Urine Pregnancy Test Research Articles

The role of auxiliary nurse-midwives and community health volunteers in expanding access to medical abortion in rural Nepal

Medical abortion was introduced in Nepal in 2009, but rural women’s access to medical abortion services remained limited. We conducted a district-level operations research study to assess the effectiveness of training 13 auxiliary nurse-midwives as medical abortion providers, and 120 female community health volunteers as communicators and referral agents for expanding access to medical abortion for rural women. Interviews with service providers and women who received medical abortion were undertaken and service statistics were analysed. Compared to a neighbouring district with no intervention, there was a significant increase in the intervention area in community health volunteers’ knowledge of the legal conditions for abortion, the advantages and disadvantages of medical abortion, safe places for an abortion, medical abortion drugs, correct gestational age for home use of medical abortion, and carrying out a urine pregnancy test. In a one-year period in 2011–12, the community health volunteers did pregnancy tests for 584 women and referred 114 women to the auxiliary nurse-midwives for abortion; 307 women in the intervention area received medical abortion services from auxiliary nurse-midwives. There were no complications that required referral to a higher-level facility except for one incomplete abortion. Almost all women who opted for medical abortion were happy with the services provided. The study demonstrated that auxiliary nurse-midwives can independently and confidently provide medical abortion safely and effectively at the sub-health post level, and community health volunteers are effective change agents in informing women about medical abortion.

A Clinical Study of Ectopic Pregnancies in a Tertiary Care Hospital of Chittagong, Bangladesh

Background: Motherhood, an eternal, universal and inherent dream which every woman has. This dream may not always be pleasant and it can involve nightmares. One of this is ectopic pregnancy: A pregnancy which can be life threatening. Aims : 1. To know the age group, parity, gestational age and the risk factors with re-spect to the ectopic pregnancy. 2. To know the clinical presentation of the ectopic pregnancy. 3. To know the treatment and morbidity and mortality associated with ectopic pregnancy.Materials & methods : A total of 47 admitted patients who were di-agnosed as ectopic pregnancy cases were retrospective analyzed between the periods from January 2013 to June 2014 at Chattagram Maa-O-Shishu Hospital Medical College, Agrabad, Chittagong. The following parameters: age, parity, gestational age, risk factors, clinical presentation, need for blood transfusion and findings on ultrasonogram and at surgery and morbidity associated with ectopic pregnancy were noted.Results: The incidence of the ectopic pregnancy in the pres-ent study was 7.4/1000 deliveries. A majority of the cases were multigravidas and majority of the cases gestational age were six to ten weeks. In most of the cases, there were no identifiable risk factors. The commonest risk factors present were history of MR (12.7 %)and abortion (10.6), history of tubal surgery (2.2%), infertility (2.2%) and pelvic inflammatory diseases (4.2%).The commonest symptoms were abdominal pain (89.3%), amenorrhea (78.7%) and abnormal vaginal bleeding (63.5%); and commonest signs were abdominal tenderness (70.5%), cervical excitation (52.6%) and adnexal tenderness (50.4%). Almost half (45%) were in a state of shock at admission. Ultrasound, a urine pregnancy test and serum B-hCG were the investigative modalities which were used. Surgery by open method in the form of salpingectomy (92.3%), salpingo-oophorectomy (5.5%) and salpingostomy (2.1%) were the mainstay of management. Morbidity included anemia (50.9%), blood transfusion (78%) and wound infection (2.1%). No maternal mortality noted.Conclusion: Early diagnosis, identifying of underlying risk factors and timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i3.20993

Acceptability and feasibility of phone follow-up with a semiquantitative urine pregnancy test after medical abortion in Moldova and Uzbekistan

