Infertility

Age: ‍ years old

Gender: female



HISTORY:

Presents with infertility

Attempted to conceive for ‍ ‍monthsyears

Frequency of intercourse: ‍ times per ‍weekmonth

Menstrual cycles: ‍ days, ‍regularirregular

Type of infertility: ‍primarysecondary

G‍01234 P‍01234 A‍01234

Fertility treatments: ‍none

Fertility investigations: ‍none



Associated symptoms: *Try using right-click for negatives*

‍menstrual irregularity

‍amenorrhea

‍heavy periods

‍painful periods

‍pain during intercourse



Contributing factors:

‍tobacco use

‍alcohol use

‍obesity

no history of: ‍miscarriages, ‍endometriosis, ‍polycystic ovary syndrome, ‍premature ovarian failure, ‍uterine fibroids, ‍pelvic inflammatory disease, ‍thyroid problems, ‍cancer

no use of: ‍chemotherapy, ‍radiation therapy



Male partner:

Age: ‍

Previous children: ‍yesno

Contributing factors:

‍drug use

‍alcohol use

‍tobacco smoking

‍weight

‍certain occupations

no history of: ‍cancer treatment, ‍environmental toxins, ‍varicocele, ‍ejaculation issues, ‍infections, ‍tumors, ‍undescended testicles, ‍hormone imbalances, ‍chromosome defects, ‍surgeries

no use of: ‍medications





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Metrics: weight: ‍ ‍kglbs, height: ‍ cm, waist: ‍ cm, BMI: ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Breasts: ‍normal, ‍mass, ‍axillary adenopathy

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Anorectal: DRE ‍normal, ‍blood, ‍mass, anus ‍

Pelvic:

- External genitalia: ‍normal, ‍rashlesions, ‍inguinal lymphadenopathy

- Vagina: ‍normal, ‍lesions, discharge ‍normal, ‍foul-smelling

- Cervix: ‍normal, ‍, ‍IUD strings visualized

- Bimanual exam: ‍normal, uterus ‍tendernessmass, adnexa ‍tendernessmass ‍on righton left, ‍cervical motion tenderness

- Tests performed: ‍Pap smearHPV test, ‍vaginal culturechlamydia/gonorrhea screeningHSV sample, pH ‍< 4.5 (normal)> 4.5, KOH sniff test ‍negative

- ‍Pelvic exam performed with chaperone 

Skin: ‍rashlesions on ‍

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Infertility ‍likelysuspectedpossible

DDx: polycystic ovary syndrome, ovulatory dysfunction, tubal factor infertility, endometriosis, uterine abnormalities, male factor infertility, unexplained infertility, thyroid dysfunction, hyperprolactinemia, pituitary tumors, adrenal disorders, premature ovarian failure, amenorrhea, oligomenorrhea, anovulation, uterine fibroids, uterine polyps, intrauterine adhesions, cervical stenosis, vaginal septa, genetic abnormalities, immunological factors, environmental toxins, lifestyle factors, obesity, extreme weight loss, excessive exercise, stress, age-related factors, sexually transmitted infections, chronic diseases, medication side effect, chemotherapy, radiation therapy, substance abuse, sperm disorders, varicocele, erectile dysfunction, ejaculatory dysfunction





PLAN:

Investigations:

- Blood work: ‍CBC, ‍FSH, ‍LH, ‍estradiol, ‍progesterone, ‍prolactin, ‍TSH, ‍AMH, ‍testosterone, ‍DHEAS, ‍βhCG

- Pelvic ultrasound

- Hysterosalpingogram

- Genetic testing

- Semen analysis

Treatments:

- Lifestyle modifications: ‍healthy diet, ‍regular exercise, ‍weight loss, ‍quit smoking, ‍limit alcohol, ‍reduce stress

- ‍Fertility medications

- ‍Metformin

- ‍Medroxyprogesterone

- Intrauterine insemination

- In vitro fertilization

- Intracytoplasmic sperm injection

- Donor eggs or sperm

Further care:

- Referral to fertility specialist

- Referral to psychologist

- Follow-up in ‍ ‍weeksmonths

- Return if no pregnancy after 6 months of treatment, if new symptoms develop such as pelvic pain or irregular periods, or if emotional distress occurs