History, Physical Examination and Risk Assessment in Infertility

The clinical interview and examination are the first and often most informative steps in evaluating an infertile couple. A structured reproductive, medical, surgical, sexual, and lifestyle history, combined with a focused physical examination of both partners, identifies risk factors and directs which investigations are most likely to be useful.

Definition

History and examination in infertility comprise a systematic, couple-based clinical assessment of reproductive history, menstrual and ovulatory patterns, coital frequency, prior pregnancies, medical and surgical history, lifestyle exposures, and a focused physical examination, used to identify risk factors and guide further investigation.

Scope

This topic describes the components of a couple-based history, the targeted physical examination of female and male partners, and the lifestyle and exposure risk factors relevant to fertility. It is reference material on what the assessment covers and why; it does not provide individualised clinical instructions.

Core questions

• Which elements of the reproductive and menstrual history point toward ovulatory, tubal, uterine, or male factors?
• What does the focused physical examination of each partner look for?
• Which lifestyle and exposure factors are relevant to fertility and prognosis?
• How does history and examination shape the choice of subsequent tests?

Key concepts

• Menstrual and ovulatory history
• Coital frequency and timing
• Obstetric and gynaecological history
• Pelvic and breast examination
• Male reproductive and genital examination
• Age and duration of infertility
• Lifestyle factors (smoking, alcohol, weight, exposures)
• Sexual history and coital function

Mechanisms

History elements map onto the physiology of conception: irregular or absent menstruation suggests an ovulatory disorder, severe dysmenorrhoea or deep dyspareunia raises the possibility of endometriosis or tubal disease, prior pelvic infection or surgery points to tubal factors, and a history of testicular problems or sexual dysfunction points to male factors. Physical examination looks for signs of endocrine disorders, pelvic abnormalities, and, in the male partner, testicular size, varicocele, and genital anatomy. The pattern of findings narrows the differential and prioritises confirmatory tests.

Clinical relevance

A thorough history and examination can reveal causes before any test is ordered and ensures that investigations are appropriately targeted, which is efficient and avoids unnecessary procedures. As reference content it explains the structure and rationale of the assessment; it does not direct the care of any specific couple.

Evidence & guidelines

The components of female and male assessment are described in the ASRM committee opinions on diagnostic evaluation of the infertile female (Practice Committee, 2015) and male (Practice Committee, 2012), in the AUA/ASRM male infertility guideline (Schlegel et al., 2021), and in NICE CG156 (2013, updated 2017).

History

Structured couple-based assessment became standard as reproductive medicine recognised that male and female factors contribute comparably and that history alone identifies many relevant risk factors. Successive committee opinions codified the elements of history and examination for each partner (Practice Committee, 2012; Practice Committee, 2015).

Seminal works

• practice-committee-asrm-2015-female
• practice-committee-asrm-2012-male
• schlegel-2021

Frequently asked questions

Why is the history taken from both partners?

Because male and female factors each contribute substantially to infertility, a couple-based history ensures that contributing factors in either partner are identified and investigated.

What does a regular menstrual cycle suggest in the history?

Regular, predictable cycles make an ovulatory disorder less likely and help direct attention toward tubal, uterine, or male factors, though confirmatory testing is still part of a full evaluation.