Last reviewed: 7 Feb 2021
Last updated: 14 May 2020
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
Other diagnostic factors
- headaches, galactorrhea, and visual disturbance
- anosmia
- frequent respiratory infections
- pain, blood, or pus with ejaculation
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
Diagnostic investigations
1st investigations to order
- sperm concentration
- sperm motility
- sperm morphology
- seminal fluid parameters
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
Treatment algorithm
Contributors
Authors
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
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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