ObjectiveTo evaluate the feasibility and acceptability of phone follow-up with a home semiquantitative pregnancy test and standardized checklist, and compare the alternative method of follow-up with in-clinic follow-up after medical abortion. Study DesignTwo thousand four hundred women undergoing medical abortion with mifepristone and misoprostol in Moldova and Uzbekistan were randomized to phone or clinic follow-up. All women in the clinic group returned to the clinic 2 weeks later. Women randomized to phone follow-up used a semiquantitative pregnancy test at the initial visit and repeated the test at home 2 weeks later when they also filled out a symptom checklist. Women were called at 2 weeks to review the test results and checklist. Participants who screened “positive” were referred to clinic to verify abortion completion. ResultsMost women in the phone group were successfully contacted on the phone (97.6%). Staff were unable to contact one woman in the phone follow-up group, and all women in clinic group returned to the clinic. The ongoing pregnancy rate was similar in both groups (0.4–0.6%), and the semiquantitative pregnancy test identified all ongoing pregnancies in the phone follow-up group. Women in the phone group found the test and checklist easy to use, and most (76.1%) preferred phone follow-up in the future. Overall, 92.8% of women in the phone group did not undergo in-clinic follow-up. ConclusionPhone follow-up with a semiquantitative urine pregnancy test and symptom checklist is a feasible and a highly effective approach in identifying ongoing pregnancy after medical abortion. ImplicationsThe semiquantitative pregnancy test can make home follow-up after medical abortion possible for many women and provide reassurance that ongoing pregnancies will be detected.

Follow-up after medical abortion: does simple equal safe?

In The Lancet, Kevin Sunde Oppegaard and colleagues1 report the findings of a multicentre European non-inferiority trial of 924 women who underwent early medical abortion and were randomised to clinical routine follow-up at 1–3 weeks (n=466), or home self-assessment with a semiquantitative urinary pregnancy test followed by telephone consultation (n=458). The primary outcome was the percentage of women with complete abortion not requiring further medical or surgical intervention within 3 months.

Contraceptive Use and Pregnancy Incidence among VOICE Participants in Uganda

Background: Recent HIV prevention trials have required use of effective contraceptive methods to fulfill eligibility for enrolment. We compared pregnancy rates in participants enrolled in the VOICE (MTN-003) trial who initiated depot medroxyprogesterone acetate (DMPA) or combined oral contraceptives (COCs) at enrollment (new users) relative to those already on DMPA or COCs. Methods: Data were analyzed from HIV-1 seronegative participants enrolled in Uganda. Prior to enrolment information on contraceptive type and initiation date was obtained; contraception was provided to new users. Participants received urine pregnancy tests at monthly follow-up visits. Cox proportional hazards models stratified by baseline contraceptive method were used to compare pregnancy incidence among new users (initiated 60 days prior to enrolment). Participants were censored after the first observed pregnancy on study. Results: Of 322 women enrolled 296 were COC or DMPA users; 82 (28%) were new users (50 [61%] initiated DMPA and 32[39%] initiated COCs) and 214 (72%) were established users. Overall pregnancy incidence was 13.35 per 100 person-years [p-yrs] (49/367 p-yrs) with an incidence in DMPA users of 5.39 per 100 p-yrs (13/241 p-yrs) compared to 28.62 per 100 p-yrs (36/126 p-yrs) in COC users. In new DMPA users pregnancy incidence was 10.20 per 100 p-yrs versus 3.48 per 100 p-yrs in established DMPA users (adjusted hazard ratio [aHR]=2.84; 95% confidence interval [CI] 0.92 - 8.74). Similarly in new COC users pregnancy incidence was 42.67 per 100 p-yrs versus 23.67 per 100 p-yrs in established COC users (aHR 2.08; 95% CI 1.02 - 4.23). Conclusions: New contraceptive users in VOICE had an increased pregnancy risk. Pregnancy incidence was high among both new and established COC users. New DMPA and all COC users participating in HIV prevention trials may benefit from intensive contraceptive counseling and provision of less user-dependent methods.

