Discipline
: Obstetrics & Gynaecology
Sub Discipline
: Gynaecology
Document Title
: Gynaecology Infertility Note (Male)
 Months 
PREVIOUS INVESTIGATIONS AND TREATMENTS FOR INFERTILITY
MEDICAL AND SURGICAL HISTORY WITH POSIBBLE ADVERSE EFFECTS ON FERTILITY
OTHER FACTORS WITH POSSIBLE EFFECTS ON FERTILITY
SEXUAL HISTORY OF BOTH PARTNERS
PHYSICAL EXAMINATION
 cm 
 kg 
 mmHg 
 mmHg 
UROGENITAL EXAMINATION
Please Update Method
Please Update Method
Please Update Method
INVESTIGATION
SIGNATURES