A 41-year-old G2 P1011 presents with a 6 month history of menometrorrhagia (excessive and irregular menses). Her past medical history reveals one full term pregnancy conceived by ovulation induction with insemination three years ago. Before that pregnancy, her FSH was noted to be 11.8 mIU/ml on day three of the cycle. One year after the delivery she reinitiated ovulation induction with gonadotropin and conceived. Unfortunately, an ectopic pregnancy was diagnosed and she underwent methotrexate therapy (50mg/m2) which resolved the ectopic pregnancy. She has continued to attempt pregnancy but without ovulation induction because her FSH climbed to 23 mIU/ml on day three.
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