Initial Andrological Evaluation of the Infertile Male

Evaluation of a man presenting for couple infertility starts with obtaining a thorough medical history, and the couple's reproductive and sexual history. Semen analysis, according to World Health Organization recommendations, is the cornerstone of male partner evaluation. A comprehensive physical examination is essential for every male partner, with adequate assessment of the development of secondary sexual characteristics. However, more complex testing than semen analysis (eg, sperm DNA fragmentation index) may be required in selected cases. For men with oligozoospermia or azoospermia, a hormonal evaluation should be performed, including at least total testosterone, follicle stimulating hormone, and luteinising hormone. Genetic testing should be offered to azoospermic men and those with severe oligozoospermia. Ultrasound of the genitourinary tract can provide additional information in select cases. PATIENT SUMMARY: A complete medical history, physical examination, and semen analysis are essential components of the initial evaluation of men being assessed for infertility. The evaluation must proceed in parallel for male and female partners to optimise management for infertile couples.