INFERTILITY, FEMALE
INFERTILITY, FEMALE: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- 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.
- Are there abnormal secondary sex characteristics? Patients with Turner's syndrome, Simmonds' disease, Fröhlich's syndrome, and virilism may exhibit abnormal secondary sex characteristics.
- 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.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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