Male infertility

{Male infertility}

[+] yes, present, positive
[-] no, absent, negative
[~] equivocal
[\] not applicable, not performed
[?] unknown, unsure, unavailable
{ } annotation, comment

HISTORY
Fertility history:
  Previous conceptions: 
  Period of infertility (time trying to conceive): 
  Frequency of intercourse: 
  Libido:

Partner:
  Age: 
  Pregnancy history: 
  Recurrent miscarriage?:

Sexual development history: (abnormalities)
[-] testicular descent
[-] pubertal development, including facial/body hair
[-] loss of post-pubertal body hair
Details:
-

Systemic illness history:
[-] major head trauma
[-] gonadal surgery
[-] gonadal trauma
[-] gonadal irradiation
[-] penile surgery or trauma
[-] post pubertal mumps +/- orchitis
[-] genital infections/STIs
[-] prostatitis
Details: 
-

Chemical/drug exposures:
[-] alcohol
[-] tobacco
[-] cannabis
[-] opioids
[-] anabolic steroids
[-] corticosteroids
[-] cytotoxic drugs
[-] pesticide exposures
Details: 
-

FAMILY HISTORY
[-] genetic conditions

PHYSICAL EXAMINATION
General examination:
  Height (m): 
  Weight (kg): 
  BMI (weight/height^2):

{abnormalities}
[-] thyroid
[-] skin
[-] penis
[-] testes
[-] varicocele
[-] hydrocele
[-] epididymal thickening or cysts
[-] pubic, facial, axillary hair
Details:
-

ASSESSMENT
Clinical summary:
[+] 
[~] 
[-]

Diagnosis/es:
1. 
2.

Differential diagnosis:
-

MANAGEMENT PLAN
Diagnostic investigations requested:
SEMEN ANALYSIS 
[\] Volume [>1.4-1.7 mL]
[\] Sperm concentration [>12-16 x10E6/mL]
[\] Total sperm number [>33-46x10E6/ejaculate]
[\] Morphology [>3-4% normal forms]
[\] Vitality [>55-63% live]
[\] Progressive motility [>31-34%]
[\] Total (progressive and non-progressive) motility [>38-42%]
{If poor, consider repeating in 4-6 weeks}

[\] Sperm antibodies

SEROLOGY 
[\] HIV
[\] HBsAg
[\] HCAb

ENDOCRINE TESTING {if abnormal semen analysis}
[\] Testosterone: 
[\] FSH: 
[\] LH:

IMAGING
{Consider in normal testicular volumes, normal serum testosterone, FSH, and LH, and azoospermia}
[\] Scrotal and transrectal ultrasound

Treatment: 
-

Referrals: 
-

FOLLOW-UP
Outstanding issues:
-

Next appointment:
-

Male infertility

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