Advanced maternal age subfertility — DRCOG MCQ
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Correct answer: A — Refer for fertility assessment now
The best answer is “Refer for fertility assessment now”. Refer for fertility assessment now is the best answer because the vignette is testing Advanced maternal age subfertility and the recommended approach is consistent with NICE CG156. The other tests may be useful in different pathways, but they would not be the most direct first investigation for this presentation. Specifically, Speculum examination, Thyroid function tests, Pelvic ultrasound, Start clomifene in primary care would be suboptimal in this scenario. The first investigation should answer the immediate clinical question and follow the relevant UK pathway. 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