Past medical history, including childhood and development, should be gathered. Specifically, any history of torsion, cryptorchidism, or trauma in childhood may play a role in the etiology. Systemic illnesses, such as diabetes mellitus, neurologic disease, such as multiple sclerosis, and previous cancer treatment, such as chemotherapy or radiation, may be involved in the fertility problem. Past surgeries may lead to the etiology, specifically retroperitoneal and bladder neck surgery. Previous hernia repair may cause vasal and secondary epididymal obstruction.
Infections can affect fertility in several ways.
Febrile episodes may transiently decrease spermatogenesis, although this is usually self-limited. Mumps in adolescence may lead to mumps orchitis. Sexually transmitted diseases, specifically Chlamydia and gonorrhea, may cause ductal obstruction, as can any inflammatory condition within the testes or epididymides. The duration and amount of exposure often dictates the severity and reversibility of the spermatogenic dysfunction. Finally, both family history and review of systems may suggest an etiology.