Medical history and physical examination for infertility

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Exam Overview

The medical history gathers information that may suggest causes for infertility in each of the partners. Issues that will be discussed during the medical history apply to both the man and the woman and include:

• Use of any prescription or nonprescription medicines.
• Use of alcohol or marijuana.
• Exposure to occupational or environmental chemicals.
• Exposure to radiation.
• Past infections in the reproductive or urinary tract (especially sexually transmitted diseases).
• Prior surgical procedures in the abdomen (such as appendix removal or hernia repair) and reproductive tract.
• Whether either partner's mother used DES while pregnant with the adult now trying to conceive.
• Sexual practices, including birth control use.
• Pain during sex.

The woman may also be asked about her:

• Age at first menstruation.
• Menstrual cycle characteristics (length, associated pain).
• Pap test results.
• Pregnancy history.

The man may be asked about his:

• Number of offspring (with present or previous partners).
• Exposure to heat (hot tub or sauna use).
• Frequency of sexual intercourse.

A physical examination determines the general health of both partners. The doctor will pay special attention to the outer sex organs, as well as characteristics such as breast development and body hair in both partners, to check for structural abnormalities or signs of possible hormone problems.

A semen sample is generally taken for analysis (see the topic Semen Analysis).

Why It Is Done

The medical history and physical examination will be the first step in evaluating infertility problems. Infertility usually is defined as a couple's inability to achieve pregnancy after 1 year of unprotected sex, or 6 months if the woman is 35 or older.

Results

Information from the medical history and physical examination is used to evaluate the couple and determine what further tests may be needed.

Occasionally the couple only needs to learn how to estimate when the woman is likely to be ovulating so that they can have sex then. This increases the chances of pregnancy.

If one partner has been exposed to drugs, chemicals, or radiation that may have affected his or her reproductive organs, initial testing may begin with that person.

If the woman is menstruating infrequently or not at all, testing to determine whether she is ovulating normally may be done first.

If one partner has had children recently and the other has not, testing may be focused initially on the childless partner.

If abnormalities are seen on the physical exam, further testing may be needed. Blood tests may be done to check for possible hormonal problems. Ultrasound or laparoscopy may be done to check for structural problems.

What To Think About

Both partners should be present for the initial visit. The doctor may explain further testing procedures, the treatments available, and success rates of treatment. It is important that both partners understand the risks associated with testing, as well as the possible outcomes of treatment.

Planning and good communication can help you prepare for handling difficult testing and treatment-related decisions together. This is a critical point for making decisions about setting limits on infertility testing.

Complete the medical test information form (PDF) (What is a PDF document?) to help you prepare for this test.

Credits

Last updated:	March 21, 2008
Author:	Sandy Jocoy, RN
Reviewed By:	Sarah Marshall, MD - Family Medicine, Kirtly Jones, MD - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC