History

Male Sexual and Reproductive History

Gathering information about the patient’s sexual and reproductive history is essential to evaluate possible infertility. The first step in obtaining a proper reproductive and sexual history is to determine how long the couple has been attempting to conceive. Long durations of infertility may suggest involvement of a more severe male or female factor. It is crucial to inquire whether the patient has previously initiated a pregnancy with another partner as prior proven fertility suggests that significant derangement in sperm production is unlikely.

Erectile dysfunction and abnormal ejaculation can also negatively impact fertility potential. Many men may be unaware of this association or may be unwilling to discuss these symptoms. The examining physician must elicit this information, especially for men with systemic illnesses such as poorly controlled diabetes mellitus, multiple sclerosis, and Parkinson’s disease. These illnesses can cause neurological damage resulting in erectile dysfunction and/or ejaculatory disorders. Additionally, many men with spinal cord injuries will have varying degrees of erectile dysfunction and ejaculatory disorders. They typically exhibit low-volume ejaculate, retrograde ejaculation, or aspermia, which are often reported by the patient as “dry ejaculation” or low-volume ejaculate.

Patients should also be assessed for known risk factors associated with decreased fertility, including but not limited to, recurrent urinary tract infections (UTIs), prostatitis, epididymo-orchitis, postpubertal mumps, and sexually transmitted diseases. Infections involving the genitourinary tract in men may result in obstruction. Obstruction can occur at the level of an ejaculatory duct, vas deferens, or epididymis. Ejaculatory duct obstruction may present with an insidious sign such as isolated low-volume ejaculate.