The objective of evaluating men presenting with infertility is threefold. Those are identify modifiable factors to improve fertility through behavioral change, medical, and/or surgical therapies, identify nonmodifiable factors affecting fertility potential, and provide appropriate counseling, expectations, and resources to men and their partners based on their evaluation. All men undergoing fertility evaluation should undergo a history, physical examination, and semen analysis. Beyond history and physical examination, semen analysis is the first investigation performed in evaluating a man's fertility status. Specific semen analysis abnormalities may be defined as poor sperm concentration, reduced semen volume, poorly motile sperm, abnormal morphology, dead sperm, or absence of sperm. Some studies suggest progressive motility is important in achieving pregnancies 15–17 while studies did not find statistically significant difference once controlled for other semen parameters. The differential diagnosis for pretesticular causes of azoospermia includes congenital abnormalities. Testicular azoospermia is the result of the testicles not responding to appropriate levels of follicle-stimulating hormone and luteinizing hormone.