What questions should be asked of a patient during a fertility work-up?

Key Questions for a Fertility Workup

A comprehensive fertility workup should include detailed questioning about reproductive history, medical conditions, lifestyle factors, and physical examination 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

Questions for Female Partner

Reproductive History

• Duration of infertility and previous attempts to conceive 1
• Age at menarche and menstrual cycle characteristics (regularity, duration, flow) 1
• Previous pregnancies and outcomes (live births, miscarriages, abortions, ectopic pregnancies) 1, 2
• Previous fertility treatments and responses 1, 3
• Coital frequency and timing relative to ovulation 4, 1
• Current contraceptive methods or previous use 4
• Pain during intercourse 1

Medical History

• Past surgeries, particularly pelvic or abdominal 1
• Previous hospitalizations 1
• History of sexually transmitted infections or pelvic inflammatory disease 4, 1
• History of endometriosis 4
• Current medications and allergies 1
• Chronic medical conditions (diabetes, thyroid disorders, etc.) 4, 1
• Previous abnormal Pap smears or cervical procedures 1

Lifestyle Factors

• Smoking status 4, 1
• Alcohol consumption 4, 1
• Caffeine intake 1
• Recreational drug use 4, 1
• Exercise patterns 1
• Weight changes 4, 1
• Occupational exposures 1
• Stress levels 1

Questions for Male Partner

Reproductive History

• Previous pregnancies with current or former partners 2
• Previous fertility evaluations or treatments 4, 3
• Coital frequency and any sexual dysfunction 4
• History of undescended testicles, testicular trauma, or infections 4

Medical History

• Systemic illnesses (e.g., diabetes mellitus) 4
• Prior surgeries, particularly genital or inguinal 4
• Past infections, especially mumps orchitis 4
• Current medications (prescription and nonprescription) 4
• Allergies 4

Lifestyle and Environmental Factors

• Occupational hazards 4
• Exposure to excessive heat 4
• Smoking status 4
• Alcohol consumption 4
• Recreational drug use 4
• Anabolic steroid use 1

Family History Questions for Both Partners

• Family history of infertility 4
• Genetic conditions or birth defects 4
• History of recurrent pregnancy loss 1
• Family history of early menopause (for female partner) 1

Social and Psychological Assessment

• Relationship status and duration 1
• Screening for intimate partner violence 4
• Psychological impact of infertility 4
• Support systems available 4

Important Considerations and Pitfalls

Timing of Evaluation

• Begin evaluation after 12 months of regular unprotected intercourse in women under 35 1, 5
• Begin after 6 months in women over 35 1, 6
• Immediate evaluation for women over 40 or those with known conditions affecting fertility 6

Common Pitfalls to Avoid

1. Delaying evaluation in women over 35 1
2. Focusing solely on female factors without concurrent male evaluation 1, 6
3. Overlooking lifestyle factors that affect fertility 1
4. Failing to consider underlying endocrine disorders 1
5. Neglecting emotional and psychological support during the evaluation process 1

Next Steps After History Taking

• Physical examination of both partners 4, 1
• Laboratory testing including semen analysis, ovulation assessment, and hormone evaluation 1
• Imaging studies such as transvaginal ultrasound and hysterosalpingography 1

By systematically addressing these questions during a fertility workup, clinicians can efficiently identify potential causes of infertility and develop appropriate treatment plans for affected couples.