Evaluation of the subfertile couple: the fine points

The basic fertility evaluation depends more on the history than findings at the initial visit. The previous reproductive history of both partners, the duration of infertility in this union, frequency of coitus, and a complete menstrual history often point to the diagnosis and correct therapy. Previous medical records pertaining to the problem are another source of information, and recent studies such as semen analysis results, ultrasound and salpingographic reports should be sought; the actual films are preferable to the reports. Previous surgeries, thought to be unrelated to fertility, may have been performed--try to get the operative report. There are myriad drugs that can interfere with fertility in either gender; therefore, a thorough history of past and present use as well as environmental toxin exposure is necessary. Often the routine prenatal tests for titers against common viral illnesses which can cause fetal damage have not been performed. Specific ethnic groups will need special testing. No invasive test or therapy should be performed on the female partner in the absence of a recent semen analysis. Ovulation evaluation can take the form of a basal body temperature chart; it's free, doesn't hurt, and is accurate in detecting the presence of ovulation, except for the exact timing. The over-the-counter urinary LH detection kits are highly reliable in predicting the actual day of ovulation. Serial ultrasounds to do this are not cost effective. This paper will discuss these points and the commonly performed evaluations such as salpingography and endoscopy. Specific hormonal evaluations of the amenorrheic patient and those with suspected polycystic ovarian syndrome will also be discussed.