HISTORY:
Infertility for
Frequency of intercourse: times per
Menstrual cycles: days,
Previous children:
G P A
Fertility treatments:
Fertility investigations:
Other elements:
Male partner:
Number of previous children:
Other elements:
EXAM:
General appearance:
Vital signs: , BP , HR , RR , SpO2 %, Temp °
Measurements: weight: kg, height: cm, waist: cm, BMI:
Neck:
Heart: ,
Lungs: ,
Breasts: -R: , -L:
Abdomen: , , ,
Anorectal: DRE , anus
Pelvic:
- External genitalia: ,
- Vagina: , discharge ,
- Cervix:
- Uterus: ,
- Adnexa: -R , -L
- Tests performed: , , , , vaginal pH , whiff test with KOH
- Performed with chaperone
Skin:
Mental status: , , speech , mood , thought process , , judgment
ASSESSMENT:
DDx:
PLAN:
- Blood work: , , , , , , , , , ,
- Pelvic ultrasound
- Hysterosalpingogram
- Genetic testing
- Semen analysis
- Lifestyle modifications: , , , , ,
-
-
-
- Intrauterine insemination
- In vitro fertilization
- Intracytoplasmic sperm injection
- Donor eggs or sperm
- Referral to fertility specialist
- Referral to psychologist
- Follow-up in
- Return if no pregnancy after 6 months of treatment, if new symptoms develop such as pelvic pain or irregular periods, or if emotional distress occurs