A couple has been trying to conceive for 18 months. The woman is 38 years old with regular cycles. Semen analysis is normal. What is the most appropriate initial investigation?

• A Hysterosalpingography
• B Ovarian reserve testing (AMH and AFC) ✓
• C Laparoscopy with dye test
• D Mid-luteal progesterone

Explanation

In a woman over 35 years with 18 months of infertility, ovarian reserve testing (AMH and antral follicle count) is the most appropriate initial investigation because age-related decline in ovarian reserve is the most likely cause. Tubal assessment is important but secondary. Mid-luteal progesterone is unnecessary with regular cycles. Laparoscopy is invasive and not first-line.

Reference: NICE Guideline NG7: Fertility Problems, 2017 (updated 2023) ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.