Male Infertility

Question 1

Causes of Male Infertility

Answer 1

Pre-testicular
- Hypogonadotrophic hypogonadism - Kallman Syndrome
- Hyperprolactinaemia
- Pharmacological - Anabolic steroid use.

Testicular
- Varicocoele
- Cryptorchidism
- Testicular cancer
- Chemotherapy
- Genetic Azoo or oligospermia
- Klinefelter syndrome.
- Infection
- Injury
- Primary ciliary dyskinesia.
- Anti-sperm antibodies

Post-testicular
- Retrograde ejaculation
- Absence of vas deferecne
- Vasectomy
- Nerve injury.
- Ejaculatory duct obstruction.

Question 2

History for screening of male infertility causes

Answer 2

• Age of patient and partner
• Reproductive history of patient and partner.
• Sexual practices - Frequency, penetration, use of lubricant, timing of intercourse
• Sexual function - Libido, erection, ejaculation
• Paediatric history - Cryptorchidism, hypospadias, testicular torsion, mumps orchitis
• Virilisation history
• Previous urogential surgery
• History of STI’s
• Evidence of urinary symptoms (UTI / BPH)
• Exposures (EtOH, smoking, occupational, environmental, lifestyle. Remember heat exposure.
• Medications and drug use - Testosterone, illicit drugs
• Cancer history - Radiotherapy, chemotherapy.
• ?Prolatcinoma - Anosmia, visual field defects.
• Family history of genetic diseases or infertility.

Question 3

Physical examination for male infertility

Answer 3

• General, height, weight
• Secondary sexual characteristics
  
  • Hair distribution, muscle mass, adiposity
• Gynaecomastia
• Review abdomen and inguinal region for surgical scars.
• Penis - Position of meatus
• Scrotum
  
  • Testicular palpation - Size, consistency, presence of masses, location
  • Epididymis - Induration, engorgement, Cyst
  • Vas deferentia - Agenesis, atresia, granuloma
  • Spermatic cord - Varicocoele

Question 4

Patient counselling recommendations regarding optimising fertility

Answer 4

• EtOH - <= 4 units per day
• Reduce or cease smoking
• BMI > 30 is likely to reduce fertility
• Opioids, cannabis, testosterone can interfere with fertility
• Avoid exposure to heat, pesticides, ionising radiation
• Intercourse at least every 2 days around ovulation.