The Physical Exam
It may not be the most pleasant thing in the world, but having a physical exam by a urologist is an important part of the diagnostic process. By assessing your genitalia, the urologist can look for signs of low testosterone levels, varicoceles, or other structural issues which may be the cause of low sperm count. Having an idea of what to expect can make the process a little easier.
If the RE requests a urology evaluation, ask for a referral. It is really important to consult someone who has experience working in the infertility field. The timing is absolutely crucial if surgery is required, and it can't be stressed enough that your urologist MUST understand what is required.
The urologist will ask you to remove your pants and underwear and put on a gown. He will then ask you to stand up and lift your gown.
He will look at and palpate (the medical word for touch) your penis and testicles to make sure that everything is structurally normal. He'll look to make sure that the urethral meatus (opening) is in the correct place, and that the testicles are firm and the appropriate size. He'll feel your testicles to make sure that the vas deferens and epididymis are present and feel normal.
Finally, the urologist may choose to do perform a digital rectal exam to assess the size of your prostate. To do this, the urologist will insert a gloved, lubricated finger into the rectum in order to feel the prostate. The exam will be very brief.