Male infertility Evaluation - Physical examination of Infertile male
The male partner can sometimes be overlooked when couples try to conceive.
The male factor is the sole cause in 30% of infertility cases.
Examining and evaluating the man is often invaluable in infertility management.
General body habitus
- Disproportionately long extremities are seen in Hypogonadotropic hypogonadism
- (Kallman’s syndrome ) or Klienfelters syndrome
- The thyroid gland needs to be palpated.
- Chronic Bronchitis can be associated with Congenital Epididymal dysplasia seen in Youngs Syndrome.
- Situs inversus associated with immotile sperms seen in immotile cilia(Kartageners) syndrome.
- Breasts are observed and palpated for
- Nipple discharge may be seen with prolactin-secreting pituitary tumors in the breasts.
- An enlarged liver suggests Hepatic Dysfunction, which may be associated with infertility due to altered sex steroid metabolism.
Local examination of the Male Genitalia
- A local examination is often an opportunity to identify physical conditions such as Varicocoele(blood collection in the scrotum) which can impact male reproduction.
- Men with large varicocele sustain a greater improvement in semen quality following varicocele surgery than men with small or subclinical varicocele.
- The scrotal examination is performed. Use of an orchidometer to measure testicular size. Normal testicular volume ranges from 15 to 30 cm.
- The testis should be firm inconsistency.
- Small soft testis indicates poor spermatogenesis.
- In general, testis that is normal in size and consistency usually have normal sperm production.
- Whereas small-volume soft testis is associated with impaired spermatogenesis.
- Bilateral Congenital Absence of Vas Deferens will have Azoospermia associated with low seminal volumes.
- The penis and urethral meatus are examined for condylomata.
- The location of the meatus is noted.
- Severe hypospadias may result in inadequate delivery of semen into the vagina.
The examination is quick and painless and an important aspect of the male partner evaluation