• Difficulty achieving or maintaining an erection
• Inability to ejaculate during intercourse
• History of injury to the testicles
• History of infection in the prostate gland, epididymus, or testicles
• History of mumps as a teenager
• History of an undescended testicle

Tests That Couples Can Do at Home

You can begin your fertility tests at home before you even see your doctor. One of the most important questions that your doctor will ask is, "Do you produce an egg every month?" There are two simple tests that you can do at home to help answer this question. Each test will require a trip to your local pharmacy and a modest investment of a few dollars.

Basal Body Temperature Chart
First, you need to purchase a basal body temperature thermometer.  To determine if you are releasing an egg each month, begin taking your temperature with this special sensitive thermometer before you get out of bed each morning. Start taking your temperature on the first day of your period. Chart the results of your temperature on the special graph paper that accompanies your thermometer. Also mark the chart each time you have intercourse. At the end of he month, examine the pattern of your chart. If you notice that the temperature in the morning is lower in the first 10 to 14 days of the month than in the last 10 to 14 days, then it is likely that you are producing an egg. I recommend to my patients that they keep a basal body temperature chart for approximately three months.

Next, look at the chart and see where you have marked the chart for intercourse. Do the marks correspond to the time around the temperature change? If they do, then you are timing intercourse to the release of the egg in an appropriate manner.

Whether or not your temperature chart matches the above description, the information that you have gathered will be very useful to your doctor.

Ovulation Predictor Kits
Another test for ovulation that you can do at home is generally called an ovulation predictor kit. There are many brands to choose from at your local pharmacy. These kits allow you to test your urine for the presence of the hormone LH. Since LH rises temporarily just before ovulation, the indicator stick in the test kit will change color just before the egg is released. I recommend that you begin testing your urine on cycle day 10 (cycle day 1 is the first day of full menstrual flow). Continue testing your urine daily until you detect a color change on the indicator stick.

When your indicator stick changes color, plan to have intercourse that day and/or the following day. Also, keep a record of the cycle day number when the indicator stick changes color. Whether or not the ovulation predictor kit changes color, the information that you have gathered will be very useful to your doctor.

There are two tests that every infertile couple needs to have.

Semen Analysis
The first is a semen analysis from the male partner. He should have this test regardless of how many children he has or pregnancies he has caused. This is because sperm counts can change over time and up to 35-40% of all infertility is related to a male factor. The test is performed after 36 to 48 hours of abstinence and is painless. The semen specimen is usually collected by masturbation but sometimes can be collected in a special collection condom during intercourse.

hysterosalpingogram
The second test, called a hysterosalpingogram or tubogram, helps determine if the uterine cavity is normal in size and shape, and whether the fallopian tubes are open or closed. This test is an x-ray and uses an iodine-based contrast agent which is injected into the uterus through the cervix. If you are allergic to iodine or shellfish you should speak with your doctor to determine how the important information normally revealed by the hysterosalpingogram should be obtained.

Other Diagnostic Tests

Blood tests
Some doctors recommend a series of hormone tests for their patients who are trying to become pregnant. These tests evaluate the pituitary gland, the thyroid gland, the adrenal gland, and the ovaries. Some of these tests -- including tests for FSH, estradiol, and progesterone -- are drawn at a specific time in menstrual cycle while others -- including tests for prolactin -- need to be drawn early in the morning before woman has eaten.

Post-coital test
This test is performed around the time of ovulation. A couple having this test is asked to have intercourse in the evening and the woman to report to her doctor's office for the test the following morning. A small amount of cervical mucous is obtained painlessly in procedure similar to a pap smear. The mucous is then placed on a glass slide. The doctor evaluates the slide to determine the number of sperm present and moving.

Endometrial Biopsy
An endometrial biopsy is a sample of uterine lining tissue obtained by placing a small straw into a woman's uterus just before she expects her period. The test causes mild to moderate cramping, which lasts about 10 minutes. This test measures ovulation indirectly by evaluating the effect of the monthly hormones on the uterine lining tissue.

Hysteroscopy and Laparoscopy
These surgical tests allow the doctor to look inside the uterus (in the case of hysteroscopy) and at the outside of the uterus, ovaries, and fallopian tubes (in the case of laparoscopy). Conditions including uterine polyps, fibroids, adhesions, and endometriosis can be diagnosed and surgically treated with these techniques.