Question of the Week # 360

360)  A 30 year old woman presents to your office accompanied by her husband. She is concerned about her inability to conceive despite having regular intercourse for the past six months.  Her menstrual cycles have always been regular and she has not been using oral contraceptives for the past 10 months. She denies any cold or heat intolerance. She has no other complaints. She does not smoke or drink alcohol. On examination, she is age-appropriate. Pelvic examination is benign. A urine pregnancy test is negative. You counsel the couple and  advise them on continuing regular sexual intercourse. Which of the following is the most appropriate next step?

A) Semen analysis

B) Re-evaluate in 6 months

C) Obtain luteal-phase progesterone level

D) Serum FSH level

E) Hysterosalpingography

10 Responses

  1. a. Semen Analysis..

  2. A) Semen analysis – first rule out male cause of infertility -easier

    • Think again! What is the definition of infertilty? Infertility evaluation should only be started after the definition of infertility is met. Questions on USMLE step 3 are based on easy topics and most common topics. But they test the correct understanding of the common concepts. Is the information provided in the question sufficient to define infertility?

    • Ohhh…wait for 6 more months and then investigate? as she cannot be diagnosed as infertile until 12 months of unprotected intercourse

      B) Re-evaluate in 6 months

      • very tricky 🙂

  3. semen analysis

  4. Ans ..(D)

  5. Infertility means not being able to get pregnant after one year of trying. And in Q it mentions only 6 month, so after USMLE GALAXY hint am assuming choice B, otherwise I would have chosen A- and started with ruling out male infertility factor first.

    • Correct!

  6. bbbbbbbbb

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