AKT-3901

AKT-3901

You assess a 31-year-old patient who has been experiencing difficulty in conceiving despite regular intercourse for 9 months. The patient is in good health and has no history of sexually transmitted infections. Menstrual periods have always been irregular, with months between menses. The patient’s BMI is 20 kg/m² and physical examination is unremarkable.

Semen analysis shows normal results. The patient’s blood test results are as follows:

Reference Range (female)
Day 21 progesterone (nmol/L) 16 >30
LH (mUI/mL) 22 3.3-100
FSH (mUI/mL) 8 <30
Total testosterone (nmol/L) 3.6 <2.7
Prolactin (mIU/L) 325 <700
SHBG (nmol/L) 20 19-145

What is the most appropriate initial step to enhance the couple’s chances of conceiving?