Female infertility

Female

Presenting Issue

• 32yo F presenting for initial fertility workup; unable to conceive after 14 months of regular unprotected intercourse.

Pregnancy Hx

• G2P1M1: 1x spontaneous miscarriage at 7 weeks gestation (2022), managed conservatively; 1x term pregnancy (2020).

Parity

• P1 (1 live birth, 0 stillbirths).

TTC

• Trying to conceive for 14 months. Tracking ovulation via LH urine strips with regular surges detected. Coitus 2–3 times per week during fertile window. No prior fertility treatments.

Complications

• Previous pregnancy (2020) complicated by diet-controlled GDM. No preeclampsia or obstetric haemorrhage.

Types of delivery

• NVD at 39+2 weeks in 2020.

PMHx

• Mild asthma, subclinical hypothyroidism.

Menstrual cycle

• Regular 28–30 day cycles, 5 days duration. Moderate dysmenorrhoea on days 1–2, responsive to NSAIDs.

Bleeding

• Menorrhagia on day 1–2 with occasional small clots; no IMB or PCB.

Dyspareunia

• Mild deep dyspareunia reported occasionally in the luteal phase; no superficial dyspareunia.

Dyschezia

• Nil dyschezia.

Dysuria

• Nil dysuria, urgency, or frequency.

Premenstrual spotting

• 2 days of light brown spotting prior to menses onset every cycle.

Endometriosis

• Suspected mild endometriosis given cyclical dysmenorrhoea, premenstrual spotting, and deep dyspareunia; no formal laparoscopic diagnosis.

CST

• 14/05/2023: HPV not detected; routine 5-yearly recall.

Anorexia

• Nil Hx of anorexia nervosa or other eating disorders; stable BMI 23.4 kg/m².

Hypothalamic amenorrhoea

• Nil history or clinical suspicion of hypothalamic amenorrhoea.

Pcos

• No known history of PCOS; regular ovulatory cycles and normal ovarian morphology on pelvic US (2022).

Hyper/Hypo-androgenism

• Nil clinical signs of hyperandrogenism (no hirsutism, acne, or alopecia); serum free androgen index WNL.

Urological Hx

• Recurrent uncomplicated UTIs in early 20s; nil issues over the past 5 years. No renal calculi.

Other conditions

• Iron deficiency without anaemia (ferritin 18 µg/L in Nov 2023).

PSHx

• Laparoscopic appendicectomy (12/08/2015).

Allergies

• Cefalexin (maculopapular rash). Seasonal allergic rhinitis (pollen).

Medicines

• levothyroxine (Eutroxsig®) 50 mcg PO mane
• folic acid 500 mcg PO daily
• ferrous fumarate (Ferro-f-tab®) 310 mg PO daily
• salbutamol (Ventolin®) 100 mcg INH PRN

FMHx

Maternal

• Mother: Endometriosis, T2DM (diagnosed age 58). Maternal aunt: Breast Ca (diagnosed age 62).

Paternal

• Father: HTN, hyperlipidaemia.

SHx

EtOH

• Social drinker, 1–2 standard drinks per week; currently abstaining during luteal phase.

Smoking

• Non-smoker (never smoked).

Rec drug use

• Nil current or past recreational drug use.