The most important step for any treatment is a detailed history from the couple that is both from the husband and the wife.
When a couple enters your Fertility Office, the first thing is the soft greeting from the receptionist, making them comfortable at the first go. Making them easy & comfortable gives them a sense of security and arrived at the right place.
Now the couple enters the doctor’s Chamber, and the smiling, calm look of the doctor should comfort them further. Directly jumping on history taking should not be done. Its essential to talk 2 mins generally as in from where they have come, and some encouraging words and details about the doctor herself should be briefed to the couple.
Once they are relaxed, start taking relevant history.
- Name –So that she is addressed politely. Assess the religion as many treatment modalities are not allowed in some religions.
- Age- Important as it tells on her fertility status.
- Profession- are the working hours hampering their fertility or use of technology.
- Marital status -How long are they married? Consanguinity, especially in certain religion-it helps to know certain genetic diseases in the family
- Menstrual cycles-Regularity, flow, the interval of cycles, and her LMP. This reflects on any gynecological issues and her ovarian reserve too. History of dysmenorrhoea premenstrual or Postcoital for Endometriosis. Irregular periods for PCOS or no periods from childhood in Primary Amenorrhoea. Severe menorrhagia with dysmenorrhoea in fibroids or adenomyosis.
- Obstetric History- No.of is living issues and IUD(Preterm and term), Previous any abortions- at what gestation was the abortion and caused if known and when POC where send for karyotyping or NGS, whether it was missed. Heartbeat was skipped like in APLA syndrome or blighted ovum. Some patients give a classical history of UPT positive, and then they bled. It can be just natural pregnancy, so do ask for an ultrasound done or not. Treatment is done for abortions like MTP, D&C, normal inductions, or hysterotomy, or rarely hysterectomy.
- History of ectopic pregnancy. At what gestation, treated medically or surgically, which side, tubal status and see the previous discharge reports.
- Any adoptions also affect the psychological status of the couple and, in the case of a previous marriage, any issues.
- Coital history-How is their sexual life? Frequency of sexual intercourse. Since how long trying and used any contraceptive in the past esp pills or IUD?
- Primary vaginismus if present
- Past or present history. Any surgeries before or medical conditions now or before or taking any medications. Allergies to any medicines.
- Family history-Any diseases in the family or any child in the family suffering from any genetic disorder.
- Any previous treatment history- ovulation inductions/IUIs/IVF’s done in past & details of when, where, and how many times.
Many times single women may also demand IUI for conception.
Name– Relevant for identity & addressing
Age-Reflects on sperm aging and quality and whether the right age to have a child as above 55 years not recommended.
Profession-As may hamper the sperm quality or availability of husband (army/navy/those working abroad/etc.). Use of laptops, late-night shifts, Bluetooth, radiation, drivers, and many more.
Any history of smoking, tobacco, substance abuse, etc.
History and present complains-Any mumps or tuberculosis in the past, inguinal hernia or surgery in the inguinal region, testicular tumors, trauma, radiation therapy, cancer, lump in the lower abdomen, ejaculatory dysfunction, erectile disorder, hypospadias, etc.
Any previous reports on Semen analysis
Compatibility in both couples-Which is essential, and any doctor can judge while taking history. Also, in HIV discordant couples, IUI may be the treatment of choice.
Stress-related any issue
House with family members, so privacy is a challenge.
Investigations for IUI
- Per speculum examination- reveals important information about the health of cervix & vagina, location of the cervix, any scars or discharge, septae if any
- Pelvic USG
- Hemoglobin, RBS, Rubella IgG, HPLC for Thalassemia
- Viral markers- HIV, HBs Ag, HCV
- Other investigation depending on history- TSH/ Prolactin
- Semen Analysis, Tubal patency test
Ovarian Reserve Testing? USG with AFC adequate. Role of AMH?
- The use of AMH as a routine screening tool for DOR in a low-risk population is not recommended.
Ovarian reserve testing should not be performed routinely but may be used in select women undergoing ovarian stimulation with exogenous gonadotropins.
(ASRM Committee Opinion 2015)
- Postcoital testing and endometrial biopsy should not be performed as part of the routine diagnostic evaluation of the infertile female
(ASRM Committee Opinion 2015)
- Tubal Patency test– Women who are not known to have comorbidities (such as pelvic inflammatory disease, previous ectopic pregnancy, or Endometriosis) should be offered hysterosalpingography 
- Where appropriate expertise is available, screening for tubal occlusion using hysterosalpingo-contrast-ultrasonography should be considered. It is an effective alternative to hysterosalpingography for women who are not known to have comorbidities. 
- Women who are thought to have comorbidities should be offered laparoscopy and dye so that tubal and other pelvic pathology can be assessed at the same time. (2004 NICE Guidelines)
- Routine laparoscopy should not be performed in the evaluation of the infertile female but may be warranted when there is a strong suspicion of advanced stage endometriosis, tubal occlusive disease, or peritoneal factors
Given individual circumstances, there may be a place for diagnostic laparoscopy for young women with a long duration (>3 years) of infertility but no recognized abnormalities.
- (ASRM Committee Opinion 2015)
Seeds of Innocence is a leading chain of fertility clinics with several branches across India. Armed with a team of experienced and highly qualified IVF specialists, we are a one-stop solution to all your woes and concerns regarding infertility.