Medical History Review and Physical Examination

The medical history and physical examination will be the first step in evaluating infertility problems, as medications,childhood illness, injury,chronic disease, injury, reproductive organ surgery and recreational drug use can affect fertility.

Issues discussed during the medical history may include:

• The use of any prescription or non-prescription medicines
• The use of alcohol, marijuana or other substances
• Exposure to occupational or environmental chemicals
• Exposure to radiation
• Past infections in the reproductive or urinary tract (especially sexually transmitted diseases)
• Prior reproductive or abdominal surgical procedures (like appendix removal or hernia repair)
• Sexual practices, including birth control use
• Any pain felt during sex
• Age at first menstruation
• Menstrual cycle characteristics (length, associated pain)
• Pap test results
• Pregnancy history

Your reproductive endocrinologist will pay special attention to the outer sex organs, as well as characteristics such as breast development, to check for  abnormalities or  possible hormone problems.

Information from the medical history and physical examination will be used to determine what further tests may be needed, if any, and what possible solutions exist.

The solutions to each woman’s problems differ. For example, one woman who is having trouble conceiving might only need to learn to estimate when she is likely to be ovulating, as this increases chances of pregnancy. A second woman may be menstruating irregularly or not at all – in this situation, the solution may be more complex and require more testing.

Tests Your Reproductive Endocrinologist might recommend include:

• Blood testing
• Ovulation testing, like an endometrial biopsy, to verify ovulation and inspect the lining of the uterus
• Fallopian tube testing
• Hormone testing, to measure levels of female hormones at certain times during a menstrual cycle
• Ovarian reserve testing
• Ultrasound
• Measurements of thyroid function (a thyroid stimulating hormone (TSH) level of between 1 and 2 is considered best for conception)
• Laparoscopy, where a doctor inspects the pelvic organs
• Fertiloscopy, a relatively new surgical technique used for early diagnosis
• Pap smear, to check for signs of infection
• Pelvic exam, to look for abnormalities or infections
• Patient-specific X-rays