Medical History

A good medical history of the couple may suggest the cause of infertility. It will help the doctor in making diagnosis if the couple can provide a good medical history. This will save time and cost because you do not have to repeat the same tests or unsuccessful treatments. The detailed history that may be asked include: past medical and surgical events, current health status, diet and lifestyle, occupational risks, history of sexual development, use of birth control, previous pregnancies or miscarriages and sexual practices. The medical history can be collected by the doctors, embryologists or nurses. The following histories are relevant and should be volunteered during consultation:

The women

1. Long menstrual cycle
 
The average of a normal menstrual cycle is 28 days. Menstrual cycle that is shorter than 21 days and longer than 35 days is considered as abnormal. Long menstrual cycle, ie every 2 to 3 months, or amenorrhea (no menses at all) implies failure of ovulation. In other words, there is no mature egg released from the ovary and ready to be fertilised by the sperm.
2. Dysmenorrhea (Painful menses)
 

It is normal to have mild abdominal pain on the day before menses come which is due to increase blood flow to the pelvic and fluid congestion. The accumulation of fluid in the pelvic will cause bloated tummy and mild abdominal pain. The pain will disappear when your menses comes. Menses pain which is occurs during your menstruation may be due to endometriosis ( the growth of endometrial cells outside the uterus) because of the backward flow blood to the pelvis. Endometriosis bleeds in the pelvis during menstruation and cause irritation and pain . This pain will worsen when menstruation proceeds. Endometriosis may cause inflammation and formation of scar tissue. This scar tissue may block the Fallopian tubes or interfere with ovulation.
3. History of sexually transmitted diseases (STDs)
 
STDs such as gonorrhea and chlamydia will cause pelvic adhesion. Pelvic adhesion will eventually cause the pelvic organs stick and stuck together, blockage of Fallopian tubes, damage to the cilia (tiny hairs that help to 'sweep' the fertilised or unfertilised egg along the Fallopian tube and toward uterine cavity) in the Fallopian tubes and failure of transport of the egg into the Fallopian tube. In the case of unfunctional cilia, the fertilised egg cannot be 'swept' to the uterine cavity and remains at the ampula of the Fallopian tube. The fertilised egg will develop and implant there and lead to ectopic pregnancy.
4. History of appendix
In rare cases of ruptured appendix, the infection will spread through the pelvic organs such as ovaries, Fallopian tubes and uterus and cause scar tissue and adhesion. As mentioned above, the scar tissue and pelvic adhesion interfere with ovulation.
5. History of previous pelvic surgery
Previous pelvic surgery may cause pelvic adhesion and interfere with ovulation.
6. Sexual problems
 
Sexual problems such as vaginismus (disability of sexual penetration), vaginal dryness and dyspareunia (painful sexual intercourse) may lead to coitus failure or reduce the couples' desire and frequency of sexual intercourse. Subsequently, the chance of getting pregnant is decreased.
7. Previous investigation and treatment for infertility
 

This is important as we need not to repeat the same test and save time and cost. Please bring along the following if you have:

a) Hormone assay report

b) Hysterosalpingogram (HSG) report

c) Laparoscopy report

d) Previous surgery report

 

The men

1. History of sexually transmitted diseases (STDs)
 
The infection of STDs such as gonorrhea and chlamydia may cause the formation of pus cells in testis, vas deferens, bladder or urethra. These pus cells will decrease sperm motility and associate with male infertility. The infection may also lead to the formation of scar tissue and block sperm passage.
2. History of mumps
 
If mumps occurs in male after puberty and the viral infection spreads to male reproductive organs, it may associate with male infertility. The viral infection may cause inflammatory in testis, prostate, or urethra and affect sperm motility.
3. Genital surgery
 
Previous history of genital surgery such as testicular surgery or inguinal hernia repair may associate with infertility. The surgery may injure the male reproductive organs such as vas deferens or testis and affect the sperm production or transportation from testis to urethra.
4. Sexual problems
Sexual problems that affects male include erectile dysfunction (ED), premature ejaculation and retrograde ejaculation (backward flow of semen into bladder instead of urethra). These may lead to failure of coitus or sperm deposition into vagina and associate with infertility.
5. Previous investigation and treatment for infertility

This is important as we need not to repeat the same test and save time and cost. Please bring along the following if you have:

a) Semen analysis report

b) Previous surgical report

Subsequent investigation will be done depending on the findings from history and physical examination.