INFERTILITY, FEMALE

Ask the Following Questions:

1. Are there abnormalities on pelvic examination? Abnormalities found on the pelvic examination are cervicitis, stenosis of the cervix, fibroids, retroverted uterus, tubo-ovarian abscesses, and polycystic ovaries.
2. Are there abnormal secondary sex characteristics? Patients with Turner's syndrome, Simmonds' disease, Fröhlich's syndrome, and virilism may exhibit abnormal secondary sex characteristics.
3. Are there other abnormalities in endocrine examination? The physical examination may disclose hypothyroidism, hyperthyroidism, Simmonds' disease, or acromegaly.

DIAGNOSTIC WORKUP

Routine studies include a CBC, urinalysis, urine culture and colony count, chemistry panel, thyroid profile, VDRL test, and a vaginal smear and culture. Cervicitis should be biopsied and treated. The next logical step is to obtain a specimen of semen from the husband for sperm count.

If the above tests are negative, referral to a gynecologist is in order. If one is not available, further workup can be done, including a serum FSH and LH, serum estradiol, and serum progesterone to determine the presence of pituitary or ovarian causes of ovulatory dysfunction. A hysterosalpingogram can be done. The patient can keep a temperature chart to determine if ovulation occurs. Cervical mucus studies can be done for spinnbarkheit testing and ferning , and the presence of significant white cells should be noted. Pelvic ultrasound may be done, and laparoscopy may be necessary to rule out other conditions that may affect fertility. A trial of clomiphene citrate may be given. Endometrial biopsy may also contribute to solving the diagnostic dilemma.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

Other Book Chapters Related to Infertility

Read excerpts from these other book chapters related to Infertility:

Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Infertility

• Back to symptom: Infertility: Introduction (review 227 causes)
• Next Book Extract About Infertility: INFERTILITY, MALE (Algorithmic Diagnosis of Symptoms and Signs)
• All Book Extracts: All Online Book Extracts for Infertility

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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