This document provides guidelines for evaluating male infertility. It discusses obtaining a history regarding infertility, sexual function, medical issues, infections, exposures to toxins, and family history. A physical exam evaluates factors like virilization, the penis, testes, and epididymis. Investigations include hormone levels, semen analysis, and tests for azoospermia like a vasogram or ultrasound. Causes of infertility are then managed medically, surgically, or with hormones depending on the specific issue found. The goal is to diagnose and address any reproductive abnormalities contributing to the couple's inability to conceive after a year of unprotected intercourse.

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