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Male Fertility Questionnaire

Male Fertility Questionnaire

If you and your spouse are having fertility problems, you definitely want to get to the bottom of them and hopefully go on to a happy, healthy pregnancy. Before you head off to the doctor together for your first fertility appointment, here is a fertility worksheet that you can use to answer some important questions your doctor will probably ask. Many things, such as surgery, disease or injury can affect sperm production and cause fertility problems.


How old are you?

What medications are you currently on? Do you take any recreational drugs?

Were you born with either of your testicles undescended?

Have you ever had a tumor in your testicles?

Have you had any swelling or pain in your testicles or groin lately? Have your testicles sustained an injury in the past six months?

Do you have any chronic diseases? (Diabetes, Thyroid Conditions, Cancer)

Did you ever have the mumps? If yes, was it after puberty?

Have you ever had X-rays of your groin area, or radiation or chemotherapy?

Have you had chronic bladder or urinary infections in the past?

Have you had any sexually transmitted diseases in the past? When was your last STD test?

Have you ever had a vasectomy or vasectomy reversal?

Do you have sexual dysfunction or erectile difficulties?


Are there any chronic diseases or genetic abnormalities in siblings, parents or extended family?

Has anyone in your family suffered from a miscarriage or stillbirth?


Do you smoke? If yes, how much?

How many alcoholic beverages do you consume each week?

Do you spend time in hot tubs or jacuzzis?

Does your job have you working around dangerous chemicals or substances?

Do you ride a bike? If yes, how often?

Do you wear boxers or briefs?

While some of these questions may seem strange, they can all contribute to fertility problems. For example, frequent bike riders may reduce sperm production, while dangerous chemicals in the workplace can make you impotent.

Be prepared not only for these questions, but an array of others. Depending on your situation, your doctor may ask how often you and your spouse have sex, how many sexual partners you've had, and any difficulties you're having ejaculating or keeping an erection. Don't be embarrassed these are questions that your physician needs to provide you with the best possible care. Print out this male fertility worksheet and give it to your doctor during your first visit.



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