Differential Diagnosis

The patient presents with difficulty conceiving, generalized body aches, and seeks pre-conception advice. Considering her symptoms and history, the differential diagnoses can be categorized as follows:

• Single Most Likely Diagnosis
  • Unexplained infertility: Given the patient's age (37), regular menstrual cycles, and only 3 months of attempting conception, unexplained infertility is a plausible diagnosis. The patient's age is a significant factor, as female fertility declines with increasing age, especially after 35.
• Other Likely Diagnoses
  • Polycystic Ovary Syndrome (PCOS): Although the patient reports regular menstrual cycles, PCOS can sometimes present with regular cycles, especially in lean patients. The heavy flow and pain during menses could be related to hormonal imbalances seen in PCOS.
  • Thyroid dysfunction: Thyroid disorders can affect fertility and cause generalized body aches. Although there's no specific mention of thyroid symptoms, it's a common enough condition to consider in the differential.
  • Endometriosis: The patient's pelvic pain during menses and generalized body aches could suggest endometriosis, a condition known to affect fertility.
• Do Not Miss Diagnoses
  • Tuberculosis: Given the patient's origin from India, a country with a high prevalence of TB, and her symptoms of generalized body aches, TB should be considered, especially as it can affect fertility and has systemic manifestations.
  • Systemic Lupus Erythematosus (SLE): SLE can cause generalized body aches, joint pain, and affect fertility. It's a diagnosis that could have significant implications if missed.
  • Hyperprolactinemia: Elevated prolactin levels can disrupt menstrual cycles and fertility. Although not directly suggested by the patient's symptoms, it's an important condition to rule out due to its impact on fertility.
• Rare Diagnoses
  • Premature Ovarian Failure (POF): Although the patient has regular menstrual cycles, POF can occasionally present with regular cycles, and her age puts her at a slightly higher risk.
  • Adrenal disorders: Certain adrenal disorders, like congenital adrenal hyperplasia, can affect fertility and menstrual regularity, though they are less common.
  • Genetic disorders: Conditions like Fragile X syndrome can affect fertility, but they are rare and would typically be associated with other symptoms or family history, which is not indicated in this case.