Differential Diagnosis for Infertility and Irregular Cycles
- Single Most Likely Diagnosis
- Polycystic Ovary Syndrome (PCOS): This is the most likely diagnosis given the patient's history of irregular cycles, which have become increasingly infrequent, and symptoms such as fatigue and night sweats. PCOS is a common cause of infertility and ovulatory dysfunction, and the patient's previous regular cycles that have become irregular, along with her symptoms, align with this diagnosis.
- Other Likely Diagnoses
- Hypothalamic Amenorrhea: Given the patient's history of increasing cycle irregularity and amenorrhea, hypothalamic amenorrhea should be considered, especially if stress, weight changes, or intense exercise could be contributing factors. However, the patient's BMI is within the normal range, which might make this less likely.
- Premature Ovarian Insufficiency (POI): Although less common, POI could explain the patient's amenorrhea and difficulty conceiving. The presence of night sweats could also suggest hormonal changes associated with POI.
- Thyroid Dysfunction: Despite the patient's normal TSH, thyroid dysfunction can sometimes present with subtle symptoms and affect menstrual regularity. Given her history of hypothyroidism, ensuring her levothyroxine dose is adequate and considering further thyroid function tests might be warranted.
- Do Not Miss Diagnoses
- Pituitary Tumor: A pituitary tumor could cause amenorrhea, infertility, and symptoms like fatigue and night sweats due to hormonal imbalances. Although rare, missing this diagnosis could have significant health implications, making it a "do not miss" condition.
- Hyperprolactinemia: Elevated prolactin levels can disrupt menstrual cycles and cause infertility. This condition can be due to various causes, including pituitary tumors, and is crucial not to miss due to its treatable nature.
- Rare Diagnoses
- Congenital Adrenal Hyperplasia: This is a rare genetic disorder affecting the adrenal glands, which can lead to hormonal imbalances, irregular menstrual cycles, and infertility.
- Androgen Insensitivity Syndrome: A rare condition where an individual is genetically male but has resistance to male hormones, leading to female external genitalia but undescended testes and no uterus or ovaries. However, given the patient's history of a previous pregnancy, this is highly unlikely.
- Other rare genetic or endocrine disorders: There are several rare genetic and endocrine disorders that could potentially cause the patient's symptoms, but these would be less likely and might require more specific diagnostic testing to identify.