Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Oct 30 2020

Male Infertility

Images infertility.jpg
  • Snapshot
    • A 35-year-old man presents to the physicians office with concerns about his fertility. He has a history of cryptorchidism. Though he had been counseled on the possibilities of infertility, he had not given it much thought until he became engaged. He wishes to furtively evaluate his sperm before approaching the topic with his fiancée.
  • Introduction
    • Definition of infertility
      • inability to conceive
        • after 1 year of unprotected sex in the absence of any known causes of infertility
        • after 6 months if the woman is > 35 years old or in couples with known risk factors for infertility
    • Terms related to sperm cells
      • oligozoospermia
        • decrease in number of sperm cells in ejaculate
      • azoospermia
        • no sperm cells in ejaculate
      • asthenozoospermia
        • decrease in sperm motility
      • teratozoospermia
        • abnormal morphology
    • Epidemiology
      • 10-15% of reproductive-aged couples in the US
      • 12% of men are infertile
        • 80% of men with infertility have oligozoospermia with asthenozoospermia, but with normal morphology of sperm
        • more common in those over 40-years-old
        • often unable to determine etiology
      • Types of Male Infertility
      • Endocrine and Systemic Disorders
      • Genetic Disorders of Spermatogenesis
      • Acquired Disorders of Spermatogenesis
      • Post-testicular Defects and Disorders of Sperm Transport
      • Kallmann syndrome 
      • Hemochromatosis
      • Pituitary disorders
      • Post-irradiation
      • Exogenous androgen use
      • Obesity
      • Klinefelter's syndrome (XXY)
      • Androgen insensitivity syndromes
      • 5-alpha-reductase deficiency
      • Myotonic dystrophy
      • Infection causing orchitis (e.g.,mumps, tuberculosis, and leprosy)
      • Epididymo-orchitis (often due to gonorrhea and chlamydia)
      • Cryptorchidism
      • Testicular torsion
      • Varicocele
      • Vas deferens abnormalities
      • Cystic fibrosis
      • Ejaculatory duct obstruction
      • Retrograde ejaculation
  • Presentation
    • Symptoms
      • inability to conceive
      • history of undescended testical
      • history of orchitis
      • history of surgical procedure in the area
      • absence of sense of smell
        • Kallmann syndrome
    • Physical exam
      • hypogonadism
      • body habitus
        • decreased muscle mass and increased body fat may indicate androgen deficiency
        • obesity
      • abnormal scrotum
        • varicocele
      • gynecomastia
  • Evaluation
    • Standard semen analysis
      • measure semen volume and pH
      • assess sperm concentration, motility, and morphology
      • sperm leukocyte count
      • microscopy for debris, agglutination, and immature germ cells
      • tested for hyperviscosity
    • Specialized semen analysis
      • sperm autoantibodies
      • semen culture
      • sperm-cervical mucus interaction
    • Endocrine tests
      • testosterone, lutenizing hormone, and follicle-stimulating hormone
    • Genetic testing if suspicious for cystic fibrosis or other genetic disorder
  • Differential Diagnosis
    • Female infertility
    • Insufficient time to conceive
    • Past vasectomy
  • Treatment
    • Limited treatment available
    • Lifestyle modification
      • smoking cessation
      • reduce alcohol intake
      • exercise and weight loss
    • Treat underlying condition if possible
      • varicocele ligation
      • dopamine agonist for hyperprolactinemia
      • testosterone supplementation if deficient
    • Assisted reproductive techniques
      • manual extraction of mature spermatozoa or spermatids in testicular biopsy
      • in vitro fertilization
      • intrauterine insemination
      • artificial insemination with donor semen
  • Prognosis, Prevention, and Complications
    • Prognosis
      • depends on etiology of infertility
      • factors associated with better prognosis
        • younger age of female partner
        • shorter duration of infertility
        • higher percent of sperm concentration
        • good sperm motility
        • normal sperm morphology
    • Complications
      • psychiatric complications
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options