Should Informed Consent from the Husband be Required Prior to Giving of Clomiphene?

QUIZ THE EXPERT FERTILITY AND STERILITY Copyright" 1976 The American Fertility Society

Vol. 27, No. 12, December 1976 Printed in U.S.A.

SHOULD INFORMED CONSENT FROM THE HUSBAND BE REQUIRED PRIOR TO GIVING OF CLOMIPHENE? QUESTION

plicated course of therapy, it is well to matters with both husband and review At the recent meeting of the American wife in consultation. This affords an opCollege ofObstetricians and Gynecologists, portunity to review the course of diagnosis the discussants on a panel, "Induction of and treatment and to project the diagnosOvulation," stated that the husband tic and therapeutic approaches which they should be required to give informed concan anticipate. Such an interview, usualsent prior to giving of clomiphene to the ly scheduled at the completion of the sowife. I certainly believe in informed concalled "routine" diagnostic procedures, sent when it is necessary, but as long as the wife has been properly informed as to the does much to alleviate anxiety. The husnature of the medication, the alternatives, band appreciates this involvement and and the possible complications, I feel that usually makes every effort to accommoit is an undue imposition on the physician date his schedule so that he can be presand medically unnecessary to require an- ent. This level of communication is esother visit from the husband, who usually sential when a course of action such as is not present. I would like to ask whether a major operative procedure or the use of this is a common practice and whether it is Pergonal is contemplated. Discussions really believed legally necessary in pre- would necessarily include consideration of the risk-benefit ratio. On the other hand scribing clomiphene and Pergonal. the use of clomiphene is associated with ~ M.D. different dimension of risk --certainly conLakeland, Florida siderably lower-and in my judgment it is reasonable to assume that the wife will ANSWER transmit to her husband information on This question touches upon the in- the reasons for the treatment and possible dividual physician's general attitude to- side effects. I do not feel that it is legally ward informed consent. The husband necessary to obtain a formal informed should, of course, be involved in some way consent from the husband prior to prein the decision-making process. I make it scribing clomiphene. There may, however, be an advantage a practice, whenever possible, to see the husband and wife together initially. Prior in involving the husband when possible in to a decision which would involve a com- a discussion of the use of Clomid. This

We so~i~it questions for."Quiz t~e Expe~" dealing with current advances or concerns in the field offertility and stenhty. Each questlOn pubhshed Will be answered by an individual with special expertise. Questions should be directed to the Editor, .Roger D. Kempers, M.D" 200 First Street, S.W., Rochester, Minn. 55901. Questions should not exceed 250 words.

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QUIZ THE EXPERT

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centers about coital timing. The husband should be made aware that Clomid is being given in an effort to induce ovulation and that, if therapy is successful, ovulation can be anticipated between 2 and 10 days after the last pill is administered. If there is failure of ovulation on the standard dosage and a substantially higher dose is contemplated, or if combinations of Clomid and Pergonal are being considered, one would be well ad-

December 1976

vised to review the implications of these approaches with both husband and wife. LUIGI MASTROIANNI, JR., M.D.

Department of Obstetrics and Gynecology University of Pennsylvania Hospital of the University of Pennsylvania Philadelphia, Pennsylvania 19104 September 13, 1976

PROLACTIN-PRODUCING PITUITARY ADENOMA QUESTION

In a patient with galactorrhea, does the finding of a normal serum prolactin value rule out the possibility of a prolactinproducing microadenoma of the pituitary? M.D.

Minnesota

ANSWER

Normal values for serum prolactin may be found in patients with a prolactinproducing adenoma of the pituitary. In such patients we presume, but do not know, that the pituitary tumor is secreting prolactin with a structure slightly different from that of normal or naturally occurring prolactin or perhaps biologically active fragments of normal prolactin, which are not detected completely by the prolactin assay since the assay is designed to measure normal prolactin.

Incidentally, it is also important to realize that a normally appearing sella turcica on standard roentgenograms of the skull does not rule out the possibility of a prolactin-producing microadenoma of the pituitary. While most such microadenomas will be apparent on tomographic studies of the sella, even these may be within normal limits in the presence of a micro adenoma. Hence, if the presence of a microadenoma of the pituitary is strongly suspected despite normal prolactin values and normal tomographic study of the sella, the next step would be to do bilateral carotid angiography with magnification and subtraction roentgenograms, a procedure which is capable of demonstrating micro adenomas as small as 3 to 4 mm in diameter. RAYMOND V. RANDALL, M.D. Consultant, Internal Medicine Professor of Medicine Mayo Medical School Rochester, Minnesota 55901 September 9, 1976