Diagnosis of infertility

Infertility is defined as the inability to conceive after 1 year of unprotected intercourse, with 75% of patients able to conceive after 6 months and 90% of patients able to conceive after 1 year [3]. This inability to conceive can be caused by male or female factors. Twenty percent of cases result from solely male factors, whereas 40% of cases are caused by male and female factors combined; therefore, male-factor infertility affects 60% of infertile couples [4]. The evaluation of male infertility begins with a thorough history that includes a sexual history, past medical history, and family history. Pertinent information garnered from the sexual history includes frequency and timing of coitus and potency. A patient's past medical history is equally important and provides information regarding congenital abnormalities, cryptorchidism, inguinal or retroperitoneal surgery, radiation, infections, medications, toxic exposures, and past pregnancies. A family history may reveal cystic fibrosis, congenital anomalies, or hormonal abnormalities. Once a satisfactory history has been obtained, the physician can proceed to a physical examination. The physical examination should be directed to evidence of hormonal imbalances, testicular volume, parates-ticular pathology, and prostate abnormalities. The physical examination is supplemented with the semen analysis evaluating volume, sperm concentration, motility, and morphology. Hormonal analysis includes serum follicle stimulating hormone, luteinizing hormone, testosterone, and prolactin. Finally, a scrotal ultrasound and transrectal ultrasound are included if indicated. It is only after the completion of this evaluation that a decision can be made regarding treatment options. Patients who have testicular cancer presenting with infertility should be evaluated using these parameters to ensure an accurate diagnosis and appropriate treatment regimen.

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