I will pay for the following essay Subfertility. The essay is to be 12 pages with three to five sources, with in-text citations and a reference page.Download file to see previous pages... She is curre

I will pay for the following essay Subfertility. The essay is to be 12 pages with three to five sources, with in-text citations and a reference page.

She is currently taken digoxin and calcichew D3.

For the current problem, the couple has visited a GP who has prescribed clomifene which was to be taken from day two up to day five of her menstrual cycle for last three months in order to help with ovulation induction.

Menstrual History: The woman reports having regular menstrual cycles of 4/28 days with normal flow. She has no complains of dysmenorrhea or intermenstrual bleeding. She has had regular cervical smears which were reported to be normal. The woman denies the use of any form of contraception.

Sexual History: The couple report having regular, unprotected sexual intercourse. The frequency of intercourse is atleast thrice a week. There are no complains of dysparunea, post coital bleeding or any other problems.

Past Obstetric History: The woman has been pregnant once almost 14 years back. She has never conceived after that. She does not report having any miscarriages or undergoing any terminations of pregnancy.

Social History: The woman did not have any addictions or allergies. The male partner admitted to being an ex-smoker who had quit 10 years back. He did not report any use of alcohol or any other psychoactive substances.

Findings on Examination: The woman had a BMI of 21. The blood pressure taken was normal. Pelvic examination done was unremarkable and did not reveal any signs of an obvious pathology. In order to rule out any ongoing infections, swabs were taken and sent for laboratory testing.

Differential Diagnosis: Keeping the history and examination, which did not reveal any particular findings, in view, a provisional diagnosis of secondary subfertility was made. This could have several different causes both on the part of the male and the female. Any abnormality in the female genital tract, ranging from problems in ovulation to those in implantation can lead to subfertility. Similarly, amongst males, problems with ejaculation, sperm count, number and quality can lead to subfertility. In order to determine which of the causes was present in this couple, further investigations were imperative.

Investigations ordered and their results: In order to elucidate a specific cause for the subfertility a number of tests were ordered. For the woman, rubella, FBC, day 3 FSH, LH, testosterone, Sex hormone binding globulin, and day 23-progesterone were ordered. For the male, a semen analysis was ordered. Both the partners were counseled about how to give samples and what purpose these tests were going to serve.