Male Infertility

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