Last reviewed: June 2020
Last updated: May  2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • history of prior pelvic surgery
  • irregular menstrual cycles
  • hirsutism
  • acne
  • palpable uterine abnormalities
  • adnexal abnormalities
  • galactorrhoea

Other diagnostic factors

  • dyspareunia
  • cul de sac abnormalities

Risk factors

  • age >35 years
  • history of sexually transmitted disease
  • very high body fat
  • very low body fat
  • cigarette smoking
  • auto-immune disease
  • history of appendicitis
  • psychiatric disease
  • substance abuse
  • alcohol consumption
  • caffeine consumption
  • stress

Diagnostic investigations

1st investigations to order

  • semen analysis
  • luteal-phase progesterone
  • urinary luteinising hormone (LH)
  • transvaginal ultrasound scan
  • hysterosalpingogram
  • hysterosalpingo-contrast sonography (HyCosY)
More 1st investigations to order

Investigations to consider

  • basal follicle-stimulating hormone (FSH)
  • serum LH
  • serum estradiol
  • free serum testosterone
  • serum TSH
  • serum prolactin
  • clomifene challenge
  • saline infusion sonogram
  • 3-dimensional ultrasonography
  • MRI pelvis
  • laparoscopy and hysteroscopy
  • karyotyping
More investigations to consider

Emerging tests

  • serum inhibin
  • antral follicle count
  • serum anti-mullerian hormone (AMH)
More emerging tests

Treatment algorithm

Contributors

Consultant Gynaecologist

Subspecialist in Reproductive Medicine

Newcastle Fertility Centre

Newcastle upon Tyne

UK

Disclosures

JAS is an honorary secretary of the British Fertility Society; she is also the head of a large NHS fertility service.

Dr Jane A. Stewart would like to gratefully acknowledge Dr Jared C. Robins, a previous contributor to this topic. JCR declares that he has no competing interests.

Peer reviewersVIEW ALL

Professor of Clinical Obstetrics and Gynecology

University of Cincinnati College of Medicine

Cincinnati

OH

Disclosures

DW declares that he has no competing interests.

Assistant Clinical Professor

Division of Reproductive Endocrinology

University College of Medicine

Cincinnati

OH

Disclosures

MA declares that she has no competing interests.

Assistant Clinical Professor

Department of Obstetrics and Gynecology

University of North Dakota School of Medicine

Fargo

ND

Disclosures

SD declares that she has no competing interests.

Consultant Gynaecologist

Subspecialist in Reproductive Medicine

Liverpool Women's NHS Foundation Trust

School of Reproductive and Developmental Medicine

Liverpool

UK

Disclosures

AD declares that he has no competing interests.

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