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
Risk factors
- age >35 years
- history of sexually transmitted infection
- very high body fat
- very low body fat
- cigarette smoking
- auto-immune disease
- history of appendicitis
- history of caesarean or instrumental vaginal delivery
- psychiatric disease
- substance misuse
- alcohol consumption
- caffeine consumption
- occupational or environmental exposures
- stress
Diagnostic investigations
1st investigations to order
- semen analysis
- luteal-phase progesterone
- urinary luteinising hormone (LH)
- transvaginal ultrasound scan
- chlamydia antibody testing
- hysterosalpingogram
- hysterosalpingo-contrast sonography (HyCosY)
- basal follicle-stimulating hormone (FSH)
- saline infusion sonogram
- antral follicle count
- serum anti-Müllerian hormone (AMH)
Investigations to consider
- serum LH
- serum oestradiol
- free serum testosterone
- serum TSH
- coeliac disease testing
- serum prolactin
- 3-dimensional ultrasonography
- pelvic MRI
- laparoscopy and hysteroscopy
- karyotyping
Treatment algorithm
Contributors
Authors
Andrew Drakeley, MBChB, MD, FRCOG
Consultant Gynaecologist
Hewitt Fertility Centre
Liverpool Women's Hospital
Liverpool
UK
Disclosures
AD is Director and stock holder of IVF 2.0 and Horizon Fertility. AD is an advisor to TMRW Life Sciences and Cambridge Clinical Laboratories, and has received conference attendance support from Ferring, Merck, IBSA, and Theramex Pharma.
Lewis Nancarrow, MD, MRCOG
Subspecialty Trainee in Reproductive Medicine
Hewitt Fertility Centre
Liverpool Women's NHS Foundation Trust
Liverpool
UK
Disclosures
LN has been reimbursed for conference attendances by Ferring and for presenting at a fertility nurses conference by IBSA.
Acknowledgements
Dr Andrew Drakeley and Dr Dr Lewis Nancarrow would like to gratefully acknowledge Dr Daphne Chong, Dr Jane A. Stewart, and Dr Jared C. Robins, previous contributors to this topic.
Disclosures
DC declares that she has no competing interests. JAS is a past Chair of the British Fertility Society; she is also the head of a large NHS fertility service. JCR declares that he has no competing interests.
Peer reviewers
Daniel Williams, MD
Professor of Clinical Obstetrics and Gynecology
University of Cincinnati College of Medicine
Cincinnati
OH
Disclosures
DW declares that he has no competing interests.
Mira Aubuchon, MD
Assistant Clinical Professor
Division of Reproductive Endocrinology
University College of Medicine
Cincinnati
OH
Disclosures
MA declares that she has no competing interests.
Stephanie Dahl, MD
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.
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