A 37-Year-Old Woman Comes to the Office for Evaluation of Infertility

question 292

Multiple Choice

A 37-year-old woman comes to the office for evaluation of infertility.  She and her 39-year-old husband have not been able to conceive after 18 months of unprotected and frequent intercourse.  Menstrual cycles occur every 28 days, last 5 days, and have heavy bleeding and cramping on the first day.  The patient had a miscarriage at age 27 that required a dilation and curettage.  The couple had another spontaneous pregnancy 6 years later that resulted in an uncomplicated term vaginal delivery.  The patient feels well and has no medical conditions.  She has never had a sexually transmitted infection.  She does not use tobacco, alcohol, or illicit drugs.  The patient is an aerobics instructor and teaches two 60-minute classes daily.  Blood pressure is 120/80 mm Hg and pulse is 84/min.  BMI is 23 kg/m².  She has no thyromegaly.  Breast examination shows no palpable masses, axillary lymphadenopathy, or expressed nipple discharge.  Pelvic examination reveals normal external genitalia, a well-rugated vagina, a mobile uterus, and normal ovaries.  Which of the following is the most likely underlying cause of this couple's failure to conceive?

• A)Decreased ovarian reserve
• B)Hypothalamic dysfunction
• C)Hypothyroidism
• D)Primary ovarian insufficiency
• E)Uterine leiomyomata
• F)Uterine synechiae

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