Efficacy of dehydroepiandrosterone to overcome the effect of ovarian ageing (DITTO): a proof of principle randomised controlled trial protocol

IntroductionDehydroepiandrosterone (DHEA) has been proposed to improve pregnancy rates in women with diminished ovarian reserve undergoing in vitro fertilisation (IVF) treatment. However, evidence regarding its efficacy is supported by a...

Can women determine the success of early medical termination of pregnancy themselves?

ObjectiveTo determine the outcome of early medical termination of pregnancy (TOP) among women who choose a “self assessment” follow up comprising a self-performed low sensitivity urine pregnancy test with instructions on signs/symptoms that mandate contacting the TOP service. Study designA retrospective review of computer databases of 1726 women choosing self-assessment after early medical TOP (<9 weeks) in the UK. The main outcome measures were (a) number of women choosing self-assessment, (b) contact rates with TOP service and (c) time to presentation with an ongoing pregnancy (failed TOP). ResultsNinety-six percent of women having an early medical TOP and going home to expel the pregnancy chose self-assessment. Two percent of women made unscheduled visits to the TOP service. One hundred and eighty-eight women (11%) telephoned the service about concerns related to complications or the success of treatment. There were eight ongoing pregnancies (0.5%; 95% confidence interval 0.2–0.9%). Four were detected within 4 weeks of treatment; the remainder were not detected until one or more missed menses after the procedure. ConclusionsMost women having an early medical TOP, who go home to expel the pregnancy, choose self-assessment. Relatively few women make unscheduled visits or telephone the TOP service. Most ongoing pregnancies are recognized at an early stage, although late presentation (as with all methods of follow up) does still occur. Implications statementIf women are given clear instructions on how and when to conduct a urine pregnancy test and on signs/symptoms that mandate contacting the TOP service, then they can confirm the success of early medical TOP themselves. Late presentation due to failure to recognize an ongoing pregnancy is rare.

English

Immature teratoma accounts for 10 - 20% of all ovarian neoplasms in women less than 20 years of age with peak incidence between 15 - 19 years and they account for 30% of deaths arising from ovarian cancer in this age group. (1) Immature teratomas are rarely found to be bilateral, (2) Immature teratomas are malignant in nature and the most common sites of dessemination are peritoneum, retroperitoneal lymph nodes, hematogenous spread to Lung liver and brain is unusual.(3) We report a case of an immature teratoma of the ovary in a 14 year old girl who presented to us with acute pain abdomen. On examination patient was febrile, tachycardia present and abdominal rigidity was seen. Ultrasound examination showed a pelvic mass with fluid in morrisons pouch suggesting internal haemorrhage. Urine pregnancy test was done to rule out ectopic pregnancy. Patient was taken for emergency laparotomy. On laparotomy ruptured ovarian mass was seen with hemoperitoneum. Unilateral salpingo - oophorectomy was done and specimen sent for Histopathological examination which revealed immature ovarian teratoma stage I, Grade 3. Post- operative period was uneventful. Patient was referred to cancer centre for chemotherapy and further management. Patient was put on BEP regime.(Bleomycin Etoposide, Paclitaxal).on further follow up

P26.13: Advances in urine pregnancy testing and implications for clinical problems of early pregnancy

<scp>P</scp>26.13: Advances in urine pregnancy testing and implications for clinical problems of early pregnancy

Simplified follow-up after medical abortion using a low-sensitivity urinary pregnancy test and a pictorial instruction sheet in Rajasthan, India--study protocol and intervention adaptation of a randomised control trial.

BackgroundThe World Health Organisation suggests that simplification of the medical abortion regime will contribute to an increased acceptability of medical abortion, among women as well as providers. It is expected that a home-based follow-up after a medical abortion will increase the willingness to opt for medical abortion as well as decrease the workload and service costs in the clinic.Methods/DesignThis study protocol describes a study that is a randomised, controlled, non-superiority trial. Women screened to participate in the study are those with unwanted pregnancies and gestational ages equal to or less than nine weeks. The randomisation list will be generated using a computerized random number generator and opaque sealed envelopes with group allocation will be prepared. Randomization of the study participants will occur after the first clinical encounter with the doctor. Eligible women randomised to the home-based assessment group will use a low-sensitivity pregnancy test and a pictorial instruction sheet at home, while the women in the clinic follow-up group will return to the clinic for routine follow-up carried out by a doctor. The primary objective of the study this study protocol describes is to evaluate the efficacy of home-based assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet 10–14 days after an early medical abortion. Providers or research assistants will not be blinded during outcome assessment. To ensure feasibility of the self-assessment intervention an adaption phase took place at the selected study sites before study initiation. This resulted in an optimized, tailor-made intervention and in the development of the pictorial instruction sheet with a guide on how to use the low-sensitivity pregnancy test and the danger signs after a medical abortion.DiscussionIn this paper, we will describe the study protocol for a randomised control trial investigating the efficacy of simplified follow-up in terms of home-based assessment, 10–14 days after a medical abortion. Moreover, a description of the adaptation phase is included for a better understanding of the implementation of the intervention in a setting where literacy is low and the road-connections are poor.Trial registrationClinicaltrials.gov NCT01827995. Registered 04 May 2013.

English

Gestational trophoblastic disease is a broad disorder of abnormal fertilization of ovum. Early detection and treatment is the best approach to prevent mortality and morbidity of patients of gestational trophoblastic tumors. All trophoblastic cells produce hcg (human chorionic gonoadotropin) and can easily be detected in urine of pregnant ladies. When urine pregnancy test become negative in a highly suspected patient, the management becomes difficult. In this case, though the urine pregnancy tests were negative on several occasions, serum β hcg level was very high > 1500000 mIU/ml (positive) and patient was cured by chemotherapy.

Performance of a checklist to exclude pregnancy at the time of contraceptive initiation among women with a negative urine pregnancy test

ObjectiveOur objective was to measure the sensitivity and specificity of a six-item “pregnancy checklist” at excluding early- or luteal-phase pregnancy among women with a negative urine pregnancy test who were initiating contraception. Study designThis was a secondary analysis of the Contraceptive CHOICE Project, a prospective cohort study of 9256 women in the St. Louis region. Women who had a negative urine pregnancy test on the day of enrollment were included in this analysis. Women with a positive urine pregnancy test or without urine pregnancy testing were excluded. We identified all luteal-phase pregnancies that occurred among women with a negative urine pregnancy test. We calculated the sensitivity, specificity, positive predictive value and negative predictive value (NPV) and likelihood ratios of the pregnancy checklist for excluding luteal-phase pregnancies. ResultsThere were 6929 women included in this analysis; 69% of these women met at least one checklist criterion to exclude pregnancy (“negative screen”). There were 36 luteal-phase pregnancies (0.5%) subsequently diagnosed among women with a negative urine pregnancy test. The sensitivity and specificity of the checklist were 77.7% and 69.1%, respectively. The NPV of the checklist was 99.8% and the positive predictive value was 1.3%. ConclusionAmong women with a negative urine pregnancy test, the pregnancy checklist can be used to safely exclude more than 99% of early pregnancies at the time of contraceptive initiation. ImplicationsIn patients with a negative urine pregnancy test, a pregnancy checklist using six criteria based on patient history has high NPV in excluding early pregnancy. This checklist can be used to facilitate same-day initiation of contraceptive methods, including long-acting reversible contraception. Although the checklist had a high false positive rate, initiation of contraception should not be delayed in women with a “positive screen.” Rather women who desire an intrauterine device or implant can be “bridged” with a shorter-acting method until pregnancy can be excluded.

