Diane - Reproduction 1
Diane is a 30 year old female who has been married for five years and has been actively trying to conceive for three years. She reports extensive family pressure from her husband and mother-in-law primarily, but also from her own parents. Before trying to conceive, Diane used an IUD for contraception. Her periods have always been irregular, and her last period was 5 months ago. She reports that her husband was "not very happy" about the missed periods.
Diane reports that she is having sex twice a week, but isn't actively trying any other methods to assist insemination. She reports not enjoying sex as much now as three years ago, and is growing more frustrated with her inability to have children. At this point, she says that she and her husband don't talk about the issue very much, remarking that everything has already been said.
There is no previous history of infertility in the husband's family, and the only remarkable history in Diane's family is that her sister has a pelvic kidney.
- 30 year old female
- married 5 years ago
- Trying to conceive for 3 years
- Frustrated about this
- Husband laid off 3 months ago
- Mother-in-law really wants kids
- Some family pressure to have kids
- Have sex twice a week
- Doesn't enjoy sex as much now as three years ago
- hasn't considered artificial insemination or other methods
- Sister has pelvic kidney
- No other investigations
- Had IUD before she started trying to conceive
- Hasn't had a period for 5 months; periods are sporadic
- partner "not very happy" about the missed periods
- Don't talk about it very much
- No hospitalization, previous medical history, etc.
- appeared remarkably uncomfortable
- Works at Kwik-e-maid
What wasn't asked?
- Do you have any STIs?
- How many partners have you had?
- What are some basic tests that should be carried out? (What are the next steps?)
- What are the societal implications of infertility? Historically, have they always been this way?
- Examine the following scenarios in discussing gender roles:
- Diane - 30 year old woman (this case)
- Diane - 15 year old girl with mullerian agenesis
- Diane - 42 year old man with vasectomy who is married but hasn't told his 28-year old wife
- Diane - 25 year old Somali woman married for 2 years; translator says that not conceiving for 2 years is culturally unacceptable
- Diane - 30 year old physician who has just setup practice, and hasn't conceived in 1 year.
- What are some physician biases?
- Discuss comfort level with some of these issues
Objectives for week 2
- Why is it important to couples to have kids?
- What is the psychology of cheatiing?
- What is intraepithelial neoplasia (LSIL - Lowgrade squamous intraepithelial lesion)?
- What would Diane have found if she net-searched for "abnormal pap smear"? What would one find on med-professional sites
- What's the deal with premature-onset menopause and anovulation?
- Can be caused by STIs, namely HPV 
- There are three types 
- Can be prevented by yearly pap smears
- There is a psychological stress component to risk of intraep. neoplasias 
Googling for abnormal pap smears
- Medline Plus: Infertility
- Cognitive-behavioral treatment decreases cardiovascular and neuroendocrine reaction to stress in women waiting for assisted reproduction
- Health inequality and users' risk-taking: a longitudinal analysis in a French reproductive technology centre
- Cultural beliefs in Southwestern nigeria regarding infertility