infertility and thus help focus the diagnostic evaluation. Components of the infertility history are listed in the table .

History — The most important points in the history are:

• Duration of infertility and results of previous evaluation and therapy.
• Menstrual history (cycle length and characteristics), which helps in determining ovulatory status. For example, regular monthly cycles with molimina (breast tenderness, ovulatory pain, bloating) suggest the patient is ovulatory and characteristics such as severe dysmenorrhea suggest endometriosis.
• Medical, surgical, and gynecological history (including sexually transmitted infections, pelvic inflammatory disease, and treatment of abnormal Pap smears) to look for conditions, procedures, or medications potentially associated with infertility. At a minimum, the review of systems should determine whether the patient has symptoms of thyroid disease, galactorrhea, hirsutism, pelvic or abdominal pain, dysmenorrhea, or dyspareunia. Young women who have undergone unilateral oophorectomy generally do not have reduced fertility since young women have many primordial follicles per ovary; however, prior unilateral oophorectomy may impact fertility in older women as they may develop diminished ovarian reserve sooner than women with two ovaries  .
• Obstetrical history to assess for events potentially associated with subsequent infertility or adverse outcome in a future pregnancy.
• Sexual history, including sexual dysfunction and frequency of coitus. Infrequent or ineffective coitus can be an explanation for infertility.
• Family history, including family members with infertility, birth defects, genetic mutations, or mental retardation. Women with fragile X premutation may develop premature ovarian failure, while males may have learning problems, developmental delay, or autistic features.
• Personal and lifestyle history including age, occupation, exercise, stress, dieting/changes in weight, smoking, and alcohol use, all of which can affect fertility.

Physical examination — The physical examination should assess for signs of potential causes of infertility. The patient’s body mass index (BMI) should be calculated and fat distribution noted, as extremes of BMI are associated with reduced fertility and abdominal obesity is associated with insulin resistance.

Incomplete development of secondary sexual characteristics is a sign of hypogonadotropic hypogonadism. A body habitus that is short and stocky, with a squarely shaped chest, suggests Turner syndrome.

Abnormalities of the thyroid gland, galactorrhea, or signs of androgen excess (hirsutism, acne, male pattern baldness, virilization) suggest the presence of an endocrinopathy (eg, hyper- or hypothyroidism, hyperprolactinemia, polycystic ovary syndrome, adrenal disorder).

Tenderness or masses in the adnexae or posterior cul-de-sac (pouch of Douglas) are consistent with chronic pelvic inflammatory disease or endometriosis. Palpable tender nodules in the posterior cul-de-sac, uterosacral ligaments, or rectovaginal septum are additional signs of en
dometriosis.

Vaginal/cervical structural abnormalities or discharge suggest the presence of a müllerian anomaly, infection, or cervical factor.

Uterine enlargement, irregularity, or lack of mobility are signs of a uterine anomaly, leiomyoma, endometriosis, or pelvic adhesive disease.

Lice are parasitic insects that can be found on people’s heads, and bodies, including the pubic area. Human lice survive by feeding on human blood. Lice found on each area of the body are different from each other. The three types of lice that live on humans are:

• Pediculus humanus capitis (head louse),
• Pediculus humanus corporis (body louse, clothes louse), and
• Pthirus pubis (“crab” louse, pubic louse).

Only the body louse is known to spread disease.

Lice infestations (pediculosis and pthiriasis) are spread most commonly by close person-to-person contact. Dogs, cats, and other pets do not play a role in the transmission of human lice. Lice move by crawling; they cannot hop or fly. Both over-the-counter and prescription medications are available for treatment of lice infestations.

Misdiagnosis of head lice infestation is common. The diagnosis of head lice infestation is best made by finding a live nymph or adult louse on the scalp or hair of a person.

Because adult and nymph lice are very small, move quickly, and avoid light, they may be difficult to find. Use of a fine-toothed louse comb may facilitate identification of live lice.

If crawling lice are not seen, finding nits attached firmly within ¼ inch of the base of hair shafts suggests, but does not confirm, the person is infested. Nits frequently are seen on hair behind the ears and near the back of the neck. Nits that are attached more than ¼ inch from the base of the hair shaft are almost always non-viable (hatched or dead). Head lice and nits can be visible with the naked eye, although use of a magnifying lens may be necessary to find crawling lice or to identify a developing nymph inside a viable nit. Nits are often confused with other particles found in hair such as dandruff, hair spray droplets, and dirt particles.

If no nymphs or adults are seen, and the only nits found are more than ¼ inch from the scalp, then the infestation is probably old and no longer active — and does not need to be treated.

Syphilis

Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex. Occasionally, the disease can be passed to another person through prolonged kissing or close bodily contact. Although this disease is spread from sores, the vast majority of those sores go unrecognized. The infected person is often unaware of the disease and unknowingly passes it on to his or her sexual partner.

Pregnant women with the disease can spread it to their baby. This disease, called congenital syphilis, can cause abnormalities or even death to the child.

Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

Syphilis can be easily diagnosed with a quick and inexpensive blood test at LA MEDICAL CARE

Syphilis is caused by the bacteria Treponema pallidum.

Syphilis infection occurs in three distinct stages:

Early or primary syphilis. People with primary syphilis will develop one or more sores. The sores resemble large round bug bites and are often hard and painless. They occur on the genitals or in or around the mouth somewhere between 10-90 days (average three weeks) after exposure. Even without treatment they heal without a scar within six weeks.

The secondary stage may last one to three months and begins within six weeks to six months after exposure. People with secondary syphilis experience a rosy “copper penny” rash typically on the palms of the hands and soles of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. They may also experience moist warts in the groin, white patches on the inside of the mouth, swollen lymph glands, fever, andweight loss. Like primary syphilis, secondary syphilis will resolve without treatment.

