The beta-hCG on the second case is very high as expected at 37850 IU/L.

Just to continue with this theme, I came across a puzzle late yesterday, another hormonal profile on a 30-year-old lady with irregular menstrual bleed, request from GP via order comm, results are:

FSH 8.3

LH 3.5

Progesterone 7.7

Beta-hCG 1587

Now, I need some help to explain this high beta-hCG in the face of what looks like normal follicular phase gonadotrophins. All tests were double checked and there was no urine sent for pregnancy test. I shall ask for a repeat next week, but in the meantime any explanation is welcome.

Regards

Mohammad

From: Mohammad Al-Jubouri <[log in to unmask]>
To: [log in to unmask]
Sent: Thursday, November 22, 2012 3:47 PM
Subject: Infertility hormonal assessment

Many thanks for the many replies I have received so far, most of you correctly identified the possibilty of pregnancy and asked for Beta-hCG result which was 270 IU/L confirming very early pregnancy.

One colleague said he would put a comment "congratulations she is pregnant now"; though I wouldn't say congratulations yet as this is very early pregnancy and may be even occult ending by the next period.

Incidentally this pm, there was another hormonal profile on a very young lady with irregular periods from a GP via order comm, this showed:

FSH <0.1

LH <0.1

Oestradiol >11010

Progesterone 183

Prolactin 3266

Testosterone 2.3

Beta-hCG awaiting

Even if I am confident that she is well into her pregnancy, I wouldn't say congratulations as it could be an unwanted pregnancy.

So is this sort of request excessive? it all depends on the clinical situation they are investigating, for example in the first instance if they were only assessing luteal function/ovulation then requesting day 21 progesterone is sufficient. While in the second case they are investigating possible PCO, so the request is justified.

Regards

Mohammad

From: Mohammad Al-Jubouri <[log in to unmask]>
To: [log in to unmask]
Sent: Thursday, November 22, 2012 12:02 PM
Subject: Infertility hormonal assessment

A GP requested the following hormones on a young female patient with a clinical detail of "infertility"; the request came via the GP order comm system and the results were as follows:

FSH 1.3 mU/L

LH 0.5 mU/L

Oestradiol 938 nmol/L

Progesterone 71 nmol/L

Prolactin 480 mU/L

What would be your comment? would you consider this as excessive requesting?

Regards

Mohammad

Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist

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