Assisted Reproductive Technology

A 38-year-old woman with a 5-year history of secondary infertility undergoes diagnostic laparoscopy, which reveals stage III endometriosis with adhesions and a 3 cm endometrioma on the left ovary. Her husband's semen analysis is normal. After surgical excision of the endometrioma and adhesiolysis, the couple attempts natural conception for 12 months without success. Repeat semen analysis remains normal. Transvaginal ultrasound shows no recurrent endometrioma. What is the most appropriate next step in management?

A 32-year-old woman with a 3-year history of primary infertility presents to the fertility clinic. Her husband's semen analysis is normal. Hysterosalpingography shows patent fallopian tubes bilaterally. Transvaginal ultrasound reveals multiple small follicles (2–8 mm) in both ovaries with a total antral follicle count of 28. Serum FSH on day 3 is 8.2 mIU/mL, LH 7.1 mIU/mL, and testosterone 0.8 ng/mL. She has irregular menses (cycle length 35–45 days), mild hirsutism, and BMI 28 kg/m². What is the most appropriate first-line management for this couple?

A 32-year-old woman with a 4-year history of primary infertility presents to the fertility clinic. Her menstrual cycles are regular (28 days), and hysterosalpingography shows patent fallopian tubes. Her husband's semen analysis is normal. Transvaginal ultrasound reveals a normal uterus and ovaries with adequate antral follicle count. Baseline FSH is 6.2 mIU/mL and AMH is 2.8 ng/mL. After 3 cycles of intrauterine insemination (IUI) without conception, the couple is counselled for in vitro fertilization (IVF). During the IVF cycle, she receives gonadotropin stimulation and undergoes oocyte retrieval. Twelve metaphase II (MII) oocytes are retrieved. After 18 hours of incubation with prepared sperm, 8 oocytes show evidence of two pronuclei (2PN). The couple wishes to know the fertilization rate and the next step in embryo development. What is the fertilization rate in this cycle, and what is the expected timeline for embryo transfer?

A 38-year-old woman with a 6-year history of secondary infertility undergoes evaluation. Hysterosalpingography reveals a normal uterus but right-sided hydrosalpinx with a patent left fallopian tube. Her partner's semen analysis is normal. Transvaginal ultrasound confirms a large right hydrosalpinx (diameter 4 cm) with no evidence of endometriosis. Baseline FSH is 8.5 mIU/mL and AMH is 1.9 ng/mL. The couple is counselled for IVF. Before commencing ovarian stimulation, the fertility specialist discusses the presence of hydrosalpinx and its impact on IVF outcomes. Which of the following statements regarding hydrosalpinx and IVF is MOST accurate?

A 32-year-old woman with a 4-year history of primary infertility presents to the fertility clinic. Her husband's semen analysis is normal. Her menstrual cycles are regular (28 days), and hysterosalpingography shows patent fallopian tubes. Transvaginal ultrasound reveals a normal uterus with no fibroids. Serum FSH, LH, prolactin, and thyroid function tests are all normal. After 2 years of timed intercourse without conception, the couple is counselled for assisted reproductive technology. During the first IVF cycle, she receives GnRH agonist for pituitary downregulation followed by gonadotropin stimulation. On day 10 of stimulation, transvaginal ultrasound shows 8 follicles (3 measuring 18 mm, 2 measuring 16 mm, 3 measuring 14 mm), and serum estradiol is 1200 pg/mL. What is the most appropriate next step in management?