History:

Marie, a 30-year-old female and her husband, Peter, a 32-year-old male present for workup and treatment for infertility. They have been trying to conceive for 18 months. Marie has never been pregnant and Peter has never fathered a child. Prior to 18 months ago, they used oral contraceptive pills for birth control.

Marie had the onset of menorrhea at age 13. She has symptoms of dysmenorrhea and menorrhagia, both of which have worsened since discontinuing birth control pills. She had a normal Pap test approximately 6 months ago. Marie is taking folic acid and multi vitamins, but no other medications. She does not smoke or use drugs and drinks alcohol socially on occasion.

Peters past medical history is significant for an undescended testicle at birth. This was surgically repaired by age 1. He denies any other significant medical history.

Peter also does not smoke or use drugs and drinks beer with his buddies on occasion.

Physical Examination:

Maries gynecologic exam revealed normal external genitalia. Examination of the vagina reveals a small amount of discharge and a slightly inflamed cervix. Vaginal and cervical cultures were obtained to test for STDs. Bimanual exam of the uterus and ovaries reveals diffuse tenderness to palpation with slight fullness in the left adnexa.

Peter had previously seen his primary care physician. According to the records his genitourinary exam revealed an uncircumcised male with normal external genitalia, no evidence of testicular masses, scrotocele, or hernias. DRE revealed no evidence of BPH or prostatitis.

Diagnostic Studies:

A complete blood count (CBC) was ordered for Marie as well as serum tests for thyroid stimulating hormone, follicle stimulating hormone and prolactin levels. A urine pregnancy test was negative.

Impression:

Primary infertility; cause undetermined.

Possible chlamydia cervicitis and possible PID.

Recommendation:

Await culture results and treat both partners with antibiotics if necessary.

Proceed with a semen analysis for Peter.

Consider a hysterosalpingogram for Marie based on her history and physical exam findings.

Literature on ART was given to them both for review and discussion at a future meeting.

Signed:

Department of Obstetrics & Gynecology

Answer the following questions, researching when necessary

1. What is cryptorchidism?

2. What procedure(s) are performed to correct it?

3. What is the CDC recommendation for child bearing women on taking folic acid?

4. What benefit(s) does it provide?

5. What is a hysterosalpingogram?

6. What is ART?

7. Describe the two major methods of ART

8. What are the functions of TSH and FSH in pregnancy?

9. What will the prolactin levels show?

10. What are newborn Apgar scores and how are they assigned?