Comprehensive Questions for Infertility Workup
A thorough infertility workup requires detailed questioning of both partners, with evaluation beginning after 12 months of regular unprotected intercourse in women under 35 years or after 6 months in women over 35 years. 1, 2
Female Partner Assessment
Reproductive History
- Duration of infertility and previous attempts to conceive
- Coital frequency and timing relative to ovulation
- Previous pregnancies and outcomes (gravidity, parity, complications)
- Age at menarche, menstrual cycle length and characteristics
- Onset and severity of dysmenorrhea
- Level of fertility awareness and previous fertility treatments
- Sexual history including pelvic inflammatory disease and STDs 1
Medical History
- Past surgeries with indications and outcomes
- Previous hospitalizations
- Medical conditions associated with reproductive failure:
- Thyroid disorders
- Hirsutism or other endocrine disorders
- Childhood illnesses affecting development
- Current medications and allergies
- Family history of reproductive failure 1, 2
Review of Systems
- Symptoms of thyroid disease
- Pelvic or abdominal pain
- Dyspareunia (painful intercourse)
- Galactorrhea (breast milk discharge)
- Hirsutism (excessive hair growth) 1
Lifestyle Factors
- Smoking status
- Alcohol consumption
- Caffeine intake (especially >5 cups daily)
- Recreational drug use
- Weight history (both underweight and obesity affect fertility)
- Use of vaginal lubricants
- Environmental and occupational exposures 1, 2
Male Partner Assessment
Reproductive History
- Frequency and timing of intercourse
- Prior fertility and duration of current infertility
- Childhood illnesses and developmental history
- Sexual history including STDs
- Gonadal toxin exposure, including heat 1
Medical History
- Systemic medical illnesses (e.g., diabetes mellitus)
- Prior surgeries and past infections
- Medications (prescription and non-prescription)
- Allergies
- Family reproductive history 1
Lifestyle Factors
- Smoking status
- Alcohol consumption
- Recreational drug use
- Occupational exposures
- Environmental exposures 1
Physical Examination Components
Female Examination
- Height, weight, and BMI calculation
- Thyroid examination for enlargement, nodules, or tenderness
- Clinical breast examination
- Assessment for signs of androgen excess
- Pelvic examination assessing:
Male Examination
- Examination of the penis, including urethral meatus location
- Measurement and palpation of the testes
- Presence and consistency of vas deferens and epididymis
- Presence of varicocele
- Secondary sex characteristics
- Digital rectal examination 1
Important Considerations
Timing of Evaluation
- Begin evaluation after 12 months of unprotected intercourse for women <35 years
- Begin after 6 months for women ≥35 years
- Immediate evaluation if risk factors are present 3
Common Pitfalls to Avoid
- Focusing solely on female factors without concurrent male evaluation
- Delaying evaluation in women over 35 years
- Overlooking lifestyle factors that affect fertility
- Neglecting emotional and psychological support during evaluation 2
Initial Testing
- For women: Assessment of ovulation (midluteal progesterone), ovarian reserve, and structural evaluation
- For men: At least two semen analyses performed at least one month apart 1
By systematically addressing these questions during an infertility workup, clinicians can efficiently identify potential causes and develop appropriate treatment plans for affected couples.