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Key Questions: Male subfertility

Module Summary:

GP and GP trainer Dr David Coleman answers key questions on male subfertility

Key Points

  • Male factors alone are responsible for up to 30% of cases of infertility and contribute to an additional 30% to 40%
  • Varicoceles are relevant in the context of a subfertility presentation
  • Factors known to affect male fertility and/or semen quality include smoking, alcohol, recreational or performance enhancing drug use, obesity, stress and advancing age
  • An azoospermic sperm sample should be repeated immediately; a suboptimal test should be repeated one to three months after the original test
  • Results outside of the normal reference ranges may reduce the chances of conceiving, but do not preclude it
  • Medical treatment for male infertility is a specialist area and NICE advises that all fertility referrals should be made as joint referrals

Authors:

Dr David Coleman is a GP in Doncaster.

Module Published:

7 December 2023

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Reviews

  • Excellent module, very comprehensive.

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  • very informative module. the marking system of quiz is very strict and one mistake can nullify all the correct points in the question.

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  • excellent module to refresh your knowledge on sperm count test and its impsct on fertility

  • Very helpful in primary care.

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  • EXCELLENT\n

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  • Helpful update. Thank you

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  • Good to know

  • bstructive azoospermia (40\\% of cases10) can be caused by bilateral absence of the vas deferens, vasectomy, blockage of the ejaculatory and epididymal ducts, or infection of the genital tracts. Spermatogenesis is usually fine; the problem is the delivery of sperm is blocked. Management therefore focuses on removing the obstruction by addressing its origin.\n\nNon-obstructive azoospermia (60\\% of cases10) is usually due to severe defects in spermatogenesis, frequently caused by primary testicular failure11 or dysfunction of the pituitary or hypothalamus (secondary testicular dysfunction). Genetic testing is advised to exclude underlying issues such as Klinefelter syndrome and Kallmann syndrome. Ultrasound and hormone profiles can provide further useful information to pin down the diagnosis.

  • excellent

  • Very good detailing of a strategy for dealing with male infertility

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