History

Coital practices

Medical history (e.g., genetic disorders, endocrine disorders, history of pelvic inflammatory disease)

Medications (e.g., hormone therapy)

Menstrual history

Potential sexually transmitted disease exposure, symptoms of genital inflammation (e.g., vaginal discharge, dysuria, abdominal pain, fever)

Previous fertility

Substance use, including caffeine

Surgical history (previous genitourinary surgery)

Toxin exposure

Physical examination

Breast formation

Galactorrhea

Genitalia (e.g., patency, development, masses, tenderness, discharge)

Signs of hyperandrogenism (e.g., hirsutism, acne, clitoromegaly)

Laboratory evaluation/specialized tests

To document ovulation: measurement of mid-luteal progesterone level, urinary luteinizing hormone using home prediction kit, and basal body temperature charting

To determine etiology if ovulatory dysfunction suspected: measurement of FSH, prolactin, thyroid-stimulating hormone, 17α-hydroxyprogesterone (if hyperandrogenism suspected), testosterone (if hyperandrogenism suspected)

To assess ovarian reserve (women older than 35 years): measurement of FSH and estradiol levels on day 3 of the menstrual cycle, clomiphene citrate (Clomid) challenge test, or transvaginal ultrasonography for antral follicle count

To assess tubes, uterus, and pelvis: transvaginal ultrasonography, hysterosalpingography if tubal dysfunction suspected or evaluation otherwise unrevealing, hysteroscopy if results of hysterosalpingography suggest intrauterine abnormality, laparoscopy if results of hysterosalpingography abnormal or evaluation otherwise unrevealing