History eliciting in male subferetiklity what to enquire

 

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Q.10 How best to elicit History of a subfertile Male Partner?.

 Point 1.Local infections, Trauma on testis, H/o Mumps, Kochs, Filariasis, Viral diseases, Polygamy, Local hygiene, . Testicular trauma, undescented testis, History of sexual dysfunction, Stress of modern society and food habits.

 Loss of libido and premature ejaculation(this warrant psychological support)

Point 2: Drug Intake/ Life style. How he spend his life ??  Degree of stress relaxation, sports,  enjoying holidays, any fear losing job, Occupational exposure to toxins, Alcohol, smoking, Cancer chemotherapy causes some damage to germ cells- e.g. cyclophospamide. What is the total number of drugs currently he is consuming?  More the number of drugs-à more probability of seminiferous tubule damage. There will be chromosomal brakes and abnormal of springs.

Point 3 : Sexual history:- Knowledge on fertile days, used of lubricants , frequency of sexual relation .

Point 4 : H/O Surgery :- Scrotal surgeryàhernia, Hydrocele, Brain surgery, Hernia repair, Retroperitoneal sympathectinmy

Point 5 : Medical diseases:/Sytemic Diseases.- If there is recurrent Respiratory tract Infections –then one should consider a) Cystic fibrosis gene mutations. In such cases vas will be congenitally absent of  vas on either side also called CABV.

There are two   special symptoms involving ciliary defects of sperm tails  . Such defects are   associated with either azoospermia or OAT. These are b) Kartageners Syndrome e.g. ciliary defects and Young syndrome which mean the there is inspissations of testicular secretions at the level of epididymal level.

Point  6 : Central Nervous system Tumours—Thyroid diseases, Liver abnormalities are not uncommon accompaniment of poor quality of sperm. Similarly visual fields problem and headache will raise suspicion prolactin disorder. Hepatomegaly associated with Gynaecomastia points to alcoholic liver diseases or other disorders of steroid metabolism.

Following points have to be enquired e.g.,

1) Pubertal development:

3) Any history of anosmia? Cannot smell properly.

4) Sexual history- Change of libido, Erectile or ejaculatory disorders. Any psychiatric drug therapy?