FSH LH : FSH ratio

Patient A was a 30-year-old white woman with a longstanding history of primary amenorrhea and infertility. By age 18 the patient had neither menstruated nor demonstrated evidence of normal breast development. At that time she was given oral contraceptives for four cycles and responded with normal vaginal bleeding. Laboratory evaluation at age 18 demonstrated a serum FSH (follicle-stimulating hormone, follitropin) value of 9 mt. units/L (see Table 1 for reference intervals), a serum LH (luteinizing hormone, lutropun) value of 6 mt. units/L, and a serum thyroxin concentration of 94 pgfL (normal).2 A laparoscopy performed later that year revealed normal but immature internal female genitalia. Several courses of clomiphene were administered, but no bleeding response was evoked. The patient again sought evaluation at age 30 because of amenorrhea, poor breast development, and infertility. On physical examination, the patient was seen to be thin, with poorly developed breasts, infantile vulva, and a small uterus. Pubic and axillary hair were normal in appearance, and there was no evidence of galactorrhea. An epithelial smear taken from the upper third of the lateral vaginal wall revealed a markedly immature maturation index (0% superficial cells), consistent with hypoestrogenicity. Intramuscular progesterone was administered, but no withdrawal