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Endometriosis-associated subfertility — DRCOG MCQ

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HardSubfertilityEndometriosis-associated subfertilityDRCOG

A 32-year-old woman has 18 months of subfertility, severe dysmenorrhoea and deep dyspareunia. She has regular cycles. Pelvic ultrasound is normal and her partner's semen analysis is normal. When should this patient be referred?

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Correct answer: B — Refer to gynaecology or fertility services for suspected endometriosis-associated subfertility

Subfertility with dysmenorrhoea and deep dyspareunia suggests endometriosis even with a normal ultrasound, so referral is appropriate. Depot contraception may improve pain but prevents conception. Prolonged delay is not appropriate after 18 months of trying with symptoms. The pearl is that normal ultrasound does not exclude peritoneal endometriosis.

Reference: NICE NG73; NICE NG257