MALE INFERTILITY

 MALE INFERTILITY

A number of patients come to clinics with history of infertility and report to semen analysis hands advised by some general practitioner or gynecologist. We must be able to interpret the report of semen analysis and tell the patient about his status.

Primary infertility affects 10-15% of married couples. About 1 of 5 cases result from male factors, 1of 3 from female factors and 1of 3 from combined factors. Clinical evaluation is required following six months of unprotected intercourse. Ask about frequency( feels fulfilling for you and your partner) and timing of intercourse (relate with female's menstrual cycle).

 MALE INFERTILITY

 Oligospermia( A low sperm count ) is the presence of less than 20 million sperms/ ml while azoospermia (decreased sperm production by the testis.)is the absence of sperm.

POSSIBLE CAUSES OF MALE INFERTILITY

Problem may be related to spermatogenesis(production of fertilizing sperm), motility of sperm, hypogonadism( low sex drive) or impotence. 

Testicular insults: Testicular torsion (The reduced blood flow), Cryptochidism (one or both of the testes fail to descend from the abdomen into the scrotum.), Trauma, Varicocele(an enlargement of the veins)

Infections:

 Mumps orchitis: Pain and swelling of the testicle (orchitis) affects up to 1 in 3 males who get mumps after puberty. The swelling can be sudden and affects only one testicle. The testies may be feel warm and the condition of tender.

Epididymitis: A condition in which an inflammation of the coiled tube at the back of the testicle that stores and carries sperms. 

Environmental factors: Excessive heat, Radiation, Chemotherapy

Drugs: Anabolic steroids, Cimetidine, Spironolactone, Alcohol, Marijuana, Sulfasalazine, Ketokonazole, Phenytoin

Systemic diseases: Thyroid or liver disease, Diabetic neuropathy, Hernia repair: may damage vas defrns

EXAMINATION: Scrotal examination for size and hydrocele., Palpate vas deferens, epidiymis,prostate., Look for features of hypogonadism such as, lack of secondary sex characters., Look for systemic cause.

INVESTIGATIONS:

Semen analysis:

Seminal fluid analysis obtained by masturbation into a glass container after 24-36 hours of abstinence. Analysis should be pertormed within one hour. Normal values are as following:

Volume: 1.5 -6 ml. (seminal fluid volume less

than 1.5 ml may result in inadequate buffering of the vaginal acidity and may be due retrograde ejaculation or androgen insufficiency.

Liquefaction: Liquefaction of seminal fluid in 15-30 min.

Motility: more than 60 % of sperm should be motile. Motility of sperm may be reduced from antisperm antibodies.

Morphology: more than 60% sperms should be of normal morphology

Sperm count: Sperm count 20 million/ml with a total countof > 60 million per ejaculate

Endocrinologic evaluation:

It is required if history, examination suggests endocrinologic basis (the study of hormones) or sperm count is low. the laboratry tests of Serum testosterone, FSH , LH and prolactin should be performed.

Scrotal ultrasound:

To detect a subclinical varicocele.

TREATMENT

Treatment of the cause.

Replacement therapy if hypogonadism.

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Female Infertillity

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