The diagnostic process starts with a physical examination at which the doctor will also take a full medical history. The physical exam is often an uncomfortable experience as the doctor examines the penis, scrotum, testicles, anus and rectum. An orchidometer is used to measure testicular volume, which is closely associated with sperm and hormone levels.
When giving your medical history be sure to include factors such as testicular or penile injuries, infections and environmental or chemical exposure. Even if it seems insignificant to you, anything unusual that has occurred to your groin should be reported. Sexual habits are also important; frequency and timing of intercourse, use of lube and previous fertility experiences are all relevant. Also report changes in libido, or other health factors such as headaches and vision changes. A family history may reveal genetic issues. If your conception was difficult, you may have difficulty conceiving as well.
Normally two semen analyses will be ordered, as well as blood tests to check for hormonal imbalances or genetic conditions. The semen samples will be used to assess both the volume of semen produced and the quality of the sperm it contains. This involves measuring the number of sperm cells, assessing the strength of their forward motion, and counting the percentage of sperm with normal morphology. The most common finding in this test is that there is a low sperm density in the semen, or ‘sperm count.’
The blood tests will look at your FSH and testosterone levels, and be used to rule out genetic issues such as Klinefelter syndrome, Y chromosome microdeletion or cystic fibrosis. Other hormonal and genetic factors may also be revealed by bloodwork, but the ones listed are the most common.
If none of the tests shows up the cause of your infertility, there are a handful of other tests that can be carried out, but these are normally considered later in the diagnostic process.