Review Question - QID 210026

This patient is presenting with infertility that has already been partially worked up. The best next step in management is to perform a hysterosalpingogram.

Infertility is typically worked up in the following order:
1. Assess sexual practices and ensure proper sexual intercourse
2. Assess for normal ovulatory cycles
3. Assess the man's sperm count twice (confirm it is normal)
4. Assess tubal patency with a hysterosalpingogram

Incorrect Answers:
Answer 1: Advise against pregnancy given the patient's age would be inappropriate as this patient is not too old to have a child. This is the patient's decision and should be made as a shared process. She should be informed of the increased risk of Down syndrome associated with increased maternal age.

Answer 2: Assess ovulation with an ovulation calendar is unnecessary as this woman already admitted to having regular menstrual cycles.

Answer 3: Continue regular intercourse for 1 year would be inappropriate as this patient has already tried to reproduce for 1 year unsuccessfully.

Answer 5: Repeat semen count would be unnecessary as this man has already had his semen count confirmed twice.

Bullet Summary:
A hysterosalpingogram is the next step in the workup of infertility once a patient has had confirmed normal ovulatory cycles and a normal sperm count in the man.