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Questions for 4/24 appointment

Posted Apr 16 2009 12:00am
My followup visit to my initial diagnosis is next Friday, 4/24. I'm having my FSH, LH, and estradiol retested on Tuesday. I'm assuming that since I haven't bled and it's been over 2 weeks since my progesterone challenge, my estradiol levels will continue to be low, my FSH high, and my LH just hanging out in mid-range levels.

I have been having minor panic attacks and just general anxiety over this appointment... the waiting is killing me, and yet, I know I'm just going to hear in person what I've already been told via email, and I'm sure emotionally, I'm going to feel like I did the day I first found out. Thankfully, I will have my husband there with me, and in a way, we've been kind of emotionally preparing ourselves for this, but it still doesn't make the waiting easier.

Since my Dx email, Dr. Gross has recommended that I compile a list of questions to email to him before the appointment. I've been researching like a fiend, and so far, here's the lists that I've come up with. I'm certainly open to suggestions that anyone might have.

Next Steps
  1. Any speculation as to what may have caused this?
  2. What is the likelihood that my high FSH could be the result of my unilateral ovariectomy combined with coming off hormonal birth control?
  3. Should I be tested for any autoimmune disorders given POF and my hypothyroidism (Hashimoto's thyroidosis, Lupus, etc.)?
  4. Barring any autoimmune disorders, what are the implications for my health with a diagnosis of POF combined with hypothyroidism?
  5. Should my remaining ovary be monitored for any complications with any cysts, if present?
  6. What are the next steps in terms of any further diagnostic testing? (FHS, LH, estradiol to be tested 4/21; Autoimmune disorders if suspected; Ultrasound on right ovary?)
Family Planning Concerns
  1. Based on my numbers, is spontaneous ovulation a possibility?
  2. Do my current hormone levels/hypothyroidism affect the consistency of cervical mucus?
  3. Can I still rely on fertility awareness to monitor possible ovulation?
  4. Is is possible for women with POF to sustain a pregnancy to term, whether naturally or through IVF (given that women with a high FSH have a greater risk of miscarraige?
  5. How can I determine if anything is left in my ovarian reserve? Should I have Anti-Mullerian Hormone testing done? What does this entail? Timeline?
  6. If there are eggs to be saved, can they be retrieved? Frozen? How long are they good for?'
  7. Should my husband have semen analysis performed? When?
  8. In terms of timeline for pursuing any artificial reproductive technology, what would you recommend?
General Health Concerns
  1. Given that I was instructed to go off hormonal birth control, is hormone replacement therapy a realistic treatment option for me? Do the benefits outweigh the costs?
  2. Cholesterol: I know this is exacerbated by hypothyroidism. Is the POF contributing at all as well? Will HRT help in treating cholesterol issues as well?
  3. What kind of supplements would you recommend (calcium, vitamin D, anything to help with POF or boost fertility)? Are estrogen supplements safe/recommended given my history of migraine?
  4. Minor menopausal symptoms: hot flashes, dizziness, insomnia, feeling unfocused/spacey; anything I can do to alleviate these symptoms? Anything major I should be on the lookout for?
  5. Are my testosterone levels a concern? Should anything be done to lower these numbers?
Miscellaneous
  1. Are there any clinical trials worth investigating? Thoughts on clinical trials/studies of POF in general?
  2. Do you have any recommendations for infertility-sensitive mental health counseling?
  3. Do you have any resources for local support groups?
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