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Urology – Infertility
Whiteboard Animation Transcript
with Alexander Pastuszak, MD
Infertility is diagnosed after a couple has been trying to achieve pregnancy for a year with regular, unprotected intercourse. In up to 50% of cases, infertility is due to a male factor, the causes of which range from physical obstruction of sperm passage to genetic defects that affect sperm production.
Male infertility can be considered along a spectrum of severity based on the number of sperm in the ejaculate. It is treatable in many men, and an understanding of the causes and approach to this condition will help the physician diagnose and treat the infertile male.
A sexual and pregnancy history aids in understanding sexual practices and whether the couple has had prior children. Also critical is knowledge of any history of childhood diseases or prior medical or surgical problems that might affect fertility, such as orchitis, testicular torsion, mumps, or cryptorchidism.
The physical exam focuses on the genitalia, but also takes into account the presence of gynecomastia or other markers of hormonal imbalance or genetic conditions. The genital exam considers the location of the urethral meatus, testis and epididymal size and consistency, the presence of the vas deferens, and whether a varicocele is present. In cases of suspected ejaculatory duct obstruction, digital rectal examination may help identify prostatic cysts.
Laboratory testing in the setting of male infertility consists of semen analysis and hormone evaluation. Ultrasound imaging can be used to assess for ejaculatory duct obstruction via determination of seminal vesicle size and evaluation for prostatic cysts, and can be helpful in confirming varicocele.
Treatment of male infertility includes both medical and surgical therapy. Medical therapy can mitigate hormonal imbalance and potentially improve sperm production, whereas surgical approaches can be used to bypass structural abnormalities or obtain sperm for use with assisted reproductive technologies.