ISM PRESENTATION

PCOS
MADISON LANE

WHAT IS ISM
The Independent Study Mentorship (ISM) Advanced Academic course
is designed for students wishing to mentor an adult professional in a
chosen career. With the mentor and the teacher-facilitator, each
student will create a unique plan of study and receive individual
instruction. Students leave the high school campus and go to the
mentors place of business to study with professionals. This course is
ideal for the self-motivated student with a passion for a particular
area of study. Students in this course must perform at a collegiate or
professional level.

ONLINE PORTFOLIO

INTERVIEWS
Life is not always predictable and neither are
patients outcomes
Not all patients are happy
The profession is very challenging
There is a lot of emotion in the job because you
gain a relationship with the patient and if it fails
there isnt always a reason
The future of reproductive medicine will be
increasingly improving technology

SURVEY
The purpose of my survey was to see if there is any
correlation between high blood pressure, high
cholesterol, diabetes, and polycystic ovarian syndrome.
I also would wanted to see how common PCOS is in our
society compared to the online statistics (1/10 women)
20% of the women survey (100 total) have been
diagnosed with PCOS
In conclusion, I have gathered that PCOS is very
common. When it comes to conditions possessed when
having PCOS I found obvious correlation. The majority
of women who have one or more of these conditions
suffer from PCOS.

INTRODUCTION
Mentor: Dr. Crochet

Bachelor of Science, Genetics at Texas A&M College Station

Doctor of Medicine at The University of Texas Medical
Branch
Residency at The University of Texas Southwestern Medical
center
Fellowship at Duke University

MENTORSHIP SITE
Center of Reproductive Medicine (CORM)
Clinic on Medical Boulevard
4 different doctors
Conduct IVFs and IUIs
Has a lab facility and a small operating room

WHAT IS INFERTILITY?
When a couple has been trying to conceive for a
year and is unable to, it is defined as infertility
After a year, it is recommended that couples see
a specialist.

WHAT CAUSES INFERTILITY

Hormonal issues
Hypothalamus or pituitary issue
Follicle issue
Premature menopause
Scarred ovaries or uterus

PRODUCT
Over the course of this semester I have decided to
focus in on PCOS the most common cause of
infertility. I have created three hypothetical case
studies with patients who have PCOS but want
different outcomes.

PCOS
Polycystic Ovarian Syndrome is when a woman
doesnt ovulate. It is the most common type of
infertility issue
Often shown by irregular periods, hirsutism, and
acne
One in ten women are affected by PCOS

Genetics increase the risk of PCOS but there is

no known cause
Some patients with PCOS have cyst on their
ovaries
High cholesterol, Type 2 diabetes, and high
blood pressure are risk factors
70% of infertility issues are caused by PCOS
PCOS affects women of all ages starting form
when they get their first period until menopause
"PCOS Cystic Acne Cure Get Clear Skin with Home
Remedies." Fight Your Infertility. N.p., 07 Apr. 2015. Web.
29 Nov. 2015.
<http://www.fightyourinfertility.com/3507/pcos-cysticacne-cure-get-clear-skin-with-home-remedies>.

BACKGROUND
PCOS was discovered in 1953 by Dr. Stein and Dr.
Leventhal
Originally it was called Stein-Leventhal syndrome
PCOS appears to be an ancient disorder
Hippocrates medical records imply PCOS was an
issue during his time period

CASE STUDY 1
An adolescent teenager, 15 YO G0
She only has a period every 3 months
Other than irregularities in her menses, patient is
a healthy 15 year old
Her main concern is getting her periods regular

DIAGNOSING
To diagnose a patient with PCOS everything else
has to be ruled out
The first thing gathered from the patient is her
history and perform a physical exam
Then a panel of blood tests are run
Imaging is also conducted via ultrasound to make
sure the uterus, fallopian tubes, and ovaries are
anatomically correct with out any obvious issues

PATIENT HISTORY AND PHYSICAL EXAM

Started her period at age 12 and has moderate pain during
her cycles. She is not sexually active.
Patient is 52 and weighs 108 pounds
Blood pressure was 108/71
A breast exam to check for lumps was performed, no
irregularities found
Pelvic exam conducted to look at the outside genitalia and
inside

LABS
TSH (Thyroid Stimulating Hormone)- Evaluating and
diagnosing hyperthyroidism
PRL (Prolactin blood test)
Testosterone levels
DHEAS (Dehydroepiandrosterone Sulfate)-Evaluate
adrenal gland function
17-OHP- Detects congenital adrenal hyperplasia
CBC- determines overall health
CMP (Comprehensive metabolic panel)- evaluates organ
function
PT (Prothrombin Time)/ PTT (Partial Thromboplastin
Time) - evaluates coagulation factors

LABS
Cushings
ACTH- helps diagnose pituitary and adrenal
diseases
Cortisol urine test (UFC)
Metabolic Syndrome
Lipid panel to evaluate the risk of heart disease
Triacylglycerol test- evaluates cholesterol levels

IMAGING
Vaginal ultrasound exam completed and no
irregularities were found

N.p., n.d. Web.

&lt;http://www.mayoclinic.org/~/media/kcms/gbs/patient
%20consumer/images/2013/08/26/10/42/ds00423_im04152_mcdc7_tr
ansvaginalultrasoundthu_jpg.ashx&gt;.

