1. Learn to take infertility history: Taking an infertility history is both simple and important. Providers can self-learn or can be taught what to ask couples suffering from infertility.
The most important part of taking an infertility history is to ask women and men of reproductive age if they are sexually active, if they are trying to get pregnant and for how long they have been trying. A couple who has had unprotected, regular intercourse for 12 months or longer is, by definition, infertile. Not all women will complain openly about their inability to get pregnant; instead they may present with surrogate complaints such as lower abdominal pain or abnormal vaginal bleeding. Unless women are specifically asked about their fertility desires, the diagnosis of infertility may be missed. (ACOG and ASRM, 2008; ASRM 2012a; ASRM 2012c)
Once a diagnosis of infertility has been established, the following questions should be asked (Ideally both partners should be seen together):
- Age of woman: female fertility declines with age and female age is one of the most important prognostic factors for prognosis and treatment outcome
- Age of man
- Duration of infertility
- Gynecological history
- Does the woman have a regular menstrual cycle? If yes, she is probably ovulating
- Menorrhagia (heavy regular bleeding) may suggest the presence of polyps or uterine fibroids
- Severe dysmenorrhea (painful periods) may be suggestive of endometriosis
- Irregular menstruation suggests irregular or absent ovulation
- Absent menstruation suggests lack of ovulation or pathology of the endometrium such as tuberculosis or intrauterine adhesions. Alternatively the woman might be pregnant or menopausal.
- Previous pelvic inflammatory disease, sexually transmitted infection, septic pregnancy complications and abdominal surgery may all cause tubal factor infertility.
- Obstetric history
- Ask about previous pregnancies and deliveries and complications related to both
- Women with recurrent miscarriages or serious pregnancy complications may require referral and investigation before they try to get pregnant again
- Male History
- Pregnancies with previous partners or attempts to get pregnant
- Previous sexually transmitted infections: some STIs can cause male infertility
- Any previous tests
- Social History
- Infertility can have many negative social implications. Health care workers should ask the woman/couple about their experiences with infertility including marital instability, stigmatization, discrimination and abuse.
- The psychological and socioeconomic environment of the patient should be explored. A couple should have the basic means to raise a child. This requires some basic financial resources. In addition, resources for possible infertility investigations and treatment should be discussed.
- Factors that may affect fertility include smoking, alcohol or drug use, exposure to environmental hazards, such as pesticides, chemicals, solvents and radiation, commonly associated with certain occupations.
- Sexual history
- Establish frequency of intercourse. For optimal fertility, couples should have intercourse every 2-3 days.
- Ask about any difficulties with intercourse. Deep dyspareunia may suggest pelvic pathology. Impotence and vaginismus can also be causes of infertility. Couples may not volunteer such information unless specifically asked.