Bee presents to the clinic with her husband, reporting that they have been trying to conceive for six years without success. She expresses concern about the growing social pressure and emotional stress associated with her inability to conceive.

Bee has regular menstrual cycles, occurring every 28-30 days, with moderate flow and minimal dysmenorrhea. There is no history of sexually transmitted infections (STIs) or pelvic inflammatory disease (PID). She has never been pregnant before. Both Bee and her husband have undergone basic fertility investigations at a local clinic without conclusive results.

Bee lives in a rural community where infertility is heavily stigmatised, often resulting in social isolation for women. Her husband's family has been urging him to take a second wife due to their inability to have children. Both Bee and her husband work in agriculture, with limited access to specialised healthcare services.

- General Examination: Bee appears healthy with no significant findings. Her BMI is within the normal range.
- Pelvic Examination: No abnormalities noted.
Investigations:
- Hormonal Profile: Normal levels of FSH, LH, and prolactin.
- Ultrasound: Normal uterine structure with no evidence of fibroids or polycystic ovaries.
- Hysterosalpingography (HSG): Bilateral tubal blockage observed.
- Husband’s Semen Analysis: Normal sperm count, motility, and morphology.

The findings of bilateral tubal blockage suggest tubal factor infertility, likely due to undiagnosed or untreated infections in the past, which may have caused tubal scarring.

Bee was counselled on her condition and the treatment options available. Due to the limitations of local healthcare facilities, she was referred to a tertiary centre for further evaluation and possible surgical intervention (e.g., tubal surgery). The couple was also informed about the option of in vitro fertilisation (IVF) as a potential treatment, although the high cost and limited availability in the region were discussed.

The couple was encouraged to maintain regular follow-ups and to seek support from a community health worker to address the psychosocial aspects of infertility. They were also advised on infection prevention and the importance of early treatment for any reproductive tract infections.