History and examination

Male:

• history - paternities; history of genital tract infection e.g. mumps orchitis, prostatitis; surgery or trauma to the male genital or inguinal region - such as a hernia repair; exposure to lead, cadmium, radiation, or chemotherapeutic agents; alcohol and cigarette intake.
  
  
• examination - general examination; assessment of secondary sexual characteristics e.g. sexual hair, build; size and consistency of each testicle and epididymis; presence of varicoele or hernia; size of prostate.

Female:

• history - pregnancies; menstrual disturbance; pelvic infection; abdominal surgery; galactorrhoea; contraception, especially use of IUCD; general state of health and nutrition
  
  
• examination - general examination; secondary sexual characteristics; galactorrhoea; hirsutism; pelvic examination.

Additionally, establish:

• frequency of intercourse
• any difficulty, discomfort or dissatisfaction with intercourse in either partner; may indicate a psychological basis to the infertility