Primary infertility affects 10-15% of married couples. About 1/3 cases result from malefactors, 1/3 from female factors, and 1/3 from combined factors.
Clinical evaluation is required following 6 months of unprotected intercourse.
Ask about frequency and timing of intercourse (relate with female’s menstrual cycle).
The problem may be related to spermatogenesis, sperm motility, hypogonadism, or impotence.
• Testicular torsion
• Mumps orchitis
• Excessive heat
• Anabolic steroids
Thyroid or liver disease
Hernia repair: may damage vas deferens
Scrotal examination for size and hydrocele. Palpate vas deferens, epididymis, prostate.
Look for features of hypogonadism such as lack of secondary sex characters.
Look for the systemic cause.
It is required if history, examination suggests an endocrinologic basis or sperm count is low.
Serum testosterone, FSH, LH, and prolactin should be performed.
• Treatment of the cause.
• Replacement therapy if hypogonadism.