Self-assessment questions

Abstract

From the list A to M, choose the most appropriate treatment in the following cases (i–v). Each answer can be used once, more than once, or not at all.A)Weight lossB)Clomifene citrate and metforminC)LetrozoleD)Clomifene citrateE)MetforminF)GonadotrophinsG)LaparoscopyH)Laparoscopy and ovarian drillingI)Laparoscopy, dye test and ovarian drillingJ)Preconception counsellingK)Ovulation induction and IUIL)IVFM)ICSIi)A 31-year-old is referred by her GP because of primary infertility of 2 years' duration. She was previously on the combined OCP for 7 years. Her cycles are irregular, ranging between 35 and 47 days. Her BMI is 26 kg/m2. The baseline investigations show an FSH level of 5.2 iu/litres, LH level of 8.3 iu/litres and oestradiol level of 153 pmol/litres. The USS of the pelvis is suggestive of polycystic ovaries. Her partner's semen analysis is normalii)A 31-year-old is referred by her GP because of primary infertility of 2 years' duration. Previously she had used a copper IUD for 7 years. Her cycles are irregular, ranging between 35 and 47 days. Her BMI is 38 kg/m2. The baseline investigations show an FSH level of 5.2 iu/litres and LH level of 7.8 iu/litres. The USS of the pelvis is suggestive of polycystic ovaries. Her partner's semen analysis is normaliii)A 31-year-old is referred by the GP because of primary infertility of 2 years' duration. She was previously on the combined OCP for 7 years. She has periods twice yearly. She has previously had two failed cycles of clomifene ovulation induction. Her BMI is 26 kg/m2. She gives a history of chlamydia infection 5 years ago. The baseline investigations show an FSH level of 5.2 iu/litres and an LH level of 12 iu/litres. The USS of the pelvis is suggestive of polycystic ovaries. Her partner's semen analysis is normal. She finds it difficult to travel for regular scans and lives far from the hospitaliv)A 39-year-old is referred by her GP because of primary infertility of 4 years' duration. Her BMI is 26 kg/m2. The baseline investigations show an FSH level of 8.2 iu/litres and an LH level of 6.3 iu/litres. The USS of the pelvis is suggestive of polycystic ovaries. Her partner's semen analysis is normal. She has had six cycles of clomifene induction with confirmed ovulationv)A 31-year-old is referred by her GP because of primary infertility of 2 years' duration. Her cycles are irregular, ranging from 35 to 47 days. Her BMI is 30 kg/m2. She is known to have type 2 diabetes. Her HbA1C is 9.4% (68.3 mmol/mol). The baseline investigations show an FSH level of 5.2 iu/litres, LH level of 8.3 iu/litres and oestradiol level of 153 pmol/litres. The USS of the pelvis is suggestive of polycystic ovaries. Her partner's semen analysis is normal