Last reviewed: June 2019
Last updated: February  2018

Summary

Definition

History and exam

Key diagnostic factors

  • inability of a couple to conceive
  • vasectomy
  • palpable and dilated testicular veins
  • erectile dysfunction and decreased libido
  • testis atrophy (testis smaller than 20 cm^3)
  • body habitus, abnormal hair distribution, and gynecomastia
  • absent vasa or epididymis
Full details

Other diagnostic factors

  • headaches, galactorrhea, and visual disturbance
  • anosmia
  • frequent respiratory infections
  • pain, blood, or pus with ejaculation
Full details

Risk factors

  • varicocele
  • cryptorchidism
  • prior chemotherapy or radiation therapy
  • current medications
  • cystic fibrosis and congenital bilateral absence of vas deferens (CBAVD)
  • Y chromosome abnormalities
  • Klinefelter syndrome (47,XXY)
  • endocrinopathy
  • genital tract infection
  • erectile dysfunction
  • previous infertility
  • retrograde ejaculation
  • obesity
  • testicular torsion or trauma
  • lifestyle including smoking and alcohol consumption
  • exposure to androgen
  • age >55 years
  • environmental toxin exposure
  • hx of CAD or diabetes
  • hx of STD
  • hot tub use
Full details

Diagnostic investigations

1st investigations to order

  • sperm concentration
  • sperm motility
  • sperm morphology
  • seminal fluid parameters
Full details

Investigations to consider

  • sperm viability
  • sperm membrane function
  • hormonal assays
  • MRI of the pituitary and hypothalamus
  • color flow Doppler imaging
  • urine testing for retrograde ejaculation
  • genetic analysis
  • sperm DNA assays
  • antisperm antibody serology
  • acrosome reaction test
  • sperm penetration assay (hamster egg penetration test)
  • sperm longevity test
  • electron microscopy
  • testicular biopsy
Full details

Treatment algorithm

ACUTE

gonadotropin or GnRH deficiencies

hyperprolactinemia due to pituitary adenoma

presence of antisperm antibodies

presence of varicocele and no other cause of infertility detected

unexplained male infertility

ONGOING

medical/surgical intervention ineffective, contraindicated, or unlikely to succeed

Contributors

Authors VIEW ALL

Director of Male Reproductive Medicine and Sexual Medicine

Henry Ford Health System

K9 Urology Clinic

Detroit

MI

Disclosures

AAD declares that he has no competing interests.

Medical Director

IVF Michigan Fertility Center

Bloomfield Hills

MI

Disclosures

AOH declares that he has no competing interests.

Dr Ali A. Dabaja and Dr Ahmad O. Hammoud would like to gratefully acknowledge Dr Benjamin Emery, the previous contributor to this monograph. BE declares that he has no competing interests.

Peer reviewers VIEW ALL

Associate Professor

Division of Urology

University of Alabama at Birmingham

Birmingham

AL

Disclosures

PNK declares that he has no competing interests.

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