Introduction
Infertility is the failure to achieve conception after one year of regular, unprotected sexual intercourse in a couple trying to achieve pregnancy
Primary:
- When the man has never impregnated a woman
Secondary:
- When the man had impregnated a woman in the past
Male factor is responsible for about 50% of infertile unions.
Clinical features
Vital points in the history:
- Duration of infertility
- Ability to have erection, penetration and ejaculation
- Family history of infertility
- History of systemic disease e.g. diabetes mellitus, hypertension, chronic liver disease and tuberculosis
- History of sexually transmitted infections and urinary tract infections
- History of genital trauma
- History of surgery: herniorraphy, orchidopexy, urethral surgeries, etc
Examination:
- Gynaecomastia.
- Penis: epispadias, hypospadias, penile deformities
- Scrotum: absence of testis, small sized testis, varicocoeles, hard and irregular epididymis
Investigations
- Semen analysis x 3
- Hormone profile (LH, FSH, testosterone, and prolactin)
- Scrotal ultrasound
- Trans-rectal ultrasound.
- Testicular biopsy
- Vasography
Treatment
Treatment objectives
- To improve semen quality and restore reproductive capability
Non-drug treatment
- Varicocoelectomy
- Epididymo-vasotomy
Surgical options:
- Vasovasotomy
- Transurethral resection of obstructed ejaculatory duct
- Gamete intra-fallopian tube transfer
- Intra-cytoplasmic sperm injection
Assisted reproductive techniques:
- Intra-uterine insemination
- In vitro fertilization