Help with a case please

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Dear friends, would you please help me with your opinion about a wonderful young patient who gives me permission to use her name and information. Her name is Jacinta and she is 20 and comes from a wonderful Catholic family. She initially came to me for NFP counselling. Upon questioning, i found out that her periods had always been irregular since age 15. She has never had a workup for this. She has always been healthy, has had no past medical problems, no surgeries, is on no medications, doesnt drink or smoke or use drugs. Her mother is very regular, and fertile, having had 6 children. Her siblings are all healthy. Upon physical exam, She is 5 foot 5 and 145 pounds. Her exam was completely

normal. Upon lab testing, all labs were normal, LH 13.0 and FSH 7.5, DHEA-S 380.4, testosterone 45, tsh 1.6, androstenedione 179, free testosterone 0.9, progesterone 0.9 (follicular phase), cholesterol normal, insulin level normal, fasting glucose normal (89), vitamin levels, including b12, folate, and D are all normal. I had ordered a prolactin level, but the lab did not draw it. Her ultrasound was read as normal, but upon reviewing it she does have multiple tiny follicles both ovaries and the ovaries are normal size and endometrial stripe is 4.0 mm. I taught her NFP, and she only got shiny, scant mucus on Days 10-13, never stretchy or egg white, and she did not get temperature elevations. To confirm, I taught her Marquette method and she

was getting basically all lows (low urine estradiol). She was using the monitor properly, and we had her collect concentrated urine. She wants to get pregnant, but moreover wants to know her diagnosis. She was given a trial of metformin, which did not help the cycles at all and a trial of oral progesterone which produced a period approximately 7 days after taking it. This patient is not ovulating and what would the group's next steps or advice be with the caveat that the patient is a practicing Catholic. Thanks in advance and Blessings, Dr. Peck, MD, CCD, ABFM, Marquette NFP Instructor

Pecks Family Practice, PLC

1688 W Granada Blvd, Ste 2A

Ormond Beach, FL 32174

(386) 677-2018 fax: (386) 676-0737 cell: (386) 212-9777

"I have chosen you from the world, says the Lord, and have appointed you to go out and bear fruit, fruit that will last, alleluia" (Cf. Jn 15:16,19)