From the Guidelines
The initial steps in evaluating infertility in a 28-year-old female should include a comprehensive history, physical examination, and initial diagnostic tests, as infertility investigations are generally initiated after 12 months of unprotected intercourse without resultant pregnancy in women <35 years of age 1. When evaluating infertility in a 28-year-old female, it is essential to consider the most common causes of infertility, including ovulatory failure, tubal damage, and male factors 1.
Initial Evaluation
The evaluation should begin with:
- A detailed menstrual history to assess ovulatory function, including cycle length, regularity, and any symptoms of hormonal imbalance
- A sexual history, focusing on frequency and timing of intercourse relative to ovulation, as well as duration of attempting conception
- A review of medical, surgical, and medication histories, along with lifestyle factors like smoking, alcohol use, weight changes, exercise habits, and stress levels
- A family history of infertility or reproductive disorders
Physical Examination
The physical examination should include:
- Assessment of BMI
- Thyroid examination
- Breast examination
- Pelvic examination to identify anatomical abnormalities
Initial Diagnostic Tests
Initial laboratory tests would include:
- Serum progesterone (day 21 of cycle) to confirm ovulation
- Thyroid function tests
- Prolactin level
- Follicle-stimulating hormone (FSH) and estradiol (day 3 of cycle) to assess ovarian reserve
- A transvaginal ultrasound to evaluate uterine and ovarian anatomy It is also crucial to recommend semen analysis for the male partner, as male factors contribute to approximately 26% of infertility cases 1.
Additional Considerations
Imaging can be used to count ovarian follicles and help determine ovarian reserve, particularly in advanced maternal age, and to diagnose polycystic ovarian morphology (PCOM) in women suspected of having polycystic ovarian syndrome (PCOS) 1. Laparoscopy remains the standard for both diagnosis and staging of endometriosis, which affects at least one-third of women with infertility 1. By following this systematic approach, common causes of infertility can be identified, and subsequent management can be guided accordingly.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Steps in Evaluating Infertility
The initial steps in evaluating infertility in a 28-year-old female involve several key considerations:
- Defining infertility as the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse 2
- Identifying the most common causes of infertility, including ovulatory dysfunction, male factor infertility, and tubal disease 2
- Recognizing that lifestyle and environmental factors, such as smoking and obesity, can adversely affect fertility 2
Diagnostic Approach
The diagnostic approach may involve:
- Evaluating ovulatory function, as ovulatory disorders account for approximately 25% of infertility diagnoses 2
- Assessing hormone levels, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and prolactin, although reference ranges may vary across laboratories 3
- Considering the patient's overall health and potential underlying chronic diseases associated with infertility 2
Care Planning
Effective care planning is essential in evaluating and treating infertility: