Male Factor Infertility Checklist for GPs
Male factor infertility is common, and contemporary guidance is clear: evaluate the male partner early and in parallel, rather than waiting for a “normal female work-up.” Initial GP actions that add the most value are (1) targeted history and exam, (2) a high-quality semen analysis, and (3) hormone testing when indicated, with prompt referral when abnormalities or red flags are present.
1) When to start the male factor work-up
Start assessment immediately if any apply (even if trying <12 months):
Prior cryptorchidism/orchidopexy, torsion, mumps orchitis, significant testicular trauma
Prior chemotherapy/radiotherapy or major pelvic/retroperitoneal surgery
Ejaculatory dysfunction or ED preventing intercourse
Suspected testicular atrophy, scrotal mass/asymmetry
Current/recent testosterone therapy or anabolic steroids/SARMs
2) First-visit history checklist
A. Fertility + sexual function
Duration trying; intercourse frequency; timing; lubricants
Prior conceptions (any partner)
Erectile function; ejaculation volume, pain, haematospermia; orgasmic symptoms; LUTS
B. Developmental + medical/surgical
Cryptorchidism, puberty timing, mumps orchitis
Febrile illness in last 2–3 months (can transiently impair semen)
Diabetes/metabolic health; symptoms suggestive of pituitary disease (headache/visual changes)
C. Medications/substances
Testosterone, anabolic steroids/SARMs
Finasteride/dutasteride, opioids, psychotropics, chemotherapy
Smoking/vaping, cannabis, heavy alcohol
D. Heat/toxin exposure
Hot baths/sauna, prolonged cycling/heat, laptops on lap
Solvents/pesticides, radiation/industrial heat
3) Focused male examination checklist
If within your comfort/resources:
BMI/waist; gynaecomastia; body hair distribution
Testes: size/consistency, tenderness
Epididymis fullness
Varicocele assessment
4) Order semen analysis early
Semen analysis (SA) is the key first-line investigation for suspected male factor infertility. Prefer a lab aligned with the WHO semen manual (6th edition, 2021) methodology and quality processes.
Practical tips that improve interpretability
Record abstinence days and any collection/delivery issues (follow lab instructions).
If SA is abnormal, repeat testing because parameters vary:
RACGP guidance: repeat after 1–3 months for mild/moderate derangements and 2–4 weeks for severe oligospermia/azoospermia, ideally at a specialised andrology lab.
Australian guideline summaries also note a second SA around ~6 weeks after an abnormal first test
What to attach to your referral
SA report(s) + abstinence period, collection time, recent febrile illness, and any testosterone/anabolic exposure
5) When to order hormones
Guidelines recommend endocrine testing when SA is abnormal (particularly oligo/azoospermia), testes are small, or symptoms/signs suggest an endocrine disorder.
Suggested GP panel (morning bloods)
Total testosterone, FSH, LH
Add prolactin if low testosterone with low/normal gonadotropins or pituitary symptoms
Patterns that should prompt referral
High FSH with small testes (primary testicular failure pattern)
Low/normal FSH/LH with low testosterone (possible hypogonadotropic hypogonadism—often treatable but specialist-led)
6) Red Flags
Refer urgently/priority to an andrologist/male fertility specialist for:
Azoospermia on SA
Marked abnormalities persisting on repeat SA, or rapidly worsening parameters
Suspected testicular tumour (hard mass, marked asymmetry)
Severe ejaculatory disorder (anejaculation/possible retrograde) impacting fertility attempts
Major endocrine abnormalities
RACGP guidance also states that any abnormality on basic evaluation (including semen analysis or hormones) warrants referral to a male infertility specialist.
7) GP actions that can improve outcomes before specialist review
Stop testosterone/anabolic agents (and document last use).
Lifestyle optimisation: smoking cessation, reduce heavy alcohol/cannabis, improve metabolic health and sleep.
Suspected varicocele + abnormal SA → refer for structured assessment and management discussion.
8) Referral letter template (copy/paste)
Reason for referral: Male factor infertility assessment and optimisation.
Include:
Ages, time trying, prior paternity
Key male history: cryptorchidism/orchidopexy, chemo/radiation, scrotal surgery, febrile illness, heat/toxin exposures
Sexual function: ED/ejaculatory symptoms impacting intercourse
Meds/substances: testosterone/anabolics, finasteride, opioids, cannabis, smoking
Exam findings (if done): testes size, varicocele suspicion/grade
Attach: SA report and hormones (TT/FSH/LH ± prolactin)
Vancouver reference summary
Katz DJ, Teloken P, Shoshany O. Male infertility – The other side of the equation. Aust Fam Physician. 2017.
American Urological Association; American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. 2020; amended 2024.
World Health Organization. WHO laboratory manual for the examination and processing of human semen. 6th ed. Geneva: WHO; 2021.
RACGP. Male infertility guidelines launched. newsGP. 11 Nov 2025.
Katz DJ, et al. The first Australian evidence-based guidelines on male infertility. Med J Aust. 2025.
