Wednesday, 1 January 2020

Male Factor subfertility


History of a male parner in an infertile couple   
Duration of infertility.
1.     Erectile and ejaculatory function along with coital frequency and timing are important. Awareness about the ovulation time, can significantly affect fertility outcomes.
2.     Surgery for hernia, or other surgery which may affect ejaculation, like orchidopexy, hernia repair, testicular torsion, testicular trauma, retroperitoneal lymph node dissection for testicular tumours and bladder neck surgery should be noted.
3.     Neurological and psychological conditions could also affect the ability to ejaculate. Infections like mumps related orchids and smallpox are associated with impaired spermatogenesis. Any infection or febrile illness is also associated with abnormal semen analysis, for up to 6 months.
4.      Delayed onset of puberty and gynecomastia may be associated with endocrine and chromosomal abnormalities and should be asked for.
1.      Detailed general examination, to identify develop­ment of secondary sexual characteristics, is important.
2.      Genetic and hormonal causes may be identified by physical features unique to them.
3.      Examination of the genitalia
      Assessing the size and the consistency of the testes, including measurement using an orchidometer, gives an idea about possible atrophy, indicating that the seminiferous tubules are inadequate.
      Palpation of the epididymis and the vas deferens helps in establishing any obstruction to the passage of sperms from the testes
      Examination of the spermatic cords will identify the presence and grade of varicocoele.
4.      Digital rectal examination
      It identifies any cystic dilatation of the seminal vesicles and ejaculatory ducts
      Tenderness in this area helps to identify prostatic infections.


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