This couple should be ideally seen together in a dedicated infertility clinic . A consultant with interest in infertility should supervise her care.
A relevant history will be taken. I will take a menstrual history. I will enquire of her last menstrual period (LMP). I will ask about the frequency of her cycles, if there are periods of amenorrhoea and any associated menorrhagia,Irregular cycles are suggestive of anovulatory infertility. dysmenorrhoea and intermenstrual bleeding.I will ask about the frequency of intercourse and any associated dyspareunia. Dysmenorrhoea and dyspareunia will point to endometriosis.A history of previous pelvic inlammatory disease,or, abdominal or pelvic surgery will be noted. This may suggest tubal pathology.
I will ask if she smokes or drinks alcohol or use any other habit forming drugs. I will also enquire of her rubella status and if she is taking folic acid .
I will note her weight and height and calculate her BMI. I will eamine for hair and fat distribution as well as acne, and acanthosis nigricans. I will check for galactorrhoea.
I will examine the abdomen for a mass arising out of the pelvis. A pelvic examination will be done to assess normality of the labia, clitoris and vagina. I will examine the cervix in speculum examination for cervical polyps/masses or discharge. A cervical smear will be done if indicated and any discharge swabbed and sent for microscopy, culture and sensitivity.
