Discuss your management plan for this patient, including patient education, referrals, and follow-ups.

Dear writer i need a discussion reply to a fellow classmates class post. I will provide the class discussion requirements and the student answer to that class discussion work. I need you to reply to their post. I will provide the discussion and after the students answer for you to answer to. Any questions let me know.Class post requirements:A 32 –year-old gravida 0 woman presents with symptoms of cyclic lower abdominal pain, dysmenorrhea, and inability to conceive after trying unprotected intercourse for the past year. Her partner has had semen analysis performed, and it is reported to be normal. The patient’s abdominal pain generally starts 1 to 2 days before her menses and lasts for the first day or so of menstrual flow. This pain has gradually worsened over the past 2 years and no longer is well controlled with non-steroidal anti-inflammatory medications. The patient has recently begun experiencing deep-thrust dyspareunia. The patient’s period has been regular with occasional episodes of mid-cycle spotting. Are there any diagnostic studies that should be ordered on this patient? Why? List the primary diagnosis and at least two differential diagnoses for this patient. Explain your reasoning for each. Discuss your management plan for this patient, including patient education, referrals, and follow-ups.Students post to respond to:Infertility can be psychologically stressful on a woman and her partner. The patient should be educated that infertility is the inability to conceive after 12 months of regularly occurring, unprotected intercourse. Though this patient mentioned that she has been trying to conceive for 12 months, she did not mention how often she and her partner are having sexual intercourse, and this should be further assessed to ensure it is occurring frequently enough. Additional education should include that infertility occurs in around 15% of couples and can be caused by a variety of factors. Fortunately, there are treatments available and about 85% of infertile couples can have a child (Bechmann et al., 2014, p. 371).The assessment of the patient should determine past medical history, such as medications, surgical history, family history, and history of pelvic infections. The provider should also assess for diet and exercise habits, and drug, alcohol, and tobacco use. The patient then requires a complete physical exam, including an external and internal pelvic exam looking for structural abnormalities (Bechmann et al., 2014, p. 374).Based off of the information collected so far, the primary diagnosis for this patient is endometriosis. Endometriosis is more prevalent in women of reproductive age and in nulliparous women. If the family history reveals a first degree relative with endometriosis the risk for it is increased almost 10-fold. Some women with endometriosis may be asymptomatic while others have intense pain. The most common symptoms of endometriosis are dysmenorrhea that is progressively worsening, and dyspareunia, especially during deep penetration (Bechmann et al., 2014, pp. 287-289). Differential diagnoses include other structural abnormalities, such as uterine fibroids, scarring, or a uterus that is abnormally shaped since these can cause problems issues with fertility and pain during intercourse. Infections, polycystic ovarian syndrome, and autoimmune disorders should be ruled out as well since these conditions can cause infertility and some of the patient’s symptoms as well (U.S. Department of Health and Human Services, 2017).Diagnostic studies should include laboratory testing for thyroid stimulating hormone, human chorionic gonadotropin, estradiol, prolactin, total testosterone, dehydroepiandrosterone sulfate, follicle stimulating hormone, and luteinizing hormone. In addition, sexually transmitted infection screening should be done to rule out infections causing infertility. Next, imaging should be done to examine the structure of the reproductive organs, and this can include a transvaginal ultrasound and magnetic resonance imaging (Bechmann et al., 2014, pp. 374-375). Note, however, that pelvic exams and imaging may appear normal in women with endometriosis. Ultimately, the diagnosis of endometriosis can only be made with a laparotomy or laparoscopy with tissue biopsy. A CA-125 may also be ordered, since this can be increased in endometriosis, but the levels may be raised in other conditions as well (Bechmann et al., pp. 289-291).The management plan for this patient will depend on her diagnostic study findings. During the laparoscopy to diagnose endometriosis conservative surgery may be done if disease is found to be extensive and if the patient is wanting to become pregnant. Pelvic adhesions or scarring may cause the infertility associated with endometriosis, and the surgeon can try to correct this. However, autoantibodies and prostaglandins may also play a role in the infertility associated with endometriosis (Bechmann et al., 2014, pp. 289-291).Clearly, there can be multiple factors for infertility beyond just endometriosis. These will need to be explored and managed as well, and frequent follow ups are important to monitor progress of treatments. Education on healthy diet and exercise is also pertinent and should be provided too. In the end, if infertility persists after surgery and implementation of the management plan, then the patient may need to be referred to a fertility specialist for more aggressive therapies, such as ovarian stimulation, insemination, and in vitro fertilization (Bechmann et al., 2014, pp. 378-379). ReferencesBechmann, C.R., Ling, W. F., Herbert, N. W., Laube, W. D., Smith, P. R., Casanova, R., & Weiss, M.P. (2014). Obstetrics and gynecology (7th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.U.S. Department of Health and Human Services. (2017). What are some possible causes of female infertility? Retrieved from nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female