Male Fertility Assessment

What is your current age?

Under 35 35–39 40–44 45 or above

How long have you been trying to conceive with your partner?

Less than 6 months 6–12 months 12–24 months More than 2 years

Have you fathered a pregnancy before?

Yes, without difficulty Yes, but took time Yes, with pregnancy loss No

Have you ever been advised to evaluate male fertility?

No Suggested casually Advised but delayed Strongly advised

Have you ever had a semen analysis done?

Yes, normal Yes, mild issues Planned Never

Have you been diagnosed with varicocele or testicular issues?

No Suspected Yes, treated Yes, untreated

Do you experience testicular pain or discomfort?

Never Occasionally Frequently Chronic

Have you had any testicular injury, surgery, or infection?

No Minor / long ago Significant Multiple or recent

How would you describe your libido (sexual desire)?

Healthy and consistent Slightly reduced Often low Very low

Do you experience erectile or ejaculation issues?

No Occasionally Frequently Consistently

How would you describe your body weight?

Healthy for my height Slightly under/over Significantly under/over Obese or very underweight

Has your weight changed significantly in the last year?

Stable Minor change Large fluctuation Very unstable

Do you have diabetes, insulin resistance, or metabolic issues?

No Borderline Diagnosed, managed Diagnosed, unmanaged

How balanced is your exercise routine?

Moderate & consistent Slightly inconsistent Rare or excessive Extreme over-exercise or sedentary

Do you often feel physically fatigued?

Rarely Sometimes Often Almost always

How often do you consume alcohol?

Rarely / none Occasionally Regularly Frequently

Do you smoke or use nicotine products?

No Occasionally Regularly Heavily

Are you exposed to heat around the groin area? (eg. hot baths, laptops, saunas, tight underwear)

Rarely Occasionally Frequently Daily

Are you exposed to chemicals, pesticides, or heavy pollution?

Minimal Moderate High Constant / occupational

How hydrated are you daily?

Well hydrated Mostly hydrated Often dehydrated Rarely hydrated

Have you used antibiotics frequently in the last year?

No / rarely Once or twice Multiple courses Very frequent

Are you currently on long-term medications? (eg. testosterone, steroids, antidepressants)

No Short-term only Long-term, monitored Long-term, unmonitored

How would you rate your stress levels?

Well managed Moderate High Constantly overwhelmed

How is your sleep quality?

7–9 hours, restful Mild disturbances Poor or irregular Chronic sleep issues

What best describes your daily work type?

Mostly active Mostly sitting work Long sitting hours Physically demanding

Question Number 1.