Version May 2024
| Male | Female |
| Duration of infertility | Duration of infertility |
| Fertility in other relationships | Number and outcome of any prior pregnancies (including ectopic and miscarriages) with the same or a different partner |
| Medical and surgical history, including testicular surgery and history of mumps | Gynecologic history, including history of pelvic inflammatory disease, fibroids, endometriosis, cervical dysplasia; surgery of the cervix, ovary, uterus, fallopian tube, pelvis, or abdomen; intrauterine device use, other prior contraceptive use, diethylstilbestrol exposure in utero, uterine anomalies. |
| Menstrual history (age at menarche, cycle length, and regularity), presence of molimina or vasomotor symptoms (hot flashes), dysmenorrhea | |
| Changes in hair growth, body weight, or breast discharge | |
| Other medical and surgical history | |
| Medications | Medications |
| History of chemotherapy or radiation | History of chemotherapy or radiation |
| Cigarette smoking, alcohol, marijuana and other drug use; environmental and occupational exposures | Cigarette smoking, alcohol, marijuana and other drug use; environmental and occupational exposures |
| Sexual dysfunction or impotence | Exercise and dietary history |
| Frequency of intercourse, use of lubricants (which may be toxic to sperm) | Frequency of intercourse, use of lubricants (which may be toxic to sperm). Presence of deep dyspareunia suggestive of endometriosis. |
| Previous infertility testing and therapies | Previous infertility testing and therapies |
| Family history of birth defects, intellectual disability, or reproductive failure | Family history of birth defects, intellectual disability, or reproductive failure |
| Pelvic or abdominal pain, symptoms of thyroid disease |
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