PAINE #PANCE Pearl – Women’s Health



Question

31yo, G0P000, is being evaluated in your clinic for infertility. She and her partner have been trying for 3 years to conceive and have not been successful. She report her partner has already had a semen analysis performed and was within normal limits. She reports a regular menstrual cycle, with little to no variability, and normal flow. She has not been on any form of contraception for 3 years. The rest of her past medical history and family history is benign.

What are types of studies that can be used in her infertility work-up?



Answer

  1. Assessment of Ovulatory Function
    • Mid-luteal phase serum progesterone typically drawn seven days prior to the start of her menstrual cycle
      • > 3 ng/mL = recent ovulation
  2. Assessment of Ovarian Reserve
    • Anti-müllerian hormone (AMH) reflects the size of the follicle pool
    • Clomiphene citrate challenge test (CCCT)
      • 100mg clomiphene on day 5-9 and measurement of day 3 and day 10 FSH and day 3 estradiol
  3. Assessment of Fallopian Tube Patency
    • Hysterosalpingogram
  4. Assessment of Uterine Cavity
    • can be assessed via HSG, but can also be assessed with a saline-infusions sonohysterography or hysteroscopy

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