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MALE INFERTITITY

CAUSES OF MALE INFERTILITY

DRUGS CAUSING IMPOTENCY AND EJACULATORY DYSFUNCTION

MALE INFERTILITY WORK-UP

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Male infertility work-up

Male Infertility Work-up

Medical history
Physical examination
Laboratory evaluation
Scrotal/rectal ultrasound

Medical History

Ask for:

Sexually transmitted diseases
Exposure to toxins
Substance use (tobacco, alcohol, other drugs)
Medications
Surgery
Radiation
Physical exertion/heat.

Physical Examination

Examine Penis

Hypospadias
Surgical or traumatic scars
Induration, plaques
Phimosis
External urethral meatus
Ulceration or urethral discharge
Size.

Examine Testes

Testicular exam	Normal findings
Site	Palpable, low in scrotum
Position and axis	Vertical orientation with epididymis lying behind or median
Volume	Related to ethnic group; mostly depends on stature
Consistency	Rubbery

Examine Epididymis

Normal Epididymis

Barely palpable
Regular outline
Soft consistency.

Look for

Painful nodules:
1. Epididymitis
2. Sperm granulomata
Caput epididymitis

Examine Prostate Gland

Rectal exam
Identify central groove
Normal prostate
1. Soft
2. Regular
3. Not painful.

Inguinal Exam

Inguinal scars
Presence of pathological enlargement of inguinal lymph nodes.

Labobratory Evaluation

Sperm/semen analysis
Sperm agglutination
STD screening
Prostatic fluid expression
Post-orgasm urine
Hormone determinations
Additional tests.

Semen Analysis

It is the most important and first requisite for evaluation of male infertility factor.

Semen Collection

Exclusive neat and clean place (room) with washing facilities
Collection after 4 days of abstinence (< 2 days -oligozoospermia and > 7 days - asthenozoospermia)
Collection by masturbation after cleaning hands and penis by soap/water and drying with sterile towel
Collection must be done in a wide mouth, clean, dry (wet - kills sperms or causes tail defects) and nontoxic container (preferably sterile container for culture or sperm preparation)
Semen sample - a potential biohazard (bacterial/ viral) for HCV, so handle with care and proper disposal after examination.

Normal

Volume	2.0 ml or more
pH	7.2-7.8
Sperm concentration	> 20 million/ml

Additional Tests

Scrotal thermography
Doppler ultrasonography
Imaging the hypothalamo-pituitary region
Testicular biopsy
Fructose test
Vasography
Endocrine lab testing
Hemizona assay.

Scrotal thermography and Doppler ultrasonography for varicocele.
Imaging the hypothalamo-pituitary region—(MRI/ CT scan of the brain) helps in diagnosing pituitary tumors.
Testicular biopsy in case of azoospermia or severe oligozoospermia.

Fructose Test

Vasography
Endocrine lab testing:

LH
Prolactin
Estradiol
Thyroid profile.

Hemizona assay (HZA): To evaluate the ability of sperm to bind to nonfertilizable nonliving oocytes.

Algorithm for management of male factor, infertility

Algorithm for management of male factor, infertility