Question

A married couple presents to a primary care physician with a complaint of infertility. They have been trying to get pregnant for approximately for a year. This is the woman’s second marriage and she has a normal 3-year old from her prior marriage. The man has never had a child to his knowledge. He denies sexual dysfunction. He has had both gonorrhea and chlamydial infection in his early 20s, with one episode of prostatitis for which he was treated. He takes no medication and his medical history is otherwise unremarkable. He denies tobacco or drug use and drinks rarely. On examination his testes are approximately 4.5 x 3x 2.5 cm bilaterally. The epididymis is irregular to palpation bilaterally. There are no varicoceles or hernias. The vas deferens is present with no abnormality. The prostate is normal to palpation. The urethral meatus is appropriately situated.

3A. What do you suspect the likely cause of infertility in this patient? Why?

Given the likely diagnosis, what would you expect to find on semen analysis? What would you expect the serum testosterone, LH and FSH to be and why?

Answer 1

Answer-

Diagnosis - STIs (sexually transmitted diseases).

• STIs play only a minor role in impairing male fertility.In this case of man For the most part, STIs affect sperm transport (e.g. by causing infection and subsequent damage to the testicular tubes through which sperm travel) rather than spermatogenesis (the production of sperm in the testes).

• some bacteria impair sperm motility and viability, and it is possible that the bacteria which cause STIs also impair sperm in these ways. Chronic inflammatory conditions (untreated STIs are considered chronic inflammatory conditions) are associated with sub optimal sperm function.

• Primary gonadal failure in men leads to high levels of FSH and LH, except in selective destruction of testicular tubules with subsequent elevation of only FSH, as in Sertoli-cell-only