Infertility History
| History of Infertility | Medical History | Gonadotoxins |
| Duration Prior pregnancies Present partner Another partner Previous treatments Evaluation and treatment of wife |
Systemic illness (i.e., diabetes mellitus, multiple sclerosis Previous/current therapy |
Chemicals (pesticides) Drugs (chemotherapeutic, cimetidine, sulfasalazine, nitrofurantoin, alchohol marijuana, androgenic steroids) Thermal exposure Radiation Smoking |
| Sexual History | Surgical History | Family History |
| Potency Lubricants Timing of intercourse Frequency of intercourse Frequency of masturbation |
Orchiectomy (testis cancer, torsion) Retroperitoneal injury Pelvic injury Pelvic, inguinal, or scrotal surgery Herniorrhaphy Y-V plasty, transurethral resection of the prostate |
Cystic fibrosis Androgen receptor deficiency Infertile first-degree relatives |
| Childhood & Development | Infections | Review of Systems |
| GU congenital anomalies Undescended testes, orchiopexy Herniorrhaphy Y-V plasty of bladder Testicular torsion Testicular trauma Onset of puberty |
Viral, febrile Mumps orchitis Venereal Tuberculosis, smallpox (rare) |
Respiratory infections Anosmia Galactorrhea Impaired visual fields |
Modified from Sigman, Lipshultz, L.I., and Howards, S.S.: Evaluation of the subfertile male. In: Infertility in the Male, 3rd edition. Edited by L.I. Lipshultz and S.S. Howards. St.Louis: Mosby-Year Book, 1997, p.174.