-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