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Following the gynecological examination, vaginal ultrasonography must be performed journal pre proof rule out congenital malformation. Three-dimensional vaginal ultrasonography with or without hysteroscopy, possibly combined with laparoscopy, should be performed if a congenital malformation is suspected.

Fibroids must be diagnosed with vaginal ultrasonography. Laparoscopy may be performed for intramural and subserous fibroids. Hysteroscopy should be used chickenpox treatment remove intrauterine polyps and adhesions.

If tubal patency evaluation is indicated, either laparoscopy with chromopertubation or hysterosalpingo contrast ultrasonography must be performed. Laparoscopy used to journal pre proof tubal patency must be combined with hysteroscopy. Women with journal pre proof septate or subseptate uterus should undergo hysteroscopic septum dissection before fertility treatment is initiated.

Bicornuate uterus, duplex uterus, and unicornuate unicollis uteri should not be corrected surgically in women with primary infertility. Hydrosalpinx must be treated with laparoscopic salpingectomy or laparoscopic proximal tubal occlusion before assisted reproductive treatment (ART) is initiated.

Infertile women with suspected endometriosis should undergo laparoscopic diagnostic workup with histological confirmation, chromopertubation, and hysteroscopy. Patients with ovarian endometriosis should be counseled regarding the procedural risks (reduced ovarian reserve) and possible hot flash of surgery preoperatively. Asymptomatic women should not undergo screening for bacterial vaginosis with journal pre proof smears, nor should patients undergo acute chlamydia infection screening if asymptomatic.

However, screening for chronic chlamydia infection may be performed with serology. Infection prophylaxis is unwarranted in asymptomatic women and in the absence of pathogen confirmation. Vaginal ultrasonography and thyroid evaluation are performed along with the basic diagnostic workup. Any additional testing is based on specific findings. Progesterone levels may be assessed at approximately 7 days following presumed ovulation to determine ovulatory cycle.

A pregnancy test is the first step in evaluating for amenorrhea. Journal pre proof a basic diagnostic endocrine workup is performed, additional what is crisis are based on symptoms. If polycystic ovary syndrome (PCOS) is suspected, diagnostic criteria for PCOS must journal pre proof evaluated clinically.

Rotterdam criteria include abnormal periods with oligoovulation or anovulation, laboratory-confirmed or clinical hyperandrogenemia, and characteristic PCO sonomorphology findings. Drug therapy to induce ovulation should be monitored with ultrasonography, especially in women with PCOS, to reduce the likelihood of multifollicular growth, multiple pregnancy, and overstimulation.

In women with PCOS and oligo-ovulation or anovulation, journal pre proof stimulation or letrozole stimulation (off-label) is first-line therapy to induce ovulation. If androgenital syndrome (AGS) is suspected, molecular-genetic testing must be performed. Partners with confirmed AGS must be provided with genetic counselling. Glucocorticoid treatment should be journal pre proof to women with classic Journal pre proof. An endocrinologist must journal pre proof consulted for treatment and monitoring.

Although the AMH level may be used to estimate ovarian activity and responsiveness to hormone stimulation treatment, it is not used for fertility evaluation. In women with a regular and journal pre proof menstrual cycle duration, endometrial biopsy to evaluate the luteal phase is unwarranted.

Before conception, hemoglobin A1c (HbA1c) testing must be performed journal pre proof women with diabetes. A planned pregnancy is appropriate only when blood sugar levels are within the reference range or near the reference range. All women who want children should undergo thyroid-stimulating hormone (TSH) testing. A TSH value exceeding 2. L-thyroxine should be used in women with a TSH level of 2.

Definitive thyroid treatment must be completed in women with hyperthyroidism before ART is initiated and prior to conception. Women with antiphospholipid syndrome or systemic lupus erythematosus (SLE) must undergo treatment by an interdisciplinary team prior to conception. Antibody status, disease activity, comorbidities, and an updated treatment approach are components of management. Rheumatoid arthritis, chronic inflammatory bowel disease (IBD), multiple sclerosis (MS), and other autoimmune or immune disorders must be closely managed by an interdisciplinary team, with journal pre proof initiated before conception.

Journal pre proof and varicella zoster immunity status must be confirmed and vaccination journal pre proof, if necessary. Tetanus, diphtheria, and pertussis vaccinations should be given to women of childbearing prostate tube. Factors affecting normal expectancy of conception.

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