A 28-Year-Old Woman, Gravida 0 Para 0, Comes to the Office

question 454

Multiple Choice

A 28-year-old woman, gravida 0 para 0, comes to the office with her husband, age 38, for evaluation of infertility.  The couple has not conceived despite frequent intercourse without contraception for over a year.  Menarche was at age 13.  The patient's menstrual cycles are irregular, and her last period was 8 weeks ago.  She has no nipple discharge.  She had trichomoniasis as a teenager.  Sexually transmitted infection testing at her most recent annual examination was negative.  Her husband had a normal semen analysis.  The patient takes a daily prenatal vitamin and does not use tobacco, alcohol, or illicit drugs.  BMI is 28 kg/m².  Blood pressure is 130/80 mm Hg and pulse is 84/min.  Heart and lung examination is normal.  The abdomen is soft and nontender, with no palpable masses.  Pelvic examination shows normal external genitalia and a mobile uterus without adnexal masses.  Urine pregnancy test is negative.  Serum TSH and prolactin levels are normal.  Free testosterone levels are elevated.  Which of the following is the most likely cause of this couple's infertility?

• A)Failure of follicle maturation
• B)Failure of müllerian duct fusion
• C)Impaired oocyte transport
• D)Pelvic adhesions and fibrosis
• E)Primary ovarian insufficiency
• F)Sex chromosome monosomy

---

Definitions:

Genetic Vulnerability

The susceptibility of an individual to certain diseases or conditions due to their genetic makeup.

Twin Studies

A research design in behavioral genetics that compares the similarity between monozygotic (identical) twins and dizygotic (fraternal) twins to determine the influence of genetics versus environment.

Antisocial Behavior

Conduct that violates social norms and can involve harm to others or property.

Narcissistic Personality Disorder

Narcissistic Personality Disorder is a mental condition characterized by grandiosity, a lack of empathy for others, and a need for admiration.