Male Infertility

Infertility is defined as failure to achieve pregnancy after 1 year of unprotected intercourse. A specific cause can be identified in approximately 80% of couples, one third of which are female factors alone, one third male factors alone, and one third a combination of both. Unexplained infertility, in which no specific cause can be identified, occurs in approximately 20% of infertile couples. The initial step in evaluation of the male is a thorough medical history, focusing on general health, erectile function, STD history, medications, surgical history, previous successful pregnancy, contraception use, drug or alcohol use, and family history of genetic disease. The first and often only test needed in evaluating male factors is semen analysis. If two consecutive analyses indicate oligospermia or azoospermia, ordering blood tests for testosterone, LH, FSH, and prolactin levels is warranted. Varicocele is the most common cause of male infertility (Griffin and Wilson, 2003)(Table 35-5).

Management consists of treating underlying infection with appropriate antibiotics, varicocelectomy, appropriate counseling about environmental factors, and referral to an infertility specialist for more extensive therapy (Frey and Patel, 2004).

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