Acute presentation of ruptured ovarian cyst secondary to torsion with ipsislateral concomitant ectopic pregnancy: A case report

Twenty-one year unmarried regularly menstruating lady without history of amenorrhea presented with acute abdomen in TU Teaching Hospital –Emergency Department. On evaluation urine pregnancy test was positive. Urgent ultrasound revealed multiloculated cystic lesion measuring 8.5 x 8 x 6.7 cms in the right adnexa anterolateral to the uterus with no intrauterine gestational sac. She underwent emergency laparotomy with right salpingo-oophorectomy. On laparotomy there was twisted and ruptured right ovarian cyst with unruptured ampullary pregnancy on the same side. There was coexistence of these two conditions which presented as acute abdomen. DOI: http://dx.doi.org/10.3126/njog.v3i2.10834 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 54-56

Ectopic Pregnancy, Still A Life Threatening Emergency - A Clinical Study Of 100 Cases

Ectopic pregnancy is still a major challenge &amp; its incidence is on the rise due to changes in lifestyle &amp; advances in medical practice. The objective was to study incidence, clinical presentation, risk factors &amp; management of cases that presented in our hospital over a four -year period. A Prospective study of 100 cases presenting as ectopic pregnancy from 15-1-2010 to 15-1-2014.During this period total of 3176 deliveries &amp; 1347 gynaecological surgeries were recorded. 100 patients had ectopic gestations accounting for 3.1% of all deliveries &amp; 7.4% of gynaecological surgeries. Peak age group was 20-29y in 59cases(59%). Gestational age at presentation was 6-8weeks for most of the cases (62%). 59 cases (59%) were multiparous &amp; 41(41%) were nulliparous. All had symptoms suggestive of ectopic pregnancy (amenorrhea, abdominal pain, giddiness, bleeding pervaginum). Diagnosis was confirmed by urine pregnancy test &amp; USG. Common risk factors present were previous surgery ie LSCS-30(30%), Tubectomy-19(19%); Abortions-32(32%); Infertility-36(36%); PID-16(16%).Out of 100cases, 93 (93%) were ruptured &amp; 7(7%) unruptured. Unruptured cases were treated medically using Methotrexate. Laparotomy was done for ruptured cases. Commonest site of Ectopic was ampulla (60%). Salpingectomy was done for most cases (73%).Although case-fatality has decreased, ruptured Ectopic gestation continues to be a common life-threatening emergency making tubal conservation inapplicable. This is of concern in a society with high premium on child-bearing.

Using a checklist to assess pregnancy in teenagers and young women.

Health care providers should assess pregnancy in women seeking contraceptive services. Although urine pregnancy tests are available in most U.S. settings, their accuracy varies based on timing relative to missed menses, recent intercourse, or recent pregnancy. We examined the performance of a checklist based on criteria recommended in family planning guidance documents to assist health care providers in assessing pregnancy in a sample of U.S. teenagers and young women. Study participants were a convenience sample of sexually active black females aged 14-19 years seeking care in an urban family planning clinic. Each participant provided a urine sample for pregnancy testing and was then administered the checklist in two formats, audio computer-assisted self-interview and in-person interview. We estimated measures of the checklist performance compared with urine pregnancy test as the reference standard, including negative predictive value, sensitivity, specificity, and positive predictive value. Of 350 participants, 31 (8.9%) had a positive urine pregnancy test. The audio computer-assisted self-interview checklist indicated pregnancy was unlikely for 250 participants, of whom 241 had a negative urine pregnancy test (negative predictive value=96.4%). The sensitivity of the audio computer-assisted self-interview checklist was 71%, the specificity was 75.6%, and the positive predictive value was 22%. The in-person checklist yielded similar results. The checklist may be a valuable tool to assist in assessing pregnancy in teenagers and young women. Appropriate use of the checklist by family planning providers in combination with discussion and clinically indicated use of urine pregnancy tests may reduce unnecessary barriers to contraception in this population.

Role of ultrasonography in diagnosis of ectopic pregnancy with clinical analysis and management in tertiary care hospital.

