| History | |
| Infrequent intercourse, lubricant use | Coital factors causing infertility |
| Irregular or infrequent menses | Ovulatory dysfunction/female factors |
| Difficulty obtaining erection | Erectile dysfunction |
| Decreased libido | Hypogonadism |
| Blood or pain with ejaculation | Prostatitis/leukocytospermia |
| Small-volume or absent ejaculate | Retrograde ejaculation |
| Anabolic steroid use | Pituitary suppression/secondary hypogonadism |
| Cryptorchidism | Oligospermia or testicular failure |
| History of testicular torsion | Oligospermia or testicular failure |
| Previous chemotherapy | Oligospermia or testicular failure |
| Previous retroperitoneal surgery | Ejaculatory dysfunction |
| Previous inguinal or scrotal surgery | Excurrent* duct obstruction |
| Headache, visual changes | Pituitary tumor |
| Anosmia | Kallmann's syndrome |
| Frequent respiratory infections | Young's or Kartagener's syndrome |
| Patient reports scrotal mass | Testicular tumor or varicocele |
| Physical examination | |
| Decreased virilization or abnormal hair distribution, gynecomastia | Hypogonadism, primary or secondary |
| Palpably dilated veins of spermatic cord | Varicocele |
| Small testes | Testicular failure |
| Impalpable vas deferens | Congenital absence of the vas deferens |
| Inguinal scars | Unreported inguinal surgery, possible excurrent duct obstruction |
| Prostate nodule | Prostate cancer |
| Other prostate mass on rectal examination | Ejaculatory duct abnormality |
| Laboratory testing | |
| Low semen volume | Ejaculatory dysfunction, incomplete specimen collection |
| Azoospermia | Obstruction vs. testicular failure (see Figure 2) |
| Leukocytospermia | Prostatitis |
| Oligospermia, asthenospermia (low motility) | Possible varicocele |
| Sperm in post-ejaculatory urine | Retrograde ejaculation |
| Elevated FSH level | Testicular failure |
| Low testosterone, low FSH level | Hypogonadotropic hypogonadism |