Differential Diagnosis for Infertility in a 27-year-old Nulligravid Woman
- Single most likely diagnosis:
- Pelvic adhesions or tubal damage due to previous pelvic infection: The patient's history of a pelvic infection in her late teens, which included symptoms such as pain with intercourse, vaginal discharge, and fever, increases the risk of developing pelvic adhesions or tubal damage, leading to infertility.
- Other Likely diagnoses:
- Polycystic ovary syndrome (PCOS): Given the family history of a sister with PCOS and the patient's BMI of 30 kg/m2, which falls into the obese category, PCOS is a plausible diagnosis. Although the patient's menstrual cycle is regular, PCOS can present with a range of symptoms, and obesity is a common comorbidity.
- Unexplained infertility: Despite the patient's regular menstrual cycles and normal semen analysis of her husband, unexplained infertility remains a possibility, as the evaluation of infertility is complex and multifactorial.
- Endometriosis: The patient's history of bloating before menses and moderate cramping could be indicative of endometriosis, a condition often associated with infertility, although she does not report pain with intercourse currently.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Ovarian cancer or other gynecologic malignancies: Although rare, any pelvic mass or abnormality could potentially be malignant. Early detection is crucial for treatment and survival.
- Tuberculosis: A rare cause of infertility, especially in areas where TB is prevalent. It can cause tubal damage and infertility, and its diagnosis is critical due to the need for specific treatment.
- Rare diagnoses:
- Congenital anomalies of the reproductive tract: Conditions such as unicornuate uterus or other Müllerian duct anomalies are rare but can contribute to infertility.
- Autoimmune disorders: Certain autoimmune conditions can affect fertility, though they are less common causes of infertility compared to other factors.
- Genetic disorders: Some genetic conditions can impact fertility, though they are rare and often present with other systemic symptoms or family histories suggestive of a genetic etiology.