For him

In many couples who are not conceiving, part of the reason is on the man’s side, and sometimes it is the main reason. Her tests take a cycle to complete and involve blood draws, scans and sometimes a dye test. Yours takes one morning and one sample. If the answer is on your side, finding it first spares her a month of tests; if it is not, that is settled early and the attention goes where it is needed. Either way it is the right place to start.

You abstain from ejaculation for two to five days, not longer, because a longer gap does not improve the result. You produce a sample by masturbation into a sterile container, either in a private room at the laboratory or at home if you can bring it in within about half an hour, kept at body temperature. No lubricant, no condom, and the whole sample matters, especially the first part. The laboratory measures it within the hour.

It is awkward and everyone knows it is awkward. The laboratory staff have done this thousands of times and do not think about it. If you would rather produce the sample at home, say so and it is arranged.

The report has three main numbers. The count, which is how many sperm there are per millilitre and in the whole sample. The motility, which is what share of them are moving, and moving forward. And the morphology, which is what share are normally shaped, and which is the number most often misread, because even in a fertile man the normal share is small. The report also notes the volume, and whether there are signs of infection.

Each number has a reference range, and a result outside it means the chance of conceiving naturally is somewhat lower, not that it is zero. Many men with a count below the range father children without any treatment. What the numbers do is decide which step is sensible: timing and simple measures, IUI, or IVF with ICSI where the count is very low.

Sperm take about three months to make, so a sample reflects the last three months of your life: a fever, an illness, a bad patch of drinking, a long stint in a hot environment. One abnormal result is repeated after a few weeks, and if the first was during or after an illness, after three months. Nothing is concluded from a single sample, and nobody should tell you it is.

The boring things, which is why they are underrated. Stop smoking, all of it. Cut alcohol to little or none while you are trying. Get weight towards a healthy range. Keep the testes cool: no laptops on the lap, no long hot baths, looser underwear, breaks from a hot workplace. Treat any infection. Then give it three months, because that is how long a new batch of sperm takes. Supplements are sold with confidence and backed by little; you will be told which ones have any evidence behind them, and it is a short list.

Where the count is zero, where it is very low, where there is a swelling of the veins in the scrotum called a varicocele, or where there is a history of an undescended testis, an injury, or an operation, a urologist or an andrologist is brought in. Some of these are treatable; a zero count in particular has several causes and some of them can be bypassed. You are told whom you are being referred to, and why, before anything is booked.

Where there are too few sperm for IUI to help, IVF with ICSI can fertilise an egg with a single sperm, and where there are none in the sample at all, sperm can sometimes be retrieved directly from the testis for the same purpose. Those are conversations for the IVF consultation, and they are had honestly, with what is possible and what is not.