When we meet couples with fertility problems, clinical histories and direct medical interviews remain fundamental. At these interviews, we need to try and find out about the whole background and all the factors that may be affecting the couple, from the past to the present. We have to try and get to know each couple very closely.
A good and detailed interview may already direct us to the causes of the problem and the possible solutions we can provide. It also enables us to perform specific individual diagnostic tests.
Beginning with the woman, it is essential to ask her about her parents and siblings: possible fertility problems they may have had, possible miscarriages, hereditary diseases, and so on. Plenty of medical problems are not hereditary, but they do appear genetically in family groups.
Of course, it is also important to find about the patient’s menstruation, how often it occurs, when she first had her period, if she had previous pregnancies with her current partner or a previous partner, and so on.
Having previously achieved pregnancy may already improve our prognosis: treating a woman who suffered a miscarriage 7 months ago is not the same as treating a woman who has been trying unsuccessfully to become pregnant for 5 years.
It is also important to look at her medical history carefully: previous gynaecological examinations, past diseases, gynaecological procedures, and so on. It is relatively common for thyroid, prolactin, diabetes and other problems to affect women’s reproductive capacity.
Likewise, it is important to detect diseases such as endometriosis, myomas and others that may be affecting a woman’s fertility and which have specific and successful treatments.
Toxic habits such as smoking decrease women’s ovarian reserve in time. This should therefore be looked into. Some medicines, such as anti-depressives, pharmaceutical drugs for arthritis and other systemic diseases may affect fertility and a future pregnancy.
As for the male, it is necessary to look into his personal, family and professional background, as well as his toxic habits.
It is well known that accidental blows or injuries to the testicles may damage fertility. Mumps in adults and varicocele are also associated with fertility reduction.
One of the most important aspects is the male in his work activity and his contact with toxic substances: some products like petrol, industrial plastics, paints and solvents, agricultural pesticides, roofing felts, heavy metals, and so on can dramatically alter fertility.
With a good, detailed and direct clinical history, we can begin to suspect where the problem lies and what specific diagnostic tests should be performed on a specific couple or what treatments should be used.
Some years ago couples used to be asked an endless string of questions, some of them quite difficult to answer and quite upsetting, without making clear what was being looked for. The saying “Those who do not know what they are looking for will not understand what they find” is still applicable.
The first meeting with the couple should not have a limited time allotted, may take longer than an hour and remains the basic foundation for good results.