History

1. The history should include the couple's ages, the duration of infertility, previous infertility in other relationships, frequency of coitus, and use of lubricants (which can be spermicidal). Mumps orchitis, renal disease, radiation therapy, sexually transmitted diseases, chronic disease such as tuberculosis, major stress and fatigue, or a recent history of acute viral or febrile illness should be sought. Exposure to radiation, chemicals, excessive heat from saunas or hot tubs should be investigated.

2. Pelvic inflammatory disease, previous pregnancies, douching practices, work exposures, alcohol and drug use, exercise, and history of any eating disorders should be evaluated.

3. Menstrual cycle length and regularity and indirect indicators of ovulation, such as Mittelschmerz, mid-cycle cervical mucus change and premenstrual molimina, should be assessed.

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