A 26yo woman with regular menses and her 28yo partner comes to the GP surgery complaining
of primary infertility for 2yrs. What would be the single best investigation to see whether she is
ovulating or not?
a. Basal body temp estimation
b. Cervical smear
c. Day2 LH and FSH
d. Day21 progesterone
e. Endometrial biopsy
answer: D
Investigations
• ovulatory
day 3: FSH, LH, TSH, prolactin ± DHEA, free testosterone (if hirsute)
day 21-23: serum progesterone to confirm ovulation
initiate basal body temperature monitoring (biphasic pattern)
postcoital test: evaluate mucus for clarity, pH, spinnbarkeit/fibrosity (rarely done)
• tubal factors
HSG (can be therapeutic – opens fallopian tube)
SHG (can be therapeutic – opens fallopian tube)
laparoscopy with dye insufflation (or tubal dye test)
• peritoneal/uterine factors
HSG/SHG, hysteroscopy
• other
karyotype
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