When a couple is infertile, the man and woman usually are evaluated together. Even if one partner has previously conceived a child, he or she should be evaluated because a new cause of infertility may have developed.
The evaluation for infertility in men usually begins with a semen analysis, also known as a sperm count. A sample of semen usually is collected in the doctor's office after the man has abstained from ejaculating for two to three days. If the semen analysis is completely normal, further evaluation rarely is needed.
If the first semen analysis is not normal, one or more additional samples may be collected. If more than one of the samples is abnormal, a more complete evaluation should be done. This evaluation typically includes:
A complete medical history, including sexual and general development, previous illnesses, medications and exposures
A general medical examination to look for evidence of hormone problems or underlying medical illnesses — This examination should focus on looking for evidence of genital infections, blocked sperm tubules, and shrinkage of the testicles.
Testing of hormone levels
Depending on these results, more specialized tests may be necessary, including an ultrasound of the testicles and scrotum, sperm-function testing, genetic tests, or a biopsy of the testicles. Your primary care doctor may be able to begin this evaluation, but you may need to be referred to a specialist (urologist or reproductive endocrinologist).