Work-up of male infertility

Many health conditions can affect male fertility, thus highlighting the need for a thorough evaluation of patients to identify treatable or reversible lifestyle factors or medical conditions. The initial step in evaluating infertility is obtaining a thorough medical and reproductive history, with specific focus on health comorbidities and lifestyle factors. A comprehensive physical examination is compulsory in the evaluation of every infertile male, including presence of adequate secondary sexual characteristics. Semen analysis, as for World Health Organization recommendations, is the cornerstone for evaluating male infertility. However, more complex testing than semen analysis may be required in particular cases. In men with oligozoospermia or azoospermia a hormonal evaluation should be performed, at least including total testosterone, follicle stimulating hormone, and luteinizing hormone. Genetic testing should be offered to azoospermic men and those with severe oligozoospermia. Ultrasound of the genitourinary tract can enrich the physical examination in many cases.