30 years old female presents with chronic cyclical abdominal pain. Pain is increased during the 5 days of menstrual cycle. Patient is married for 2 years and has not conceived till now. What is the most appropriate next step in management?
Ans. is 'a' i.e., Ultrasonography o According the clinical scenario of chronic cyclical abdominal pain with infertility the most probable clinical diagnosis is endometriosis and the most logical next step in management of this patient is to investigate the patient with ultrasonography for definitive diagnosis of endometriorsis.Fernisle Infertility : Causes, investigations andmanagementAetiologyInvestigationsManagementTubal causeo Hysterosalpingography or sonosalpingogoraphyo Falloscopyo Salpingographyo Laparoscopic chemotubationo Adhesiolysis (Lap.)o Tuboplastyo Hysteroscopic cannulation and balloonoplasty |o If failed or not feasible|Ovulationo Ovulation monitoring by ultrasound (BBT, BBI) EB for tuberculosisIVF / Gif +o Clomiphene, letrozole||AbnormalFailed||Hormonal studyFSH, LH, GnRHo FSH, LH, Prolactin|o E2, P levelPositive, No responseo Thyroid and diabetes| Response|If failed IVF Donor egg|AdoptionOther causesUltrasound, MRI, SSG, hysteroscopyTreat the causeo This above table is important to decide the clinical next step in answering the questions like the one given aboveo Clinical suspicion of endometriosis with infertility will come under the other causes as per the cable and thus Ultrasound is the best next step in management of such patient.
Ultrasonography
Test for male infertility
CT Scan of abdomen with contrast
Test for urine infection
Miscellaneous (Gynae)