TREATMENT
Since patient only wants to regulate her periods,
she was put on a birth control called Apri which is
an Estrogen/Progesterone combination
Suppresses gonadotropins (LH/FSH/HCG)
Inhibits ovulation
Can cause headaches, bloating, or weight change

CASE STUDY 2
A patient 24 YO G1P0
Has severe hair growth and moderate acne
Not looking to get pregnant

HISTORY OF PATIENT AND A PHYSICAL

EXAM
Started her cycle at age 14 has it every 28-34 days
Moderate cramps
She has had one failed pregnancy- miscarried in the first 6 weeks of
pregnancy
Not looking to get pregnant and has been on birth control for 4
years.
Regular periods but severe Hirsutism

Patient is 55 and weighs 147 pounds

Blood pressure was 127/89
A breast exam to check for lumps was performed, no
irregularities found
Pelvic exam conducted to look at the outside genitalia
and inside

HIRSUTISM
Hair growth in androgen
dependent areas
Usually due to increased
androgen levels

"Hirsutism." Hirsutism. N.p., n.d. Web.

29 Nov. 2015.
<https://pedclerk.bsd.uchicago.edu/pag
e/hirsutism>.

LABS
Labs are the same in this scenario:
Testosterone
DHEAS
17-OHP
UFC
TSH
PRL
CMP
CBC
PT/PTT
Lipid Panel
ACTH
Triacylglycerol Test

IMAGING
The 24 YO patient had a few polyps on her
ultrasound but otherwise has a very healthy
uterus.
Since the patient is not trying to get pregnant
polyps can stay.

TREATMENT

Laser hair removal recommended

Patient was put on spironolactone an aldosterone blocker
Can cause drowsiness, breast pain, dry mouth, dizziness
Aldosterone antagonist
Binds to aldosterone-dependend Na and K pumps
Slows down androgen

"Diuretic." Diuretic. N.p., n.d.

Web. 29 Nov. 2015.
<http://faculty.swosu.edu/scott
.long/phcl/diuretic.htm>.

CASE STUDY 3
32 YO G2P2 with irregular periods.
Patient wants to get pregnant

HISTORY OF PATIENT AND PHYSICAL

EXAM

Started menstruating at age 11

Abnormal periods they range from every 30 days to every
45 days
Had Chlamydia but was treated and never had any issues
Normally not many cramps while on cycle
Patient is 57 and weighs 162 pounds
Blood pressure was 132/78
A breast exam to check for lumps was performed, no
irregularities found
Pelvic exam conducted to look at the outside genitalia and
inside

LABS
Testosterone
DHEAS
17-OHP
UFC
TSH
PRL
CMP
CBC
PT/PTT
Lipid Panel
ACTH
Triacylglycerol Test
AMH- Estimate ovarian reserve
FSH- Function of reproductive organs and pituitary gland
LH- Detect ovulation
Semen Analysis- Sperm count and mobility

IMAGING
HSG
Vaginal ultrasound

"Hysterosalpingogram (HSG) - Dallas IVF." Dallas

IVF. N.p., n.d. Web. 29 Nov. 2015.
<http://www.dallasivf.com/diagnostictesting/hysterosalpingogram-hsg/>.

TREATMENT
Start treatment with Clomid an ovulatory
stimulant
Helps create follicle overgrowth
Can cause upset stomach, pelvic pain, bloating,
headache, dizziness, and hot flashes
Next step would be IVF cycles

CONCLUSION
Over the course of this semester, I was able to be
mentored by Dr. Crochet. Through his leadership I
was able to gain so much knowledge about
infertility. It was great to learn and see how a clinic
that is so specialized functions. I would like to
thank Dr. Crochet for giving me the opportunity to
shadow you in your clinic. Also, thank you to Mrs.
Click for guiding me through this semester and
help me finalize my projects.

BIBLIOGRAPHY
"Fertility Treatment: Intracytoplasmic Sperm Injection (ICSI) | BabyCenter."
N.p., n.d. Web. 09 Oct. 2015. <http://www.babycenter.com/0_fertilitytreatment-intracytoplasmic-sperm-injection-icsi_4097.bc>.
"In Vitro Fertilization (IVF): MedlinePlus Medical Encyclopedia."U.S National
Library of Medicine. U.S. National Library of Medicine, 3 Nov. 2014. Web. 22
Oct. 2015.
"In Vitro Fertilization (IVF): Side Effects and Risks - American Pregnancy
Association." N.p., 24 Apr. 2012. Web. 09 Oct. 2015.
<http://americanpregnancy.org/infertility/in-vitro-fertilization/>.
"IVF and Age - Impact of Female Aging on In Vitro Fertilization Statistics."
N.p., n.d. Web. 09 Oct. 2015. <http://www.advancedfertility.com/ivfage.htm>.
"IVF Costs - In Vitro Fertilization Costs." N.p., n.d. Web. 09 Oct. 2015.
<https://www.ihr.com/infertility/ivf/ivf-in-vitro-fertilization-cost.html>.
"Polycystic Ovary Syndrome (PCOS): Causes, Symptoms and
Treatments."Medical News Today. MediLexicon International, 28 Sept. 2015.
Web. 22 Oct. 2015