Check list for male infertility

Check list for male infertility

Check list for male infertility

Traditionally, most couples with fertility problems would want to visit a doctor for the lady to have a thorough medical check up. How ever, due to changing lifestyles, increasing consumption of toxins n foods and many other factors, this is becoming a problem of both males and females. Some infertile couples with an unremarkable female evaluation and normal semen parameters are termed unexplained infertility. It is therefore important for the doctor to evaluate the males with a thorough medical history in these categories:

Medical History

  • Fevers. Any unexplained fevers may be an indication of an underlying infectious cause or complication. Prolonged unremitting fevers are common in immunodeficiency conditions.
  • Systemic illness such as diabetes, cancer, infection, and obesity could be the cause of impotence, poor ejaculation, endocrine abnormalities and the effect of drugs used to treat them. Make sure you reveal these to the doctor when having an evaluation
  • A man with cystic fibrosis may have missing or obstructed vas deferens, the tubes that carry sperm.
  • In Klinefelter’s syndrome, where the man is born with two X and one Y chromosomes (the normal is one X and one Y). In this situation, the man has had abnormally developed testicles since puberty but possesses other normal male physical characteristics.
  • Surgical History. I f you have had any vasectomy, it is important to note that there will be no sperm production and thus infertility.
  • Orchidopexy ( surgical removal of the testes) either due to testicular torsion, trauma or prostate cancer can cause infertility
  • Cryptorchidism
  • Herniorraphy. Correction of inguinal or femoral hernias may accidentally affect the sperm production. This may be a complication of surgery that causes poof blood supply to the spermatic cord, retention of testes at inguinal level ( where there is an increased temperature above 32 degrees), destruction of testes.
  • Trauma or torsion of testes leading to destruction
  • Pelvic surgery that may have affected the testes of blood supply to testes
  • Pubertal onset of infertility

Fertility History

  • The doctor may want to know where you have fathered in previous pregnancies.
  • The doctor may want to know the duration of current infertility
  • The doctor may inquire about previous treatments for your infertility
  • The doctor may inquire about your erections and whether you manage to have penetrative sex
  • Your female partner may also be evaluated  and several tests done concurrently
  • The healthcare provider may ask you about your sexual history and try to rule out any STD and whether they were treated.
  • The doctor may inquire about your timing for pregnancy and the frequency. Most couples should know when to expect the pregnancy to occur after the menses.
  • The doctor may want to know about any family history of male infertility and other genetic conditions
  • Do you have any history of cryptorchidism, genetic conditions such as Kartagener syndrome, and hypospadias?
  • The doctor may inquire about your previous exposure to diethylstilbestrol

Medication History

The doctor may want to know about your exposure to the following drugs that can lead to male infertility

Drugs that compete with Androgen Receptors

  • Spironolactone
  • Cimetidine
  • Flutamide
  • Nilutamide
  • Bicalutamide

Drugs that have a direct Toxic Effect on Leydig Cells

  • Alkylating agents (e.g., cyclophosphamide)
  • Alcohol

Drugs that inhibit testosterone synthesis

  • Ketoconazole
  • Spironolactone
  • Cyproterone
  • Tetracycline
  • Alcohol

Drugs that stimulate production of Estradiol or its activity

  • DES (diethylstilbestrol)
  • Digoxin
  • Dibromochloropropane (pesticides)
  • Spironolactone
  • Medroxyprogesterone

Heavy Metal Toxins

  • Lead
  • Arsenic
  • Cadmium
  • Mercury

Drugs that cause pituitary Inhibition

  • Testosterone
  • Marijuana

Mitotic Inhibitors

  • Allopurinol
  • Colchicine
  • Sulfasalazine
  • Nitrofurantoin

Drugs that cause ejaculatory Dysfunction

  • Lithium
  • Antipsychotics
  • Tricyclic antidepressants
  • Valproic acid
  • Phenytoin

Others with no clear mechanism

  • Monoamine oxidase inhibitors
  • Cocaine

Foods & Toxins that cause male infertility

  • Gossypol when taken as 10 mg per day. This drug is also used to induce Male Infertility as a method of male contraception and is commonly used in China. The drug causes sperm abnormalities, and other changes in the testes. Studies have shown that it induces potentially lethal DNA mutations.
  • Methylxanthines
  • Excessive consumption of caffeine may cause temporary male infertility. The caffeine causes poor sperm motility in males.
  • Cottonseed Oil may cause male infertility; and sperm abnormalities. It increases the likelihood of potentially lethal DNA mutations in the offspring of males who have consumed it due to the gossypol content of cottonseed oil.
  • Excessive ingestion of papaya seeds may lead to male infertility.
  • Excessive consumption of raw garlic has been shown to inhibit sperm production, causing temporary male infertility.

Social History

  • Heavy drinkers of alcohol are a t risk of male infertility.
  • Tobacco has been shown to affect male fertility
  • Anabolic steroids when used for prolonged periods and in large quantities are a risk factor
  • Truck drivers, bicycle rides, cooks, those in wet heat exposure such as hot tubs, or baths and other males who work in high temperature regions are at a risk of infertility. The testes require at least temperatures of 32 degrees for normal development.
  • Exposure to ionizing radiation is also a risk factor as radiation tends o destroy the sperms
  • History of exposure to aniline dyes, pesticides and other heavy metals are a risk factor.

Treating male infertility

Testing for fertility in men