Fertility Work Up; What's after Seminal Analysis!

[tyagee]

infertility workup

what to do after ruling out male factor ? [ normal semen analysis]

endometrial biopsy or hysterosalpingogram ?

[K06100]

endometrial biopsy to rule out anovulation...then comes HSG if ovulation is confirmed but infertility is still there

[stfidel]

I have a query....sorry to post on your thread....when is FSH and progesterone level required in infertility or is it not?

[tyagee]

so...i came across similar q in uworld...

A 26-year-old woman presents for evaluation of infertility. She describes her menstrual cycles as irregular
stating that they occur anywhere between 32 to 35 days. She has no galactorrhea. She eats a balanced diet
and exercises regularly. She has no other medical problems. Her BMI is 22 Kg/m2. Physical examination is
unremarkable. W hich of the following is the most appropriate initial test to evaluate her infertility?
A Endometrial biopsy
B. Hysterosalpingogram
C. Mid luteal serum progesterone level
D. Serum testosterone
E. Karyotyping


**
what is ans here? to my surprise and shock, it was not A as discussion went in this forum.

[Anders]

Originally Posted by tyagee

so...i came across similar q in uworld...

A 26-year-old woman presents for evaluation of infertility. She describes her menstrual cycles as irregular
stating that they occur anywhere between 32 to 35 days. She has no galactorrhea. She eats a balanced diet
and exercises regularly. She has no other medical problems. Her BMI is 22 Kg/m2. Physical examination is
unremarkable. W hich of the following is the most appropriate initial test to evaluate her infertility?
A Endometrial biopsy
B. Hysterosalpingogram
C. Mid luteal serum progesterone level
D. Serum testosterone
E. Karyotyping


**
what is ans here? to my surprise and shock, it was not A as discussion went in this forum.

Guess C, as initial test.

[Novobiocin]

Originally Posted by tyagee

so...i came across similar q in uworld...

A 26-year-old woman presents for evaluation of infertility. She describes her menstrual cycles as irregular stating that they occur anywhere between 32 to 35 days. She has no galactorrhea. She eats a balanced diet and exercises regularly. She has no other medical problems. Her BMI is 22 Kg/m2. Physical examination is unremarkable. W hich of the following is the most appropriate initial test to evaluate her infertility?
A Endometrial biopsy
B. Hysterosalpingogram
C. Mid luteal serum progesterone level
D. Serum testosterone
E. Karyotyping

C. Mid luteal serum progesterone level

Originally Posted by tyagee

what is ans here? to my surprise and shock, it was not A as discussion went in this forum.

You have to understand that for step 2 there cannot be a single correct answer for a particular diagnosis (one test/treatment fits all) since the answer depends on the History/Exam findings/Test results etc,
For example, in the above question if you change the stem and keeping the answer choices same:
A is correct if the Q stem suggests endometrial pathology
B is correct if the Q stem suggests anatomical abnormality
C is correct if the Q stem suggests ovarian problem
D is correct if the Q stem suggests suggest PCOS
E is correct if the Q stem suggests Turner syndrome etc

All of them are just different steps in infertility workup and you have to pick the answer based on the information provided.

[tyagee]

Originally Posted by Novobiocin

You have to understand that for step 2 there cannot be a single correct answer for a particular diagnosis (one test/treatment fits all) since the answer depends on the History/Exam findings/Test results etc,
For example, in the above question if you change the stem and keeping the answer choices same:
A is correct if the Q stem suggests endometrial pathology
B is correct if the Q stem suggests anatomical abnormality
C is correct if the Q stem suggests ovarian problem
D is correct if the Q stem suggests suggest PCOS
E is correct if the Q stem suggests Turner syndrome etc

novo , as per my know...isnt fertility workup very streamlined...,"first rule out male factor..then female factor starting with anovulation and then tubal causes.....

[Novobiocin]

Originally Posted by tyagee

novo , as per my know...isnt fertility workup very streamlined...,"first rule out male factor..then female factor starting with anovulation and then tubal causes.....

Yes, we discussed it here

But the point I was making is that the answer depends on the info given in the question stem and there cannot be a single standard answer.