MALE INFERTILITY

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).

POSSIBLE CAUSES OF MALE INFERTILITY

The problem may be related to spermatogenesis, sperm motility, hypogonadism, or impotence.

Testicular insults

• Testicular torsion

• Cryptorchidism

• Trauma

• Varicocele

Infections

• Mumps orchitis

• Epididymitis

Environmental factors

• Excessive heat

• Radiation

• Chemotherapy

Drugs

• Anabolic steroids

• Cimetidine

• Spironolactone

• Marijuana

• Sulfasalazine

• Ketoconazole

• Phenytoin

. Alcohol

Systemic diseases

Thyroid or liver disease

Hernia repair: may damage vas deferens

Diabetic neuropathy

EXAMINATION

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.

INVESTIGATIONS

Semen analysis

Endocrinologic evaluation

It is required if history, examination suggests an endocrinologic basis or sperm count is low.

Serum testosterone, FSH, LH, and prolactin should be performed.

Scrotal ultrasound

TREATMENT

• Treatment of the cause.

• Replacement therapy if hypogonadism.