Tarimo BM

1. Infertility (male)
Evaluation of the infertile male

2. incidence
• Primary infertility affects 15% of married
couples.
• ½ of males in this group demonstrate
significant abnormalities in their reproductive
system.

3. definition
• One year of unprotected intercourse without
the female partner to conceive
• Evaluate whenever a patient presents
• Start with rapid non invasive and cost effective
evaluation

4. history
• History of infertility
Duration
Prior pregnancies
 Present wife
 Another partner
Previous evaluations
Previous treatments

5. • Sexual history
Potency
Lubricants
Timing of intercourse
Frequency of intercourse
Birth control/barrier methods

6. • Childhood and development
Undescended testis, ochidopexy
Herniorrhaphy
Y-V plasty of the bladder neck
Testicular torsion
Testicular trauma
Onset of puberty

7. • Medical history
Systemic illness
Previous/current therapy

8. • Surgical history
Retroperitoneal surgery
Pelvic injury
Pelvic, inguinal or scrotal surgery
Herniorrhapy
Y-V plasty, TURP

9. • Infections
Viral, febrile
Mumps ochitis
Venereal
Tb

10. • Gonadotoxins
Chemicals
Drugs (chemotherapy, cimetidine,
sulfasalazine, nitrofurantoin, alcohol, addictive
drugs, androgenic steroids)
Thermal exposure
Radiation

11. • Family history
Cystic fibrosis
Androgen receptor deficiency (Reifensten
syndrome)

12. • Review of systems
Respiratory infections
Anosmia
Galactorrhea
Impaired visual fields

13. Physical examination
• Any factor that affects overall health can
theoretically be responsible for abnormalities
in sperm production.
• Inadequate virilization
Body hair
Gynecomastia
Enuchoid proportions

14. • Penile curvature
• Presence of plaques
• Location of urethral meatus
• Palpate the testis in the upright position for;
• Testicular size and consistency
Decrease in size – impared spermatogenesis

15. Testicular parameters
• 4.0 – 5.5 cm length
• 2.5 cm width
• 3 cm anteroposterior dimension
• 20 – 30 g weight

16. • Epididymis induration, irregularity or cystic
changes
• Presence or absence of the vas
• Nodularity along the vas
• Engorgement of pampiniform plexus –
varicocele
• Rectal examination to evaluate the prostate
and seminal vesicles

17. investigations
• Endocrine
LH, FSH – hypogonadism
Testosterone – leidig cell function – delayed
puberty, decreased libido or impotence

18. • Sperm analysis
Not a test of fertility
• Minimal standards of adequacy
On 2 occasions
Ejaculate volume – 1.5 – 5.0 ml
Sperm density, >20 x 10power6 or 50 – 60 x
10 power6 total sperm
Motility >60%

19. Forward progression, >2 + (on a scale 0 – 4)
Morphology, >6o% normal
• And
No significant sperm agglutination
No significant pyospermia
No hyper viscosity or inadequate liquefication

20. azoospermia
• Retrograde ejaculation – sympathomimetic
agents
• FSH –
 raised 2 – 3 times of normal – investigate
further with guarded prognosis
Decreased – check LH and pituitary
Normal - check for fructose in the semen –
atresia of ejaculatory duct

21. • Vasogram
• Scroto testicular u/s and dopler u/c

22. Immunologic abnormalities
• Agglutination
• Immobilization
• Cytotoxic antbodies

23. management
• Depend on cause
Medical
Hormonal
Surgical
Varicocele repair
Epididymovasotomy
Resection of ejaculatory ducts
Testicular biopsy