Female Infertility: Medical History

Medical history (history of illness) represents an important component in the diagnosis of female infertility. Family history

• Is there a history of frequent gynecologic conditions in your family?

Social history

• What is your profession?
• Are you exposed to harmful working substances in your profession?
• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

• How long have you been trying to conceive a child with your partner?
• Has there been a pregnancy in the past? If yes:
  • With this or a previous partner?
  • Was the pregnancy carried to term or did an abortion (miscarriage) occur?
• Did your mother, if applicable, also your sister menopause prematurely?
• What is your libido (desire for sex)?
• What is the frequency of sexual intercourse/month?

Vegetative anamnesis including nutritional anamnesis.

• When was your first period?
• Is your cycle length or duration (from the first day of bleeding to the last day before the next bleeding) normal (25-35 days)? Have there been any changes in duration, strength of menstruation, etc.?
• Are you overweight/underweight? Please tell us your body weight (in kg) and height (in cm).
• Do you eat a balanced or wholesome diet?
• Do you do a lot of (excessive) sports?
• Do you like to drink coffee, black and green tea? If so, how many cups per day?
• Do you drink other or additional caffeinated beverages? If so, how much of each?
• Do you smoke? If yes, how many cigarettes, cigars or pipes per day?
• Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
• Do you use drugs? If yes, what drugs and how often per day or per week?

Self history incl. medication history.

• Pre-existing conditions (hormonal disorders, gynecological diseases, diabetes mellitus, autoimmune diseases, psychosomatic diseases (anorexia nervosa, bulimia)).
• Operations (in the area of the small pelvis)
• Radiotherapy (in the area of the small pelvis).
• Allergies

Medication history

• Cytostatic drugs (substances that inhibit cell growth or cell division).

The agents or groups of agents listed below can induce hyperprolactinemia and thus impair follicle maturation (oocyte maturation). This may result in corpus luteum insufficiency (luteal weakness) or, in severe cases, lead to amenorrhea (absence of menstruation for longer than 3 months):

• Adrenaline
• Angiotensin II
• Antiarrhythmic drugs (verapamil)
• Antidepressants
  • MAO inhibitors (moclobemide, rasagiline, selegiline, tranylcypromine).
  • Selective serotonin reuptake inhibitors, SSRIs (selective serotonin reuptake inhibitors) (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline).
  • Tricyclic antidepressants (amitryptiline, amitriptyline oxide, clomipramine, desipramine, dopexin, imipramine, maprotiline, nortriptyline, opipramol, tranylcypromine, trimipramine).
• Antiemetics (domperidone, metoclopramide).
• Antihistamines (synonyms: histamine receptor blockers or histamine receptor antagonists).
• Antihypertensives (clonidine, methyldopa).
  • Calcium channel blockers (amlodipine, dilitiazem, nifedipine))
• Antipsychotics (neuroleptics).
  • Conventional (Classical) antipsychotics (neuroleptics).
    • Butyrophenones – benperidone, fluspirilene, haloperidol, melperone, pipamperone.
    • Tricyclic neuroleptics
      • Phenothiazines (chlorpromazine, fluphenazine, levomepromazine, perazine, perphenazine, promethazine, thioridazine).
      • Thioxanthenes (chlorprothixene, flupentixol, zuclopenthixol).
  • Atypical antipsychotics (neuroleptics).
    • Benzamides – sulpiride
    • Benzisoxazolepiperidine – risperidone
    • Dibenzodiazepines – olanzapine, quetiapine
• Antisympathotonics (reserpine).
• Short-acting beta-2 sympathomimetics (SABA) – patients on SABA were 30% more likely to require 12 months or longer to become pregnant (adjusted odds ratio, OR: 1.30; 95 percent confidence interval, 0.93 to 1.81)
• Endogenous opiates (endorphins)
• Endorphin
• Hormones
  • Antiandrogens (cyproterone acetate)
  • GnRH
  • Melatonin
  • Estrogens
  • TRH
  • TSH-releasing hormone (synonyms: thyroid-stimulating hormone, thyrotropin).
• H2 receptor blockers (cimetidine, ranitidine).
• Opioids (hydromorphone, morphine).
• Oxytocin
• Psychotropic drugs (phenothiazines, thioxanthenes).
• Serotonin
• Vasopressin

Environmental history

• Anaesthetic gases
• Pesticide-laden foods (→ increase in clinical abortions) versus plant-based diets with low pesticide load (→ decrease in clinical abortions).
• Triclosan (polychlorinated phenoxyphenol; exposure to solar radiation, ozone, chlorine, and microorganisms can produce chlorinated dioxins from triclosan); triclosan is present in disinfectants, toothpaste, deodorants, household cleaners or detergents, and textiles and footwear