Endocrinology Q45

A 37-year-old woman is unable to achieve pregnancy despite 7 months of unprotected intercourse. Her menstrual cycles are normal, occurring every 28 days with associated breast tenderness and bloating. There have been no prior pregnancies or attempts to achieve pregnancy by either the patient or her male partner. There is no history of previous sexually transmitted infections. She is otherwise healthy. Medical history is significant for appendicitis at age 26 for which she had an uncomplicated appendectomy. Her only medication is a prenatal vitamin. On physical examination, vital signs are normal. She has a well-healed abdominal scar. Thyroid, skin, and pelvic examinations are all unremarkable. There is no elicitable breast discharge, no signs of hyperandrogenism, and no visual field cuts.

Which of the following is the most appropriate management?

A Obtain midluteal phase serum progesterone level

B Obtain semen analysis

C Recommend an additional 5 months of unprotected intercourse

D Refer for laparoscopy

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