The American Society of Reproductive Medicine (ASRM) and the World Health Organization (WHO) define infertility as a disease rather than a condition.1,2 It is defined as the inability to conceive and establish a clinical pregnancy after 12 months (among women less than 35 years of age) or more of regular, timed, and unprotected sexual intercourse.3 The prevalence of infertility is estimated to be 1 in every 7 couples in the developed countries and 1 in 4 couples in the developing countries. Overall infertility is estimated to affect 8% to 12% of couples in their reproductive years globally.4 Male factors are contributory in 50% of infertile couples and are the sole culprit in 20% to 30%.5 Evaluation of the infertile man often requires a multifaceted approach to identify underlying pathologies, which may be correctable (Table 14-1). The evaluation approach described here is designed to facilitate the recognition of treatable conditions such as gonadotropin deficiency, obstruction, and coital disorders; identification of those who are candidates for corrective surgery or assisted reproductive technologies (ARTs); those who are sterile and should consider adoption or artificial insemination using donor sperm; and those who should undergo genetic screening and appropriate genetic counseling (Table 14-3).
TABLE 14-1Elements of History in the Evaluation of an Infertile Man ||Download (.pdf) TABLE 14-1 Elements of History in the Evaluation of an Infertile Man
|HISTORY ||INFORMATION THAT MAY BE ELICITED |
|Infertility History ||Duration of infertility, contraceptive methods, previous pregnancies, previous reproductive therapies, age of partner, presence of female factor |
|Sexual History ||Erectile dysfunction, libido, ejaculatory problems, lubricant usage, frequency of intercourse, timing of intercourse, sexually transmitted diseases |
|Childhood Growth and Development ||Pubertal onset and progression, cryptorchidism, testicular torsion or trauma |
|Past Medical History ||Cancer and its treatment by chemotherapy or radiation therapy; systemic diseases; infectious or inflammatory conditions; congenital disorders such as cystic fibrosis, hemochromatosis, thalassemia, sickle cell disease |
|Surgical History ||Scrotal trauma; testicular torsion; orchiectomy; hernia repair; and pelvic, retroperitoneal, or scrotal surgeries |
|Gonadotoxin Exposure ||Chemotherapy, substance use (marijuana, opioids, excessive amount of alcohol), pesticides, anabolic steroids, GnRH analogs, androgen antagonists, and other drugs that suppress testosterone production or action |
|Family History ||Infertility in family; familial or genetic diseases, such as cystic fibrosis, hemochromatosis, sickle cell disease, and thalassemia |
A thorough history should identify variables and behaviors that may impede fertility potential in a male patient. Penile hypospadias, genital ambiguity at birth, inguinal hernias, and cryptorchidism in infancy or early childhood may offer clues to congenital disorders, such as partial androgen insensitivity syndrome, aneuploidy, and other disorders of sexual development. The age of onset of puberty and its progression, ...