Table 1

History, examination and investigation of female and male subfertility

Ovulatory cycles:
Average menstrual cycle length (usually within ±2 days for most women), number of menses per year, contraception history
Hypothalamic amenorrhoea:
Weight loss, excessive exercise,
psychological stress, family history
Hirsutism, acne, oligomenorrhoea
Dyspareunia, dysmenorrhoea, cyclical pelvic pain
Pelvic pain, discharge, STIs
Testosterone deficiency:
Libido, potency/erectile dysfunction,
shaving frequency, gynaecomastia.
Risk factors for testicular dysfunction:
History of mumps/orchitis
History of STIs
Previous oncological treatments
General questions:
Duration of trying to conceive
Fecundity, frequency of sexual intercourse, pubertal milestones
Medical history, medications, alcohol, smoking, illicit drug use
Headaches, galactorrhoea, visual field impairment
Kallmann syndrome:
Anosmia, incomplete pubertal development. Can be associated with other features depending on specific mutation, for example, hearing impairment, renal agenesis, synkinesia
Signs of hyperandrogenism:
Ferriman-Gallwey score for hirsutism. Acne.

Pelvic examination
Testicular volume with Prader orchidometer.
Epididymal hardness/thickening
Presence of vas deferens
Secondary sexual characteristics
 Male factorSemen analysis
MicrobiologyRubella serologyChlamydia swab/urine test
 BloodsMid-luteal progesterone level
FSH, LH, oestradiol, SHBG, testosterone, prolactin, follicular phase 17-OHP, serum AMH.
Pre-10 am fasting testosterone
FSH, LH, SHBG, albumin
Iron studies for haemochromatosis
If undergoing ART:
HIV, hepatitis B and C
Thalassaemia/sickle cell
 ImagingTVUS, HyCoSy, HSG to assess tubal patency and uterine cavityScrotal US/Doppler for varicocele or obstructive causes
  • AMH, anti-Müllerian hormone; ART, assisted reproductive treatment; BMI, body mass index; CAH, congenital adrenal hyperplasia; FSH, follicle stimulating hormone; HA, hypothalamic amenorrhoea; HIV, human immunodeficiency virus; HSG, hysterosalpingography; HyCoSy, hystero-contrast sonography; LH, luteinising hormone; 17-OHP 17, hydroxyprogesterone; PCOS, polycystic ovary syndrome; PID, pelvic inflammatory disease; SHBG, sex hormone binding globulin; STIs, sexually transmitted infections; TVUS, transvaginal ultrasound; US, ultrasound.