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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
  1. Medical history
  2. Physical examination
  3. Laboratory evaluation
  4. 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

  1. Barely palpable
  2. Regular outline
  3. 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
  1. Scrotal thermography
  2. Doppler ultrasonography
  3. Imaging the hypothalamo-pituitary region
  4. Testicular biopsy
  5. Fructose test
  6. Vasography
  7. Endocrine lab testing
  8. 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:

  1. LH
  2. Prolactin
  3. Estradiol
  4. 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

 
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