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Female infertility evaluation  

An infertility evaluation is usually initiated after one year of regular unprotected intercourse in women under age 35 and after six months of unprotected intercourse in women age 35 and older. However, the evaluation may be initiated sooner in women with irregular menstrual cycles or known risk factors for infertility such as endometriosis, a history of pelvic inflammatory disease, or reproductive tract malformations.

The initial approach should be with both the partners so that the cause can be discussed and prepare them mentally for the appropriate evaluation .The basic infertility evaluation for women includes a history and a physical examination.

Menstrual history which helps in detecting ovulatory status, normal regular cycle with premenstrual symptoms suggest normal ovulation with good fertility. Any history of irregular cycle with severe dysmenorrhoea may suggest endometriosis and anatomical abnormalities. Absence of ovulation may suggest premature menopause.

Medical history suggestive of sexually transmitted diseases, pelvic inflammatory disease, thyroid disease, h/o galactorrhoea, insulin resistance, should be extracted.  Equal importance should be given to sexual history such as dyspareunia, failure  of ejaculation, retrograde ejacualtion, any sexual dysfuction , frequency of coitus and their knowledge about  the fertile period.

History of cervical surgery or any H/O abnormal pap smear.

A general review of symptoms suggestive of other endocrine abnormalities which might be contributing to infertility is done .

A careful social history to evaluate for any environmental exposures or social habits (such as smoking, drinking alcohol, drug usage or extreme exercise) which can contribute to infertility.

Duration of infertility, the details of previous treatment and evaluation are very important to gather enough information and avoid unnecessary intervention and also give some useful information from where to get started.

Physical examination: A physical examination usually includes a general examination, with special attention to any signs of hormone deficiency or signs of other conditions that might impair fertility.

The general physical examination should include height,weight of the patient giving an estimate of Body Mass Index (BMI) . Overweight and underweight also cause irregular cycles, hormonal imbalance and anovulation .

Incomplete development of secondary sexual characteristics is a feature of hypogonadotrophic hypogonadism. A body habitus that is short and stocky, with a squarely shaped chest suggests Turner syndrome.

Other examinations include features of thyroid abnormalities, galactorrhoea or signs of excess male hormones like hirsutism , acne, male pattern baldness, virilization suggest the presence of an endocrinopathy .

Examination is incomplete without local and internal examination .During internal examination mass palpable in the fornices and adnexa might be suggestive of chronic inflammatory diseases or severe endometriosis. Vaginal and cervical structural abnormalities and discharge should be noted and treated. Abnormal Uterine enlargement , irregularity, lack of mobility are signs of a uterine anomaly, leiomyoma, endometriosis, or pelvic adhesions.