Age of the man: Male fertility decreases after 40 years of age. Sperm quality reduces and women may take longer time to conceive. There is increased risk of miscarriage in women if man’s age is > 40 years.

Duration of fertility issues is noted and any prior treatment/ tests are recorded.Fertility declines significantly after 2 years of trying naturally A thorough sexual history with frequency of sex, erection/ejaculatory problems frequency of sex, fear of having sex and desire is asked for. Having intercourse once in every 2 or 3 days will cover the fertile days Medical problems like diabetes, hypertension, tuberculosis and endocrine problems like thyroid and prolactin tumors are noted. Childhood history of viral infections, surgeries for congenital hydrocele/hernia are asked for. Injuries to the testis like twisting, cricket ball/ cycle bar trauma are noted. Family history of fertility problems is very significant. History of infertility in siblings is asked for. Occupational history suggestive of increased exposure to heat like welding, truck driving is asked for. Also stress, anxiety and sleep disorders are job related and noted.

Physical examination should include assessment of height, weight, Blood pressure, Thyroid, body habitus and general appearance. Examination of genitals: To know the testicular size, any palpable mass, to check epididymis, feel the vas deferens and to rule out varicocele.

Blood count, lipid profile and diabetic status are assessed. Hormone Assays (if needed): Follicle stimulating Hormone (FSH), Luteinizing hormone (LH), Testosterone, Prolactin, Estradiol, TSH(if needed for some patients).

Serology tests are mandatory: HIV, HbsAg, HCV, and VDRL to prevent potential transmission to their offspring’s.

Semen Analysis: Semen analysis is the mainstay and only initial investigation done for men. Though an important test, semen analysis is not always a measure of the fertility potential in the male. The sperm count can be highly variable is even in a normal fertile man.

Scrotal Ultrasound: to confirm varicocele and rule out any other abnormalities.

Treatment options:

Poor sperm quality can be helped through a change in lifestyle, losing weight by exercising regularly and having healthy food, limiting cell phone exposure, reducing alcohol and quitting smoking.

Daily supplement of antioxidant-rich foods such as vegetables, fruits, whole grains, fish, nuts and seeds can help to improve the semen parameters.

Treatment with medications should be continued for at least 2 to 3 months to notice any improvement in the semen parameters. Hormonal medications are tried to increase the sperm count. Antioxidants help to improve sperm motility and morphology.

Various treatments are also available to treat male infertility. These include

• Intra Uterine Insemination
• In vitro Fertilisation (IVF)
• Intracytoplasmic Sperm Injection (ICSI)

Varicocele surgery: This is done for men with severe grade varicocele with low count, motility and morphology.