Assessment
Questionnaire

Have a symptom?
See what questions
a doctor would ask.
 

Fertility symptoms Assessment Questionnaire

Questions Your Doctor May Ask - and Why!

During a consultation, your doctor will use various techniques to assess the symptom: Fertility symptoms. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the suspected condition) Your doctor will ask several questions when assessing your condition. It is important to openly share any pertinent information to help your doctor make an accurate diagnosis.

It is also very important to bring an up-to-date list of all of your all medical conditions, medications including dosages, and names of numbers of any specialist you see.

Create your printable checklist by answering questions that your doctor may ask below:

Privacy Statement
No private information is transferred over the internet. Do not use the "Browser back button", as this may cause data loss.

  1. How long have you been trying for pregnancy?

    Why: Infertility is defined as the absence of conception after a period of 12 months of normal unprotected intercourse.

  2. What is the frequency and timing of intercourse?
  3. Is there adequate penetration with intercourse?
  4. What is the age of the female?

    Why: after the age of 32, fertility decreases by 1.5% per year.

  5. What was the age of menarche (first menstrual period) in the female?
  6. Menstrual history in female?

    Why: e.g. days of bleeding per cycle, cycle length and regularity, inter-menstrual spotting, heaviness of period, clots, flooding.

  7. Obstetric history

    Why: if any previous conceptions? - e.g. miscarriage, termination of pregnancy, stillbirth, full term birth, details of full term births.

  8. Previous contraception history?

    Why: e.g. oral contraceptive pill, intra-muscular progesterone depot injection, progesterone implant.

  9. Does the female have symptoms of ovulation?

    Why: e.g. mid-cycle egg-white-like stretchy mucous, abdominal discomfort or breast tenderness.

  10. Past history of sexually transmitted diseases (STD) or pelvic infection in the female?
  11. Previous intra-uterine contraceptive device (IUCD) in the female?
  12. Past Surgical history in the female?

    Why: e.g. intra-abdominal surgery such as appendicitis may predispose to pelvic adhesions; genitourinary surgery such as abortions may be complicated by intra-uterine and fallopian tube infection.

  13. Body weight history?

    Why: e.g. history of anorexia nervosa or obesity may cause failure to ovulate.

  14. What are your stressors at the moment?

    Why: questions specifically about relationship, family, social support, occupation, general physical health and financial stresses. Stress related to lifestyle may affect male or female fertility.

  15. Are there any problems with the male sexual function?

    Why: e.g. erectile dysfunction, ejaculation difficulties.

  16. Recent severe febrile illness in the male?
  17. Past history of testicular problem or injury in the male?

    Why: e.g. orchitis (inflammation of the testicles), trauma, undescended testicles.

  18. Past history of sexually transmitted diseases (STD) in the male?
  19. Past medical problems in the male and female?

    Why: e.g. diabetes, epilepsy, tuberculosis, kidney disease.

  20. Past history of mumps in the male?
  21. Past history of urethral problems in the male?
  22. Past genitourinary surgery in the male?

    Why: e.g. hernia repair.

  23. Medications in the male?

    Why: e.g. some medications may affect male fertility including chemotherapy, anabolic steroids, aminoglycoside antibiotics, sulphasalazine, cimetidine, colchicines, spironolactone, phenytoin, narcotics, nitrofurantoin.

  24. Occupational history in the male?

    Why: e.g. exposure to heat, pesticides or herbicides.

  25. Drug or alcohol abuse?

    Why: e.g. alcoholism and drug addiction may affect male and female fertility.

  26. Cigarette smoking?

    Why: reduces male and female fertility.

  27. Erectile dysfunction in male?
  28. Menorrhagia (heavy periods)?

    Why: may suggest endometriosis, pelvic inflammatory disease, fibroids.

  29. Dyspareunia (pain with intercourse)?

    Why: may suggest endometriosis, pelvic inflammatory disease.

  30. Vaginal discharge?

    Why: may suggest pelvic inflammatory disease (may be an offensive, pus-like vaginal discharge).

  31. Symptoms of endometriosis?

    Why: e.g. dysmenorrhea which may start 1-2 weeks before the period and then reduces with the onset of the period, pain with intercourse, heavy periods and non-specific pelvic pain.

  32. Symptoms of pelvic inflammatory disease?

    Why: e.g. fever (if acute infection) , mild to severe lower abdominal pain, pain with intercourse, painful heavy or irregular periods, bleeding in-between the periods, abnormal and perhaps offensive pus-like vaginal discharge, painful or frequent urination.

  33. Symptoms of polycystic ovarian syndrome?

    Why: e.g. obesity, hirsuitism (excess hairiness), acne, irregular or absent menstrual periods.

Conditions listing medical symptoms: Fertility symptoms:

The following list of conditions have 'Fertility symptoms' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Fertility symptoms or choose View All.

View All A B C D E F G H I K L M N O P R S T U V W X Y Z #

Conditions listing medical complications: Fertility symptoms:

The following list of medical conditions have 'Fertility symptoms' or similar listed as a medical complication in our database.

 

By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.

Home | Symptoms | Diseases | Diagnosis | Videos | Tools | Forum | About Us | Terms of Use | Privacy Policy | Site Map | Advertise