<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 23-year-old woman comes to the physician because of a 3-month history of pain during intercourse and vaginal dryness. The patient has also had intermittent hot flashes and fatigue during this time. Over the past year, her periods have become irregular. Her last menstrual period was over six months ago. She is sexually active with one partner and does not use protection or contraception. She has a history of acute lymphoblastic leukemia during childhood, which has remained in remission. Pelvic examination shows an atrophic cervix and vagina. A urinary pregnancy test is negative. A progestin challenge test is performed and shows no withdrawal bleeding. Further evaluation of this patient is most likely to show which of the following findings?? A: Decreased GnRH levels, B: Decreased LH levels, C: Decreased FSH to estrogen ratio, D: Increased FSH to LH ratio, E: Increased TSH levels,  <response>: This is a patient with symptoms of vaginal dryness, hot flashes, irregular periods, and infertility, which are suggestive of premature ovarian failure. Her history of childhood acute lymphoblastic leukemia and treatment puts her at risk for premature ovarian failure. The pelvic exam showing an atrophic cervix and vagina also supports this diagnosis. The progestin challenge test showing no withdrawal bleeding indicates lack of estrogen effect on the endometrium. The key lab finding in premature ovarian failure is an increased FSH level compared to LH level.D: Increased FSH to LH ratio 