-IBIS-1.5.0-
tx
reproductive system
infertility: male
diagnoses

definition and etiology

definition:
Inability to fertilize an ovum. (Sterility is lack of or decreased sperm production).

etiology:
Infertility affects 15% of married couples today and appears to be increasing. In couples with a chief complaint of infertility, the male is infertile 40% of the time. Three factors are involved in a male being fertile:

• Adequate spermatozoa production in the testes: This may be impaired by environmental toxins (such as environmental chemicals, radiation, drugs, heavy metal exposure, and pollution); varicocele; undescended testis/testes; infectious disease sequelae; and endocrine diseases affecting the hypothalamic-pituitary-gonadal axis.

• Clear seminal tract: Obstruction of the tract will decrease or stop the passage of sperm from the testes to the urethra for ejaculation. This may occur from congenital abnormalities; infection of the epididymis, testes, seminal vesicles, urethra, prostate, or vasa; urethral stricture.

• Normal passage of sperm into the vagina: This might become abnormal due to surgical procedures; premature ejaculation before intromission; structural abnormalities of the female genital organs etc.

signs and symptoms

The couple has trouble conceiving and the women is found to be normal.

• Physical exam may show: varicocele; testicular atrophy; BPH; male secondary traits present or not.
• History of mumps, undescended testicle.

lab findings:
• Aspermia: No ejaculate.
• Azoospermia: No sperm in ejaculate.
• Oligospermia: Lowered sperm count.
• Decreased motility and viability.
• Abnormal sperm morphology.

course and prognosis

Course and prognosis depends solely on the cause: for example varicocele is reversible with surgery and has a 50% refertility rate; however, sequelae to mumps orchitis are typically permanent.

differential diagnosis

• Hypothyroidism.
• Adrenogenitalism.
• Hypogonadism.
• Klinefelter's syndrome.


footnotes