-Avoid smoking, alcohol use, drug use.
-Will confirm ovulation with a serum progesterone level on day 21 of a 28-day cycle or one week before presumed onset of menses.
–Hysterosalpingography will be offered to screen for uterine and tubal abnormalities in this woman with infertility who has no history of pelvic infections, endometriosis, or ectopic pregnancy.
Counseling:
>Keep BMI < 30 since losing weight may restore ovulation.
>Current recommendations are that women with unexplained infertility should not be offered ovulation induction or intrauterine insemination because these have not been shown to increase pregnancy rates. Patient understands.
-Will refer the patient to formal counseling because anxiety over infertility may cause increased stress and decreased libido, further compounding the problem.
See this excellent AAFP article, scroll down to the unexplained infertility section.
Clearblue Fertility Monitor
https://www.walgreens.com/store/c/clearblue-fertility-monitor/ID=prod6284844-product