🔎 How to Perform / Approach

1. Confirm the infertility history:
   Establish duration of unsuccessful conception, frequency and timing of intercourse, erectile or ejaculatory difficulties, previous pregnancies and whether the female partner has undergone assessment.
2. Interpret semen analysis:
   Compare volume, sperm concentration, motility and morphology with WHO 2021 lower reference limits: volume 1.4 mL, concentration 16 million/mL, total motility 42% and normal morphology 4%. Identify the abnormal parameters.
3. Confirm abnormal findings:
   Repeat semen analysis, generally after an appropriate interval, using 2–7 days of abstinence and correct sample collection. One abnormal result alone does not establish the underlying cause.
4. Take relevant history:
   Ask about cryptorchidism, mumps orchitis, genital infection, testicular trauma, previous pelvic or inguinal surgery, chemotherapy, smoking, anabolic steroids, testosterone use and occupational heat exposure.
5. Perform focused examination:
   Assess secondary sexual characteristics, testicular position and size, epididymis, vas deferens and palpable varicocele. Identify features of hormonal deficiency or genital tract abnormalities.
6. Select further investigations:
   Check FSH and morning testosterone, adding LH, prolactin or other hormonal studies as appropriate. Scrotal ultrasound is indicated for selected examination findings; genetic testing is reserved for relevant severe sperm abnormalities or suspected genetic causes.
7. Outline management options:
   Address reversible causes, discontinue gonadotoxic exposures when clinically appropriate, treat selected clinical varicoceles and manage hormonal disorders. Discuss assisted reproduction such as IUI, IVF or ICSI according to semen quality and both partners’ fertility assessment.