Question

Part 1 - Infertility Issues Jane sat nervously in the examination room. She had no idea what to expect. Her husband, Brian, gave her a reassuring smile and squeezed her hand. There was a knock on the door and then it opened to admit the physician. "Hello, Jane. I'm Dr. Klein and I'll be doing your fertility assessment today." "It's nice to finally meet you Dr. Klein. This is my husband, Brian." The two men smiled at each other and shook hands. Dr. Klein sat down on the stool and opened up a thick file. “Jane, I've looked over the medical files that you had sent over to our office and I've examined the preliminary blood tests you had done at our office last week. I just need to ask you a few questions, and then we'll do a quick examination to help me try to get to the cause of your fertility issues." "Sure, I'll answer the best I can. Was anything missing from my medical records?" Jane asked, concerned that she had forgotten to send something the doctor would need. "We've been trying to get pregnant for two years and nothing has worked. We both want kids so badly, and a friend recommended you, so I hope you can help us." Dr. Klein smiled kindly at Jane and Brian. They were young, and there was no obvious explanation in Jane's file for her infertility. Dr. Klein's initial notes about Jane's medical history and recent blood tests included the following: • 28-year-old Caucasian female. • Diagnosed at 14 with Irritable Bowel Syndrome (IBS). • Diagnosed with anemia in her early 20s; current hemoglobin levels at 7 gm/dl. Active lifestyle until past year; used to exercise daily and run half marathons until recent joint pain hindered her. • Broken wrist last year after a minor fall. • No history or abnormal pelvic exams or PAP smears. • Hormone levels (estrogen, progesterone, LH, and FSH) in normal ranges. • Patient reports her menstrual cycles are not very regular. • Positive for several classes of autoantibodies. Looking up from his notes, Dr. Klein asked, “Jane, have you been able to control your IBS symptoms? Do you still have bouts of diarrhea or constipation despite a healthy diet?" "I've never really been able to control the symptoms as much as I'd like," Jane said. "It's something I've just learned to live with. I've tried all sorts of different diets and nothing seems to help. I felt a little better on the new low carbohydrate diet that people have been talking about, but it was really hard to stick to." She looked questioningly at her husband, silently wondering what her stomach problems could have to do with her fertility issues.

Answer 1

1. Antibody is an immunoglobulin protein that is produced in our body by the plasma cells to neutralize the foreign pathogens like bacteria and viruses.

2. An autoantibody is an antibody produced by our immune system which direct's against an individual's own protein as in cases of auto immune disorders.

3. They are Rheumatoid factor or RF, autoantibody to Fc portion IgG and antinuclear antibodies. The disorders associated are rheumatoid arthritis and systemic lupus erythematoses respectively.

4. Jane might suffering from auto immune hemolytic anemia, ulcerative colitis, systemic lupus erthematoses since she suffers from anemia and joint pain with the presence of autoantibodies.