The investigation of a man’s fertility begins with a comprehensive medical history:

Topics that should be discussed with the doctor are the following (amongst others):

• Involvement in any pregnancy in the past
• Possible cryptorchidism
• Infections during childhood
• Pathological conditions (e.g. diabetes, cancer)
• Medications
• Smoking and alcohol
• Frequency of intercourse
• Possible sexual impotence

Sperm analysis is the most common (and often the only) fertility test performed on men. It is advisable for sperm analysis to be accompanied by sperm culture.

If this test is performed in a reliable lab and the results are normal, then usually this is the end of investigations for men (although there are some cases – e.g. older smokers – where a normal sperm analysis does not necessarily tell the whole story).

But if the results of sperm analysis are not the desirable ones, then there are other tests that are available:

• Testicular ultrasound
• Blood tests (e.g. FSH, LH, TSH, testosterone, prolactin)
• Genetic tests (e.g. karyotyping, Y chromosome defects e.g. Yq-microdeletions, cystic fibrosis mutations)
• More specialized sperm tests (e.g. DNA fragmentation and sperm FISH analysis)