Fertility problems in Family are suggestive of tendency of low fertility. Longer the infertility greater will be the difficulties in achievements. Failed pregnancies, early or late reflect genetic or obstetric problems. There can be repetition. What childless couple is concerned about may not be lack of fertility but pregnancy losses. Long interval between two pregnancies has negative bearing on the fertility potential. 16% women after 1 year and 9 % after 2 years of previous pregnancy do not conceive.
Contraception if used can affect fertility. Hormone preparations, pills or injectable can cause ovarian disturbance. I.U.C.D. carries the risk of introducing infection leading to pelvic and tubal factors. Surgical methods of contraceptives permanently cause tubal blockade.
Medical, Surgical and Family History:Some medical ailments of husband and wife are associated with fertility problems. Mumps in husband and the cancer therapy in both partners affect their fertility. Diabetes and hypertension do not hinder fertility but affect the pregnancy outcome. Infertility management has to be justified in such situation. Genital tuberculosis is a known cause of infertility, its prevalence in family or any other area my preclude the fertility difficulties and need to be thoroughly investigated. Infections or Surgery of reproductive organs both in husband and wife can make iatrogenic disturbances & tubal blockade. Pelvic or abdominal surgery in wife may cause pelvic adhesions. After this in selected couples husband also gets detailed clinical examination.
Examination of Wife General physical and Systemic Examinations General health of the wife is assessed. Paler, yellowness, hirsutism, acne or any unusual appearance reflect illness or hormonal disturbance.
Height, weight and blood pressure of the wife is taken. Body mass index determined. Obesity is unfavorable. Breasts are examined for abnormality. Heart, Lungs & the systems are examined too.
Abdominal Examination: All the abdominal organs; liver, spleen, kidneys, and GIT are assessed. This helps to know the abnormality of the structures and systems in the abdomen, which may be relevant.
The pelvic structures in lower abdomen are palpated. Enlargements of ovaries and uterus are felt above pelvic bones. If the uterus or ovaries are enlarged to be felt abdominally, other characteristics of the mass are observed as well. Ascites is associated with malignancies of the ovaries and should be excluded.
Internal Pelvic/Vaginal Examination The woman keeps on lying on her back as she was during abdominal palpation, slips down her trousers and the undergarments and draws her legs up. Keeping her feet together, she spreads apart her knees. This exposes her genitals. A speculum is passed into vagina, its blades are opened which separates vaginal wall to expose cervix & other areas inside vagina. State of cervix and its abnormalities are seen. Characteristics of the cervical mucus tell the hormonal and fertility status. If fertile type and couple had coitus PCT is done. Discharge if any suggests vaginal infection. If infection is suspected, a culture swab is taken.
Bimanual Examination Gynecologist introduces two fingers of the right hand into the vagina and places left hand over the lower abdomen. While keeping his left hand on the lower abdomen, uterus, ovaries and other structures in the pelvis are brought between it and the inner fingers and their characteristics palpated.
Abnormalities in their size, surfaces and the mobility are noted. Any tenderness in this examination indicates some lesion. Swelling or tenderness on the sides of uterus is sign of inflammation or abnormalities of ovaries and tubes. Cervix is rocked to one side or the other. If tender, it indicates adnexal lesion. It completes the clinical examination. Baseline ultrasound and hormones assays follow.