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.

Physical Examination:

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

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