Master Specialist Reproductive Medicine and Infertility (RMA6062)
for DHA Speciality

A 29-year-old woman with PCOS (Rotterdam criteria) presents to the emergency department with 4 days of progressive pelvic pain, bloating, and vomiting. She completed a course of clomiphene citrate 100 mg daily for 5 days, 12 days ago, and has not yet had her trigger injection. Her temperature is 36.9?C, pulse 104/min, BP 108/68 mmHg, respiratory rate 22/min. Abdominal examination reveals distension with diffuse tenderness and guarding. Transvaginal ultrasound shows bilateral enlarged ovaries (right 8.2 cm, left 7.6 cm) with multiple follicles and moderate free fluid in the pelvis. Serum beta-hCG is negative. Serum estradiol is 4,850 pg/mL. Which is the most appropriate immediate management?

A 34-year-old woman, gravida 2 para 1, presents at 7 weeks' gestation with 2 days of vaginal spotting and mild lower abdominal cramping. She has a history of two previous first-trimester miscarriages and is extremely anxious. Transvaginal ultrasound shows an intrauterine gestational sac with a fetal pole measuring 6 weeks and 5 days, and no cardiac activity. Crown-rump length is 5 mm. Serum beta-hCG is 12,400 IU/L. Which is the most appropriate next step in management?

A 38-year-old woman with a history of recurrent implantation failure undergoes frozen embryo transfer. She is prescribed vaginal progesterone suppositories 400 mg twice daily. On day 10 after transfer, she presents with severe lower abdominal pain, fever of 38.5?C, and purulent vaginal discharge. She has no history of sexually transmitted infections. Pelvic examination reveals cervical motion tenderness and adnexal tenderness. Transvaginal ultrasound shows a small amount of free fluid in the pouch of Douglas but no adnexal mass. Which is the most appropriate management?

A 42-year-old woman with a BMI of 38 kg/m? and type 2 diabetes mellitus presents for fertility assessment. She has been trying to conceive for 18 months. Her HbA1c is 9.2%. She is not on any medication for diabetes. Which is the most appropriate initial management?

A 31-year-old woman with a history of polycystic ovary syndrome (PCOS) presents with 3 days of worsening abdominal pain and distension after taking clomiphene citrate 150 mg daily for 5 days. She has not had a trigger injection. Her serum estradiol is 3,200 pg/mL. Transvaginal ultrasound shows enlarged ovaries (right 6.5 cm, left 6.0 cm) with multiple follicles and mild ascites. Her haematocrit is 48%, white cell count 14,000/mm?, and creatinine 1.1 mg/dL. Which is the most appropriate management?