Chief Complaint: Infertility
Background: Ms. L.C. is a 34 year old female presenting with concerns of infertility. She has been attempting a pregnancy over the past 16 months with no success. Patient reports that several times she thought she could be pregnant due to a cessation in her menses with accompanying constipation and some abdominal pain. Patient also reports pain that is more intense during menstruation, with “sharp and stabbing” characteristics that is not relieved by use of NSAIDs or hot compresses. The pain radiates from her lower abdominal area into her flanks, which she rates to be a 6 on a scale of 1-10. Patient reports her cycle can be irregular, with the length ranging up to 25-38 days or occasionally no period at all. She is concerned that her and her husband have not had enough intercourse for a pregnancy due to dyspareunia and general pelvic pain.
Figure 1. Photograph of Doctor and Patient (2014)
Past Medical History
- Menarche, age 10
- IUD in place, 26 to 32 years
- Pelvic mass, ruled to be non-cancerous, 30 years
- Most recent sexually transmitted infection (STI) screen negative for chlamydia, syphilis, and gonorrhea, 33 years
- Patient does not take any medications
- Patient has no history of pregnancy
Pertinent Family History
- Mother alive and healthy at 58 years of age
- Maternal grandmother passed from ovarian cancer at 42 years
- Sister, 28, also struggles with infertility
Pertinent Social History
- Patient reports stress and a decrease in sexual fulfillment from infertility concerns.
- Patient is monogamous with her primary partner.
- Patient does not drink alcohol or use recreational drugs.
- Patient follows a vegetarian diet and avoids dairy.
- Patient works as an architect for a small firm in Columbus, and occasionally travels domestically for work.