Latent syphilis. This is where the infection lies dormant (inactive) without causing symptoms.

Tertiary syphilis. If the infection isn’t treated, it may then progress to a stage characterized by severe problems with the heart, brain, and nerves that can result in paralysis, blindness, dementia, deafness, impotence, and even death if it’s not treated.

Herpes

Herpes is an infection that is caused by a herpes simplex virus (HSV). Oral herpes causes cold sores around the mouth or face. Genital herpes affects the genitals, buttocks or anal area. Genital herpes is a sexually transmitted disease (STD). It affects the genitals, buttocks or anal area. Other herpes infections can affect the eyes, skin, or other parts of the body. The virus can be dangerous in newborn babies or in people with weak immune systems.

There are two types of HSV:

• HSV type 1 most commonly causes cold sores. It can also cause genital herpes.
• HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth.

HSV spreads direct contact. Some people have no symptoms. Others get sores near the area where the virus has entered the body. They turn into blisters, become itchy and painful, and then heal.

Most people have outbreaks several times a year. Over time, you get them less often. Medicines to help your body fight the virus can help lessen symptoms and decrease outbreaks.

Definition

The human papillomavirus (HPV) test detects the presence of human papillomavirus, a virus that can lead to the development of genital warts, abnormal cervical cells or cervical cancer.

Your doctor might recommend the HPV test if:

• • Your Pap test was abnormal, showing atypical squamous cells of undetermined significance (ASCUS)
  • You’re age 30 or older

The HPV test is available only to women; no HPV test yet exists to detect the virus in men. However, men can be infected with HPV and pass the virus along to their sex partners.

Why it’s done

The HPV test is a screening test for cervical cancer, but the test doesn’t tell you whether you have cancer. Instead, the test detects the presence of HPV, the virus that causes cervical cancer, in your system. Certain types of HPV — including types 16 and 18 — increase your cervical cancer risk.

Knowing whether you have a type of HPV that puts you at high risk of cervical cancer means that you and your doctor can better decide on the next steps in your health care. Those steps might include follow-up monitoring, further testing, or treatment of abnormal or precancerous cells.

Routine use of the HPV test in women under age 30 isn’t recommended, nor is it very helpful. HPV spreads through sexual contact and is very common in young women, so, frequently, the test results will be positive. But HPV infections often clear on their own within a year or two. Cervical changes that lead to cancer take several years — often 10 years or more — to develop. For these reasons, you might follow a course of watchful waiting instead of undergoing treatment for cervical changes resulting from an HPV infection.

Risks

As with any screening test, an HPV test carries the risk of false-positive or false-negative results.

• False-positive. A false-positive test result indicates that you have a high-risk type of HPV when you really don’t. A false-positive result could lead to an unnecessary follow-up procedure, such as colposcopy or biopsy, and undue anxiety over the test results.
• False-negative. A false-negative test result means you really do have an HPV infection, but the test indicates that you don’t. This might cause a delay in appropriate follow-up tests or procedures.

How you prepare

AsNo special preparation is necessary before you have an HPV test. However, since an HPV test often is done at the same time as a Pap test, you can take these measures to make both tests as accurate as possible:

• Avoid intercourse, douching, or using any vaginal medicines or spermicidal foams, creams or jellies for two days before the test.
• Try not to schedule the test during your menstrual period. The test can be done, but your doctor can collect a better sample of cells at another time in your cycle.

What you can expect

An HPV test is usually done at the same time as a Pap test — a test that collects cells from your cervix to check for abnormalities or the presence of cancer. An HPV test can be done using the same sample from the Pap test or by collecting a second sample from the cervical canal.

During the HPV test

A combination Pap-HPV test is performed in your doctor’s office and takes only a few minutes. You may be asked to undress completely or only from the waist down.

You’ll lie on your back on an exam table with your knees bent. Your heels rest in supports called stirrups.

Your doctor will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of the vagina apart so that your doctor can easily see your cervix. Inserting the speculum may cause a sensation of pressure in your pelvic area. Sometimes the speculum feels cold when it’s first inserted.

Then your doctor will take samples of your cervical cells using a soft brush and a flat scraping device called a spatula. This doesn’t hurt, and you may not even feel the sample being taken.

After the HPV test

After your test, you can go about your normal daily activities without any restrictions. Ask your doctor about when you can expect to receive your test results.

Results

Results from your HPV test will come back as either positive or negative.

• Positive HPV test. A positive test result means that you have a type of HPV that’s linked to cervical cancer. It doesn’t mean that you have cervical cancer now, but it’s a warning sign that cervical cancer could develop in the future. Your doctor will probably recommend a follow-up test in six months to a year to see if the infection has cleared or to check for signs of cervical cancer.
• Negative HPV test. A negative test result means that you don’t have any of the types of HPV that cause cervical cancer.
• Depending on your test results, your doctor may recommend one of the following as a next step:
• Normal monitoring. If you’re over age 30, your HPV test is negative and your Pap test normal, you’ll follow the generally recommended schedule for repeat testing in three years.
• Colposcopy. In this follow-up procedure, your doctor uses a special magnifying lens (colposcope) to more closely examine your cervix.
• Biopsy. In this procedure, sometimes done in conjunction with colposcopy, your doctor takes a sample of cervical cells (biopsy) to be examined more closely under a microscope.
• Removal of abnormal cervical cells. To prevent abnormal cells from developing into cancerous cells, your doctor may suggest a procedure to remove the areas of tissue that contain the abnormal cells.