Subfertility history

Question 1

Order of history

Answer 1

General
Coitus
Partners
Woman’s gynae health

Question 2

General

Answer 2

How long been trying

Any previous Ix / Rx / IVF

Question 3

Coitus

Answer 3

Frequency
Difficulties
Relation to fertile days
Pain

Question 4

Partners

Answer 4

Age
Occupation 
BMI 
Prev children (same or different partner)
Smoking and alcohol use 
Current medications 
PMHx

Question 5

Woman’s gynae health

Answer 5

Current problems

• gynae SE
• PCOS sx - hirsutism, greasy skin, obesity
• Prolactinoma sx - galactorrhea

Gynae hx - MOSC and PMH

Question 6

Male causes of infertility

Answer 6

Coital difficulty

• mechanical
• ED
• periods of separation
• timing of intercourse
• ejaculation problems

Abnormal spermatogenesis

• Hypogonadotropic hypogonadism: pituitary disease, Kallmann’s, idiopathic, syndromic, anabolic steroids, functional (WL/steroids)
• Hypergonadotropic hypogonadism: Klinefelter syndrome, gonadal damage
• Varicocele
• Antisperm antibodies

Passage Problems

• Absence / blockage of Vas deferens
• Anatomical defects

Question 7

Female causes of infertility

Answer 7

Coital difficulty

• mechanical
• ED
• periods of separation
• timing of intercourse
• ejaculation problems

Ovulatory failure

• Hypogonadotropic hypogonadism - same as above
• Hypergonadotropic hypogonadism - premature ovarian failure
• Hyperprolactinaemia
• PCOS

Passage problems

• Tubal damage
• PID
• Endometriosis
• Congenital malformations
• Polyps / fibroids