History

Coital practices

Developmental history

Medical history (e.g., genetic disorders, chronic illness, genital trauma, orchitis)

Medications (e.g., sulfasalazine [Azulfidine], methotrexate, colchicine, cimetidine [Tagamet], spironolactone [Aldactone])

Potential sexually transmitted disease exposure, symptoms of genital inflammation (e.g., urethral discharge, dysuria)

Previous fertility

Recent high fever

Substance use

Surgical history (e.g., previous genitourinary surgery)

Toxin exposure

Physical examination

Genital infection (e.g., discharge, prostate tenderness)

Hernia

Presence of vas deferens

Signs of androgen deficiency (e.g., increased body fat, decreased muscle mass, decreased facial and body hair, small testes, Tanner stage < 5)

Testicular mass

Varicocele

Laboratory evaluation/specialized tests

Complete blood cell count (if infection suspected)

Follicle-stimulating hormone, testosterone levels (if hypogonadism suspected)

Gonorrhea and chlamydia cultures, urinalysis (if genital infection suspected)

Other laboratory studies based on history and physical examination findings

Postejaculatory urinalysis (if retrograde ejaculation suspected)

Renal and liver function studies

Scrotal ultrasonography

Semen analysis (two or more samples)

Specialized sperm studies (if initial evaluation of both partners unrevealing)

Transrectal ultrasonography (if ejaculatory duct obstruction suspected)