Cairns Urology
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Male Infertility

Male Infertility

It is important to note that when dealing with infertility the Doctor is dealing with a couple, not just an individual patient.
It is usually best practice for the couple to attend and a full history is obtained from the male patient.

Important things to note
The duration of infertility

The timing of intercourse, the age of the patient’s partner and whether the partner ovulates and if she believes that she does, how she knows she does.There are various kits available from chemists, which help identify ovulation in addition the change in cervical mucus may be of assistance or alternatively during the women’s cycle the basal temperature taken in the morning tends to rise by 0.5 degrees. At the time of ovulation and falls when the menstrual period starts.

Any conditions referable to the male genital tract, including undescended testes, trauma, infection are relevant.A history of chest diseases and sinusitis may be associated with a number of courses available for fertility particularly in conditions known as Young’s Syndrome.

Medication history can be important and the use of anti-hypertensive medication may act by interfering with ejaculation of potency.


General medical examination including noting the androgenic features is important. Examination of the abdomen and inguinal regions must be carried out as well as the genitalia.Volume measurement of the testes may give a good idea of the possibility of testes producing sperm.The presence of a of varicocele is best detected with the patient standing up. There is considerable debate as to whether surgical treatment for varicoceles is necessary to improve fertility.

Semen Analysis

The ability for a man to father children depends on the presence of sufficent numbers of normal sperm of normal morphology being able to progress in a forward direction.To collect a sample 2-3 days abstinence of ejaculation is required. The specimen should be presented to the laboratory within an hour of production into a jar, which has been supplied by the laboratory as jars which are found at home are inadequate because of presence of possible cleaning materials such as detergents.The sample should be taken to the laboratory and kept warm in transit.It is best to have at least two samples of semen to work with.

Normal semen - volume greater than or equal to 2ml. PH 7.2 to 8.0 sperm concentration greater than or equal to 20 million per ml. Motility greater than or equal to 50% showing forward progression. Morphology greater than or equal to 30% of normal forms, white cells less than 1 million per ml. Seminal fluid is normally opalescent in colour. If it contains urine it may indicate bladder neck incompetence. If urine occurs in the seminal fluid then it rapidly renders the sperm immobile.


Most blood in the semen arises from the prostate or seminal vesicles. It is unusual in the study of infertility, but may represent a malignancy within the urinary tract, but more likely as the result of Benign Prostatic Hyperplasia.Reduced ejaculatory volume may be the result of obstruction or congenital malformation of the genital tract.


pH may fall in inflammatory conditions of the genital tract and that finding may assist in making the diagnosis.

Viscosity of Semen

Ejaculate is made up of the following percentages:From the testes 5%Seminal vesicles 45-80%From the prostate 15-35%Bulbar urethral and urethral glands 2-5%The viscosity of semen is directly proportional to the protein concentration and this may vary greatly. Liquification usually occurs within 5-20 minutes after ejaculation.

Hormonal Studies

Plasma levels of FSH, LH, Testosterone and Prolactin should be measured in all infertile patients.It is usually taught that the functions of the interstitial cells are controlled by Luteinising hormone (LH) and the seminiferous tubules by follicle stimulating hormone (FSH). This seems to be a reasonable working arrangement, although there does appear to be some interaction.Elevated Prolactin levels can occur for a number of reasons including: lab variations, drugs and stress and may warrant reassessment if found elevated on a single estimation.Combination of raised FSH, small testes, azoospermia is suggestive of primary testicular failure and with that there is no treatment.

Treatment of Infertility

1. Stop smoking – there is no doubt that smoking reduces the quantity and quality of sperm produced and should be stopped in order for those to improve.
2. Control of weight and general health.
3. Reduction of alcohol intake.
4. Timing of intercourse – it may be helpful for the female to keep a chart to measure when she is ovulating.
5. In patients with low Testosterone, a Testosterone supplement must be avoided as that may well act as a contraceptive.

Seminal Fructose

Normal concentration greater than 13 micromole per ejaculate is produced in the seminal vesicles and therefore Pathology in the region of the seminal vesicles and the distal genital tract is likely to be affected by the seminal fructose concentration falling. It will also fall in specimens which are not examined properly.

Testicular Biopsy
Testicular biopsy may be carried out under local or general anaesthetic.It must be remembered that some testes do not produce sperm uniformly throughout them. Biopsy is often carried out when IVF is contemplated.

Acid Phosphatase

Normal concentration in semen greater than 200 units per ejaculate is produced in the prostate gland. This is a measure of prostatic secretion in men with ejaculatory duct obstruction. The acid phosphatase concentration may be high because of lack of the dilution by the other fluids.

Endocrine Causes of Infertility

1. Pituitary tumours2. Cushing’s Disease3. Hyperprolactinemia4. Gonadotrophin secreting pituitary tumours, hypogonadotrophic hypogonadism, haemochromatosis, anabolic steroid use, thyroid disease, diabetes (neurological and vascular) leading to ejaculatory disturbance and erectile failure.

Results of Treatment of Infertility

The results of infertility are designed to produce a live baby. Some couples are unable to produce children having normal intercourse and may be assisted by Invitro Fertilisation. Such treatments as intracytoplasmic sperm injection (ICSI) have been very effective.Sperm collected from the testis or other parts of the genital tract, may be used for ICSI.IVF is a specialist area beyond the scope of this site and the reader is referred to various texts on that subject.

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