A 28-year-old attorney is referred to your office for consultation regarding her infertility. She married at age 24 and had unprotected intercourse since age 25. She reports somewhat irregular cycles every 28 to 45 days in the last year and has brought in temperature charts with what appears to by an ovulatory pattern in one-third of the charts. Prior to a year ago, her cycles came every 28 days. She and her husband are having appropriately timed intercourse, and a semen analysis on her husband reveals a normal count, motility, and morphology. Her referring physician performed a hysterosalpingogram which showed bilateral patency of the tubes. She has no dysmenorrhea, and there is no family history of infertility or endometriosis. Her medical history is unremarkable. Her review of systems reveals that she runs 8 to 10 miles per week.
This patient's physical exam reveals a thin female (height, 63 ½ inches; weight, 105 lb.). Skin reveals no obvious hirsutism or acne. HEENT is normal. Neck is without thyromegaly or adenopathy. Chest is clear to both percussion and auscultation. Heart is regular without murmurs, rubs, or gallops. Breasts are without masses, tenderness, or discharge. Abdomen reveals no organomegaly, masses or tenderness. Extremities are normal. Neurologic is physiologic. A pelvic exam reveals and anteverted uterus with nontender, normal-sized adnexa. Rectovaginal exam is normal.
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