Diagnostic evaluation of the infertile couple

Question 1

Besides the inability to conceive after 12 months (or 6 months after 35yo) what other scenarios justify evaluation?

Answer 1

history of oligomenorrhea or amenorrhea; known of suspected uterine/tubal/peritoneal disease or stage III/IV endometriosis; known or suspected male subfertility; using donor sperm

Question 2

timing of progesterone level for ovulation

Answer 2

1 week before expected menses

Question 3

interval of greatest fertility in terms of LH kit

Answer 3

day of LH surge and following day

Question 4

when should LH kit be performed

Answer 4

midday or evening

Question 5

indication to perform additional testing or consider alternative treatments in anovulatory women

Answer 5

3-6 successful ovulation induction cycles

Question 6

indications for ovarian reserve testing

Answer 6

age over 35; single ovary; chemo or radiation; family history of early menopause; unexplained infertility; hx of poor response to gonadotropins; ART

Question 7

day10 FSH vs day3 FSH in CCCT (sensitivity/specificity)

Answer 7

day10 has a higher senisitivity but lower specificity than day3

Question 8

AMH is produced by

Answer 8

granulosa cells of early follicles (gonadotropin independent)

Question 9

low AMH is associated with

Answer 9

poor response, low embryo quality and poor pregnancy outcomes

Question 10

sensitivity and positive predictive value for hsg in regards to polyps and submucous myomas

Answer 10

50% and 30%