Summary
Definition
History and exam
Key diagnostic factors
- hx of prior pelvic surgery
- irregular menstrual cycles
- hirsutism
- acne
- palpable uterine abnormalities
- adnexal abnormalities
- galactorrhea
Risk factors
- age >35 years
- hx of sexually transmitted disease
- very high body fat
- very low body fat
- cigarette smoking
- autoimmune disease
- hx of appendicitis
- psychiatric disease
- substance abuse
- alcohol consumption
- caffeine consumption
- stress
Diagnostic investigations
1st investigations to order
- semen analysis
- luteal-phase progesterone
- urinary luteinizing hormone (LH)
- transvaginal ultrasound scan
- hysterosalpingogram
- hysterosalpingo-contrast sonography (HyCosY)
Investigations to consider
- basal follicle-stimulating hormone (FSH)
- serum LH
- serum estradiol
- free serum testosterone
- serum TSH
- serum prolactin
- clomiphene citrate challenge
- saline infusion sonogram
- 3-dimensional ultrasonography
- MRI pelvis
- laparoscopy and hysteroscopy
- karyotyping
Treatment algorithm
Contributors
Authors VIEW ALL
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 monograph. JCR declares that he has no competing interests.
Peer reviewers VIEW 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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