For men the history is obtained and physical examination is performed to search for causes of infertility. Mumps, inflammation of the testes, cryptorchidism (a condition in which one or both testes fail to descend normally), testicular injury, exposure to industrial or environmental toxins, excessive heat exposure, acute illness or prolonged fever within the previous 3 months, recreational drug use, alcohol intake, and exposure to diethylstilbestrol or anabolic steroids should be excluded. Physical examination should focus on anatomic abnormalities–i.e. decreased testicular volume, an inflamed prostate gland, hypospadias (where the penile opening is located on the wrong side), or a varicose veins in the testicule. The main diagnostic technique is semen analysis to evaluating male infertility. It should be performed after 2 to 3 days of sexual abstinence. This analyses the appearance, volume, viscosity, the sperm count, sperm motility and shape.
Specialized tests of sperm function and quality are available at major infertility centers and may be appropriate before any assisted reproduction techniques are considered.
For women, monitoring ovulation is one of the first places to start. This can be measured via an endometrial biopsy that measures the development of the uterine tissues in response to reproductive hormones. A delay of more then 2 days may suggest a luteal phase deficiency, in which the production or action of progesterone in the luteal or last half of the menstrual cycle is inadequate. For this diagnosis to be established, delay should occur in two menstrual cycles. A condition that contributes to infertility is polycystic ovarian syndrome (PCOS), where the female reproductive hormones between the brain and the ovary are imbalanced. Tests for this include looking at levels of the hormones prolactin and follicle stimulating hormone, insulin and thyroid stimulating hormone.
Looking at the patency of the Fallopian tubes through imaging techniques such as an ultrasound or xray of the area may also be a consideration in diagnosis of fertility for women. It may be related to other conditions such as pelvic inflammatory disease, the improper use of an intrauterine device, ruptured appendix, a lower abdominal surgery or ectopic pregnancy.
Home evaluation can also be used for women to assess normal ovulation. Daily measurements of basal body temperature have been used successfully to monitor ovulation. A nadir in temperature suggests impending ovulation; an increase of greater than 0.5° C characterizes the postovulatory period.
There are medications to stimulate ovulation in women. Clomiphere citrate (phenate or clomid) is an ovulation inducer; it is an antagonist to estrogen. Some adverse reactions to it include hot flashes, abdominal pain, breast pain, nausea and headaches. It should not be used by anyone with a history of liver disease, and ovarian cysts. If used for more than 12 cycles, it is thought to contribute to ovarian cancer.
Many people believe that certain vitamins should not be taken during pregnancy. Vitamin A is one example. It is only when the vitamin A is in the form of retinol (in other words, the fat soluble, animal form of vitamin A) that there is a problem. It has been found that retinol can cause birth defects if taken in excess of 10,000 IU a day. Beta-carotene, which is one of the vegetable forms of vitamin A, does not carry any risks.