Soru

An infertility evaluation is initiated for a couple who have been unable to achieve a pregnancy despite having regular, unprotected intercourse for the past $18$ months. The female partner is $27$ years of age. She reports that since discontinuing oral contraceptive pills a year and a half ago, she has not experienced a single menstrual period. Prior to starting oral contraceptives at age $18$, her menstrual cycles occurred irregularly every $3$ to $5$ months. She competes in triathlons and maintains a strict vegan diet. Her body mass index is $17.5 \text{ kg/m}^2$. Vital signs show a blood pressure of $90/60 \text{ mmHg}$ and a pulse of $50/min$. Physical examination reveals Tanner stage V breast development and normal pubic hair, with no hirsutism, acne, or thyromegaly. Pelvic ultrasound demonstrates a normal-appearing uterus with a thin endometrial stripe ($3 \text{ mm}$) and small, bilateral ovaries without cysts. Laboratory evaluation shows:

After $6$ months of concerted efforts at nutritional rehabilitation and exercise reduction, her body mass index remains $17.8 \text{ kg/m}^2$ and her amenorrhea persists. Which of the following is the most appropriate next step in medical management to help this patient conceive?