Infertility - Diagnosis and Workup
Evaluate after ...
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Description

Infertility - Diagnosis and Workup

Evaluate after 12 mo unprotected intercourse in <35 yo, 6 mo in >35 yo

DDx: ovulatory dysfunction, fallopian tube abnormalities, uterine abnormalities, cervical factors, endometriosis

Hx: duration of infertility, prior OB/GYN hx (menstrual hx, pregnancies, PID, fibroids, cervical dysplasia, endometriosis, contraceptive use, DTE exposure in utero), sexual hx (timing, frequency, lubrication, dyspareunia), meds, prior chemo/XRT, substance use, FH

Dx:

 • Test ovulation: mid-luteal progesterone (day 21, 1 wk before expected menses, goal >3), home kit to check for LH surge

 • Test ovarian reserve: FSH/estradiol (day 3, goal FSH <10, estradiol <80), clomiphene challenge test

 • Additional workup: chlamydia PCR, HSG (fallopian tubes), saline infusion sonohysterography (uterus)

 • Partner: semen analysis

Tx: if testing abnormal, refer to reproductive endocrinology for aggressive induction of ovulation, IVF, or donor oocytes



#Infertility #Diagnosis #Workup
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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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