This study is undertaken to emphasize the role of ultrasonography in the diagnosis of ectopic pregnancy and clinical analysis of the same in a tertiary care referral hospital. One hundred patients with provisional diagnosis of ectopic pregnancy were studied. Physical examination, urine pregnancy test, transabdominal scan using 5MHz transducer or transvaginal ultrasonography of 7MHz was done. The diagnosis of ectopic pregnancy was confirmed by direct observation by laparotomy or laparoscopy (which was taken as gold standard). The study showed ectopic pregnancy was most common in gravida 2 and in age group 26-30years with most of them having married life <10years. One or more risk factors were found in 66% of cases. 54% of cases presented with acute symptoms, 14% of cases in shock. Among clinical presentation pain abdomen, history of amenorrhea, bleeding per vaginum, abdominal tenderness, and cervical motion tenderness was most common. In ultrasonography, complex mass in adnexa was present in 60% of cases and hemoperitoneum in 50%. 96% of cases were tubal pregnancy with most of them tubal rupture. In 98% of cases, radical surgery was done. Salpingectomy was the most common surgery done (90%). There was no negative laparotomy in this study. There was no maternal mortality in this series. In all the 100 cases of ectopic pregnancy studied, the ultrasonography provided definitive diagnosis resulting in 100% sensitivity and 100% specificity, predictive value of positive test being 100%. Ultrasonography done in earlier weeks of gestation had sensitivity of 96% and false negative 4%.

Biosynthesized gold nanoparticle developed as a tool for detection of HCG hormone in pregnant women urine sample

IntroductionBiosynthesized gold nanoparticles is one of the novel benchmark for using medical commercial industry. Recently gold nanoparticles were used for the detection of tumor, hormones, glucose and other biomolecules in health care sectors. Due to the different functional properties AuNPs was used for hormone detection was carried out in this study. ObjectivesBiosynthesized gold nanoparticles were used to qualitatively determine the hCG hormone in pregnancy women urine sample. MethodsThe biosynthesis of gold nanoparticles using C.nudiflora plant extract. Synthesized gold nanoparticles were characterized by different analytical techniques such as FESEM, XRD and FTIR. The synthesized gold nanoparticles was used to perform hCG hormone detection on both pregnancy positive and negative urine sample.500 μL of the prepared gold solution and an equal volume of the test sample were mixed and used for assays. After that, the solution was tested using a pregnancy test strip. Results & DiscussionThe mixture of gold nanoparticles in the urine sample changed color into pink that confirmed pregnancy. Otherwise it turned into gray color that showed the absence of pregnancy. ConclusionThe method was supported 100% accurate in diagnosis of pregnancy and it may be a good alternative method for urine pregnancy test.

Ectopic Pregnancy Developing in a Cyst of the Canal of Nuck

A cyst of the canal of Nuck is a rare cause of inguinal swelling in adult women. Ectopic pregnancies that implant to rare regions are sometimes challenging to diagnose. A 45-year-old woman presented with painful swelling in her right groin with a positive urine pregnancy test. Ultrasonography, magnetic resonance imaging, and the histopathologic result of dilation and curettage suggested ectopic pregnancy in the right inguinal canal. Exploratory laparotomy, extraction of the right inguinal mass lesion, and closure of the deep inguinal ring were performed. The mass lesion measured 4×3 cm, and the histopathologic finding revealed an unusual ectopic pregnancy in the cyst of the canal of Nuck. In women of reproductive age presenting with painful swelling of the groin, ectopic pregnancy in a cyst of the canal of Nuck should be ruled out.

Simplified follow-up after early medical abortion: 12-month experience of a telephone call and self-performed low-sensitivity urine pregnancy test

ObjectiveThe objective was to determine if simplified follow-up after early medical abortion, consisting of a telephone call 2 weeks after the procedure plus a self-performed low-sensitivity urine pregnancy (LSUP) test, was successful for screening for ongoing pregnancies in the year following its introduction as standard service. Study designA retrospective computerized database review of 1084 women at a hospital abortion service in Edinburgh, UK, who had a medical abortion (≤9 weeks) and went home to expel the pregnancy was performed. Women who screened ‘positive’ at telephone follow-up on the basis of ongoing pregnancy symptoms, scant bleeding or LSUP test result were scheduled for an ultrasound. The main outcome measures were the proportion of women scheduled for telephone follow-up successfully contacted and the proportion of ongoing pregnancies detected. ResultsA total of 943 women were scheduled for telephone follow-up. Ten women presented to the hospital before the time of the follow-up call. Of the remaining 933 women, 656 [70%, 95% confidence interval (CI) 67.7-73.2] were successfully contacted. Five hundred seventy-three (87%, 95% CI 84.5–89.7) of those contacted screened ‘negative’; no false negatives occurred. Eighty-three (13%, 95% CI 10.2–15.5) screened ‘positive,’ and of those, three had ongoing pregnancies. Of the 277 (30%, 95% CI 26.7–32.7) who were not contacted, two ongoing pregnancies occurred. The sensitivity of telephone follow-up with LSUP to detect ongoing pregnancy was 100% (95% CI 30.9%–100%), and specificity was 88% (95% CI 84.9%–90.1%). The negative predictive value was 100% (95% CI 99.1%–100%), and positive predictive value was 3.6% (95% CI 0.9%–10.9%). ConclusionA telephone call and LSUP test at 2 weeks are suitable as a standard method of follow-up for screening for ongoing pregnancy after early medical abortion. Implications statementFor most women, a routine clinic follow-up after early medical abortion (to exclude ongoing pregnancy) can be replaced with a telephone call and a self-performed LSUP test at 2 weeks postprocedure.

Premenopausal Amenorrhea: What's in a Number?

A 33-year-old nulligravid woman presented to her gynecologist after experiencing 5 months of secondary amenorrhea following discontinuation of oral contraceptives. She had undergone normal puberty and menarche with no significant past medical or surgical history. Her family history was unremarkable other than a brother with developmental delay. On exam she was 165 cm tall and weighed 67 kg, with a body mass index of 24.6 kg/m2 (reference interval, 18.5–24.9 kg/m2). She did not display any evidence of hyperandrogenism (hirsutism or acne), and her pelvic exam was normal. A urine pregnancy test was negative. Initial progestin challenge testing (daily oral administration of 10 mg medroxyprogesterone acetate for 7 days) was negative (no bleeding), indicating that the patient was either hypoestrogenic or that she had a uterine outflow abnormality (e.g., uterine scarring) (1). (Progestin challenge testing provides an indirect assessment of serum estradiol concentrations. Due to false positives and negatives associated with progestin challenge testing, as well as the development of assays directly measuring serum estradiol, progestin challenge tests are not routinely used.) A uterine outflow abnormality was deemed to be unlikely given that the patient had normal menses on oral contraceptive pills and she had no history of uterine manipulation or surgery. Her serum prolactin was 8.3 ng/mL (reference interval, 0.2–24.5 ng/mL), her total testosterone (measured by chemiluminescent immunoassay) was 14 ng/dL (reference interval, 14–76 ng/dL), and her free testosterone (measured by liquid chromatography–tandem mass spectrometry) was 0.2 pg/mL (reference interval, 1.3–9.2 pg/mL). Her serum thyroid-stimulating hormone (TSH)3 was 3.03 μIU/mL (reference interval, 0.36–4.20 μIU/mL) and her follicle-stimulating hormone (FSH) was 57.3 mIU/mL (reference intervals: follicular phase, 2.5–10.2 mIU/mL; midcycle, 3.4–33.4 mIU/mL; luteal phase, 1.5–9.1 mIU/mL; postmenopausal, 23.0–116.3 mIU/mL), confirming a diagnosis of hypergonadotropic hypogonadism. ### QUESTIONS TO CONSIDER 1. What are the causes of oligomenorrhea/amenorrhea in women of childbearing age? 2. What laboratory …