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Investigating Infertility:  Asking the Right Questions

by Dr. Pamela Frank, BSc (Hons), ND

As a naturopathic doctor, there are several ways I can enhance fertility and treat infertility problems including acupuncture, herbal medicine, nutrition and vitamins.  To choose the appropriate treatment as well as asking about the usual mental, emotional and physical characteristics of the patient, a detailed reproductive history must be taken.  The following is a list of questions I ask patients who are struggling with fertility issues:

How long have you been trying to conceive? Do you know if and when you ovulate? If the answer is no, then instruct the patient on how to monitor her own ovulation with basal body temperature, cervical mucous and cervical quality. Has conventional medicine ovulation monitoring been done, i.e. repeated blood work and ultrasounds to monitor the growth and development of the egg follicle and the ebb and flow of hormones? What should be tested – FSH, LH, estradiol (cycle days 4-14), progesterone (cycle days 5-14 and 20), prolactin (more than one), TSH, Ca125, testosterone, free testosterone, fasting blood sugar and DHEAs.  Was anything abnormal on the ovulation monitoring tests? Get a copy of any tests the patient has had done, depending on who did the testing it may or may not be sufficiently thorough and the results may have been loosely interpreted.  Who has treated the patient thus far – only her GP? A reproductive endocrinologist? An OB-GYN? A fertility specialist? Does the patient have a history of: fibroids, endometriosis, abnormal PAP smear, ovarian cysts, PCOS, abortion, miscarriage, d & c or d & e, ectopic pregnancy, hirsutism, dysmenorrhea, irregular menstruation, acne, difficulty losing weight, hypoglycemia, insulin resistance, increased fasting insulin, elevated DHEAs, STD’s (especially gonorrhea or Chlamydia), hypothyroidism or diabetes? Ask detailed questions about menstruation: are her cycles regular? How many days from day one of her flow to her next first day of flow (many women don’t know exactly how to count their cycles), is the flow heavy? If so, for how many days? Is it very light? What is the colour of the flow? What is the consistency of the flow i.e. are there clots, what size, few or many? Does she have pain with her periods?  If so, have her rate it on a scale of 1 -10. Has she been on the birth control pill? Depo-Provera? IUD? Other forms of contraception?  Any adverse reactions to any form of contraception? Does she have any symptoms of PMS? What symptoms specifically - i.e. breast swelling and tenderness, irritability, water retention, headaches, emotionally labile? Has the patient been on any fertility drugs such as Clomid, Puregon, Suprefact, Lupron, Repronex, Pergonal? Copyright ©2006 Pamela Frank, BSc, ND Licensed Naturopathic Doctor