Male Infertility

It is defined as the inability to achieve pregnancy within 12 months despite regular, unprotected intercourse. There is a pure male factor in 1/3 of the cases. In the other 1/3, there are problems related to both male and female partners. In other words, there is at least a 50% male factor in couples who do not have children.
It is much easier and cheaper to start the examinations with the man in order to find out who is causing the problem. With an evaluation consisting of examination of the male’s external genitals and a spermiogram, a great idea can be obtained about the male factor.
In the presence of known risk factors such as undescended testicles or testicular tumor, and in cases where female risk factors increase, such as advanced age, evaluation can be performed before one year of marriage is completed to obtain early results.

General Anamnesis

General evaluation of the male patient begins with examining the duration of his desire for a child and how many successful attempts he has made.
Evaluation of not only the man but also the partner’s age, menstrual cycle and frequency of intercourse.

  • A history of miscarriage or a positive pregnancy test
  • Systemic diseases experienced in the last 6 months (especially whether there are febrile diseases)
  • Whether there has been recent weight gain or loss
  • Whether there is any disorder related to the genito-urinary system
  • Whether there is a problem with vision or smell
  • Possibility of encountering potential toxins (hobbies, work, etc.)extreme heat
  • Heavy metals
  • Glycol ethers and other organic solvents
Medical Anamnesis
  • Questioning the diseases that affect the person’s erection ability / testicular efficiency / hormonal status
  • Undescended testicle
  • Epispadias/ hypospadias
  • Orchitis
  • Mumps
  • Diabetes
  • Hypothyroidism
  • Pituitary disorders
  • Presence of malignancy or history of chemo/radiotherapy
Other diseases
  • COPD
  • Sleep-apnea syndrome
  • hemachromatosis
  • Liver failure
Medical Anamnesis-2
  • Drug Use
  • Taking heroin or narcotic drugs used for intrathecal pain suppression suppresses LH secretion.
  • Cytotoxic drug use
  • The use of toothpastes containing calomel in childhood can lead to mercury poisoning.
  • Alkylating agents cyclophosphamide and busulfan (used in rheumatic diseases) kill sperm.
  • Antimetabolite agents (used in psoriasis, rheumatoid arthritis and xenograft rejection) have a temporary detrimental effect on spermiogenesis.
  • Androgens, estrogens, glucocorticoids, cimetidine, spironolactone, antibacterials (quinolone group drugs, especially nitrofurantoin) and psychotropic agents may also cause infertility.
  • Surgeries undergone
  • varicocele
  • Testicular surgeries (undescended testicle, epididymectomy, etc.)
  • RPLND
  • Bladder neck and prostate surgeries
  • vasectomy
Sexual Interrogation
  • Sexual activity related to the period when a child is desired, especially considering ovulation
  • Erectile function
  • Vaginismus
  • Ejaculation problems
  • Libido
  • Whether lubricants were used during intercourse that could affect sperm movements.

Habits

  • Smoking
  • Alcohol intake
  • General Body Structure
  • The relationship between body mass index and fertility has been demonstrated.
Hair growth
  • Height
  • Gynecomastia
  • Signs of genetic disorder (down etc.)
Sperm Analysis
  • It is the most important test in male infertility.
  • However, it is a difficult and subjective test.
  • The most accepted values are included in the Laboratory manual of the World Health Organization.
  • It is important that the laboratory where the examination will be carried out is experienced in this field and complies with the necessary quality control standards.
  • Due to differences between tests, sperm analysis should be repeated at least twice at intervals of 2 weeks or more.
  • When retrograde ejaculation is suspected, the urine immediately after ejaculation should be centrifuged and sperm checked.
  • According to the spermiogram results, it cannot be said that there is no possibility of spontaneously conceiving a child for any couple, including those with azoospermia.