Male fertility

Question 1

Causes of male infertility

Answer 1

Problems with sperm production
1. Testicular injury
2. Mumps infection
3. Exposure to radiation, chemotherapy, toxin use, excessive heat
4. Heavy smoking, alcohol use
5. Varicocele
6. Exogenous hormones (steroids/testosterone)
7. Hypothalamus: Kallman’s syndrome

Coital difficulties
1. Hyprolactinemia (decrease libido)
2. Impotence (cannot erect)
3. Premature ejaculation (ejaculate too fast, cannot reach ovum)
4. Vasectomy (cannot reach)
5. Cystic fibrosis -> absence of vas deferens (cannot reach)

Problems with sperm function
1. Poor motility
2. Poor morphology

Question 2

Investigations for male infertility

Answer 2

Preconception screening
- Hep B, HIV, syphilis

Fertility investigations
- Semen analysis***

Question 3

What parameters (& their cut-offs) to look at in the semen analysis?

Answer 3

Semen volume-1.5ml
Sperm number- 39x106
Sperm concentration < 15 million/ml
Total motility < 32%
Sperm morphology < 4%

Question 4

In mumps infections, testes will appear?

Answer 4

Testes atrophy

Question 5

Pertinent fertility-specific hx taking points in males

Answer 5

1. Establish Diagnosis
   - How long have they been trying to conceive (1 year? 6 months if 35 years and above)
   - Issues with sexual intercourse (sexual dysfunction?)
   - How often is sexual intercourse (2-3 times a week)
2. Previous fertility treatments

Male
3. Age
4. Any successful impregnation before (acquired cause)
5. Drug allergies
6. Drug use: steroids, testosterone, lubricants (spermicidal)
7. Occupation
8. moking/drinking
9. Past medical and surgical history
- Testicular Surgeries/Cancers, testicular injury
- Vasectomy
- Chemotherapy
- Mumps
- Spinal cord injury
10. Family history of sub fertility
*** TRO possible causes in males

Question 6

Physical examination for males

Answer 6

General Inspection:
- Gynaecomastia (Klinefelter’s)
- Galatorrhoea
- Thyroid masses

Abdominal examination:
- Masses
- Scars (vasectomy)

Testicular examination:
- Testicular size (atrophy)
- Varicoceles
- Presence of vas deferens

Question 7

How to manage male infertility?

Answer 7

1. If low cell count:
   - Clomiphene, gonadotrophin
2. If sperm function problem:
   - Abx to treat infections
   - Varicocelectomy
3. Intra-uterine insemination
4. Donor insemination
5. In-vitro fertilization (IVF)
6. Intra-cytoplasmic injection (ICSI)
   *inject a single sperm directly into an egg to fertilize it