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. 2011 Apr;66(4):691–700. doi: 10.1590/S1807-59322011000400026

Table 2.

Clinical Male Infertility History Outline.

1) Infertility History
Age of partners, length of time the couple has been attempting to conceive
Contraceptive methods/duration
Previous pregnancy (current partner/other partner)
Previous treatments
Treatments/evaluations of female partner
2) Sexual History
Potency, libido, lubricant use
Ejaculation, timed intercourse, frequency of masturbation
3) Childhood and Development
Cryptorchidism, hernia, testicular trauma
Testicular torsion, infection (e.g., mumps)
Sexual development, puberty onset
4) Personal History
Systemic diseases (diabetes, cirrhosis, hypertension)
Sexually transmitted diseases, tuberculosis, viral infections
5) Previous Surgeries
Orchidopexy, herniorrhaphy, orchiectomy (testicular cancer, torsion)
Retroperitoneal and pelvic surgery
Other inguinal, scrotal and perineal surgery
Bariatric surgery, bladder neck surgery, transurethral resection of the prostate
6) Gonadotoxin Exposure
Pesticides, alcohol, cocaine, marijuana abuse
Medication (chemotherapy agents, cimetidine, sulfasalazine, nitrofurantoin, allopurinol, colchicine, thiazide, β– and α–blockers, calcium blockers, finasteride)
Organic solvents, heavy metals
Anabolic steroids, tobacco use
High temperatures, electromagnetic energy
Radiation (therapeutic, nuclear power plant workers), etc.
7) Family History
Cystic fibrosis, endocrine diseases
Infertility in the family
8) Current Health Status
Respiratory infection, anosmia
Galactorrhea, visual disturbances
Obesity