Male Infertility - Medical Malpractice Lawyers

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Male Infertility - Medical Malpractice

Male infertility represents the inability of a man to impregnate a woman who is otherwise fertile. In humans, male infertility represents a third of all cases of infertility but some cases refer to the rate as high as 40-50 percent. Male infertility is often referring strictly to the amount of sperm in the semen sample but semen quality plays a strong role as well.

There are pre-testicular causes of male infertility, which refers to an inability of the body to support the function of the testes. This includes drinking alcohol too much, alcohol use, smoking, small testes, strenuous bicycle riding or horseback riding, chemotherapy use, phenytoin use, the use of anabolic steroids and the use of cimetidine or spironolactone. Those who use sulfasalazine are at high risk of pre-testicular failure as are those who use nitrofurantoin. There can be genetic abnormalities, such as one called the Robertsonian translocation of the chromosomes that can affect fertility.

Testicular problems that make infertility a problem in men include poor quality sperm due to age, genetic defects in the Y chromosome, Klinefelter's syndrome, cancer of the prostate such as a seminoma, varicocele, testicular trauma, cryptorchidism, idiopathic testicular failure, mumps as a teen or adult, malaria and defects of the sperm that prevent good egg penetration. There can be an unexplained low sperm count due to no definable reason.

Post-testicular causes include having no vas deferens, having obstruction of the vas deferens, having prostatitis or other infection, having a condition called retrograde ejaculation or ejaculatory duct obstruction, having hypospadias that is untreated and being impotent.

The diagnosis of male infertility depends on a thorough history and physical examination. Generally the doctor will request two separate sperm analyses to look for abnormalities of the sperm. The doctor must ask about previous pregnancies with the same or different partner and previous problems with infertility. The doctor will ask about the duration of the infertility and about previous injuries to the scrotum or testes. Previous testicular torsion needs to be asked about as well as previous infections affecting the testes. Drug use and alcohol or smoking use needs to be asked about.

Doctors will ask about sexual habits-when and how often intercourse happens. The doctor will want to ask about the use of lubricants, which can impair fertility. Libido is discussed as well as signs and symptoms of a pituitary tumour. If a person has diabetes, he is more likely to have retrograde ejaculation or impotence. Previous hernia repair can damage the vas deferens if not done carefully enough.

The examination can show gynecomastia (enlarged male breasts), inadequate virilisation such as a lack of pubic hair or body hair. This suggests androgen deficiency. The penis, scrotum and testicles are examined. The epididymis should be looked at carefully to make sure it is normal.

On examination of the sperm sample, doctors will look at an approximation of the total amount of sperm cells and the percentage of cells that are motile with forward progression. The percentage of normal appearing sperm needs to be looked at. There can be aspermia or no sperm, oligospermia or decreased number of sperm, hypospermia, which is reduced volume of semen, azoospermia or lack of sperm cells in the semen or teratospermia, which is an increase in sperm with abnormal morphology. There is also a condition called asthenozoospermia, which involves poorly mobile sperm.

Blood is checked for an FSH level and a testosterone level. Klinefelter's syndrome can be checked for by looking at a chromosome analysis. A chromosome analysis can also check for cystic fibrosis or a Y chromosome micro-deletion.

The prevention and treatment for male infertility involves avoiding smoking, which damages sperm, avoiding marijuana and alcohol, avoiding heat on the testicles, which reduces sperm output. The scrotum should be protected with a protective cup during sports activities. Testosterone can be given to increase sperm output and any underlying condition can be addressed.

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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here