Ovulation assessment — DRCOG MCQ

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HardSubfertilityOvulation assessmentDRCOG

A 29-year-old woman has been trying to conceive for 18 months. Her cycles vary between 35 and 50 days. She asks whether she is ovulating. What is the most appropriate investigation?

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Correct answer: B — Measure serum progesterone 7 days before the expected period

The best answer is “Measure serum progesterone 7 days before the expected period”. Mid-luteal progesterone should be timed around 7 days before the expected period, not fixed to day 21 in women with long or irregular cycles. CA125 and cervical screening do not assess ovulation. Pregnancy testing is important if amenorrhoea occurs, but it does not assess luteal progesterone. Cycle irregularity suggests ovulatory dysfunction and needs tailored timing. Referral timing depends on age, duration of trying, cycle regularity and known risk factors. Investigation should proceed in parallel for both partners and should not repeat evidence already established. Ovulation assessment, semen analysis and tubal patency answer different components of the fertility pathway.

Reference: NICE CG156: Fertility problems assessment and treatment: https://www.nice.org.uk/guidance/cg156/chapter/Recommendations