06-13-2007, 02:30 PM
A couple who you have been treating for many years for various "colds and viruses" comes to the office
because they have been unsuccessfully trying to conceive for the past 3 years. They say that they are
enjoying the "act of trying" but are getting a bit concerned that there is something "wrong". The wife is
32 years old, has never had a sexually transmitted disease and has never been pregnant before. She
has had regular menstrual periods since she was 14 years old and usually has cramping and breast
tenderness a few days before menses. The husband is 36 years old and denies any sexually
transmitted diseases. He is an avid cyclist and goes on 10-mile rides each day. Neither of them takes
any medications. You perform a complete physical examination on both of the patients and find no
abnormalities. During the pelvic examination, you obtain a Pap smear, gonorrhea and chlamydia
cultures. You order thyroid function tests, prolactin levels, and a mid luteal serum progesterone level in
the wife and advise her to record her basal body temperature. The couple returns to the office 1 month
later to go over the test results. All of the studies that you ordered were normal, and the results of the
basal body temperature show a 0.6% temperature rise at day 14 that remains elevated until 13 days
later. The temperature drops and menses occurs 24 hours later. The most appropriate next step is to
A. advise him to stop bicycling so often
B. determine his testosterone concentration
C. inform them that she is not ovulating
D. obtain a semen sample for analysis
E. schedule a hysteroscopy
because they have been unsuccessfully trying to conceive for the past 3 years. They say that they are
enjoying the "act of trying" but are getting a bit concerned that there is something "wrong". The wife is
32 years old, has never had a sexually transmitted disease and has never been pregnant before. She
has had regular menstrual periods since she was 14 years old and usually has cramping and breast
tenderness a few days before menses. The husband is 36 years old and denies any sexually
transmitted diseases. He is an avid cyclist and goes on 10-mile rides each day. Neither of them takes
any medications. You perform a complete physical examination on both of the patients and find no
abnormalities. During the pelvic examination, you obtain a Pap smear, gonorrhea and chlamydia
cultures. You order thyroid function tests, prolactin levels, and a mid luteal serum progesterone level in
the wife and advise her to record her basal body temperature. The couple returns to the office 1 month
later to go over the test results. All of the studies that you ordered were normal, and the results of the
basal body temperature show a 0.6% temperature rise at day 14 that remains elevated until 13 days
later. The temperature drops and menses occurs 24 hours later. The most appropriate next step is to
A. advise him to stop bicycling so often
B. determine his testosterone concentration
C. inform them that she is not ovulating
D. obtain a semen sample for analysis
E. schedule a hysteroscopy