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Related Subjects: |Male Infertility |Prolactin |Prolactinoma |Sheehan's syndrome
Cause | Clinical Features | Investigations | Management |
---|---|---|---|
Varicocele | Painless swelling in the scrotum, usually on the left side, may be associated with testicular atrophy. | Scrotal ultrasound, physical examination showing "bag of worms" appearance. | Surgical repair (varicocelectomy), possible use of assisted reproductive techniques (ART) if fertility does not improve. |
Obstructive Azoospermia | Absence of sperm in the ejaculate, normal secondary sexual characteristics, normal-sized testes. | Semen analysis (no sperm), scrotal and transrectal ultrasound, genetic testing for cystic fibrosis if congenital absence of vas deferens is suspected. | Surgical correction of obstruction, sperm retrieval techniques for use in ART (e.g., IVF with ICSI). |
Hypogonadotropic Hypogonadism | Delayed puberty, low libido, erectile dysfunction, small testes, lack of secondary sexual characteristics. | Serum testosterone, LH, FSH levels (all low), MRI of the pituitary if a central cause is suspected. | Hormone replacement therapy (e.g., hCG and FSH), pulsatile GnRH therapy, ART if fertility is not restored. |
Genetic Causes (e.g., Klinefelter Syndrome) | Small, firm testes, gynecomastia, tall stature, low testosterone levels, often azoospermic. | Karyotype analysis, FSH levels (typically elevated), testicular biopsy may show hyalinized seminiferous tubules. | Testosterone replacement therapy, sperm extraction techniques (e.g., micro-TESE) for use in ART, genetic counseling. |
Infections (e.g., Epididymitis, Orchitis) | Painful swelling of the testes or epididymis, fever, dysuria, possible history of sexually transmitted infection (STI). | Urinalysis, urine culture, STI screening, scrotal ultrasound may show enlarged, inflamed epididymis or testis. | Antibiotic therapy, pain management, surgical drainage if abscess forms, ART if fertility is affected post-infection. |
Testicular Cancer | Painless testicular mass, sometimes associated with gynecomastia, may present with symptoms of metastasis. | Scrotal ultrasound, serum tumour markers (AFP, hCG, LDH), testicular biopsy, staging imaging (CT, MRI). | Orchiectomy, chaemotherapy, radiation depending on stage, sperm banking before treatment, ART if fertility is impacted. |
Immunologic Infertility | Possible history of trauma or surgery, antisperm antibodies may lead to sperm agglutination and reduced motility. | Antisperm antibody testing, semen analysis may show clumping of sperm. | Corticosteroid therapy in selected cases, ART with ICSI, intrauterine insemination (IUI) to bypass the cervical mucus. |
Idiopathic Infertility | Normal physical examination, semen analysis may show reduced sperm count or motility without an identifiable cause. | Comprehensive semen analysis, hormonal profile (usually normal), genetic testing if suspecting subtle chromosomal anomalies. | Empirical treatment with antioxidants, ART options such as IUI or IVF, lifestyle modification (e.g., smoking cessation, weight management). |