Infertility

Summary: Urological referral not normally appropriate

Advice: Most male-factor infertility is now best managed by review of the affected couple in the Department of Reproductive Medicine but consider referral for a symptomatic varicocele
Refer To: Reproductive Medicine, Box No 223 (see below for referral form) or to Mr KN Bullock for urological advice

Contents:

Initial assessment in general practice

  • Full clinical and drug history
  • Full physical examination (including genitalia and DRE)
  • At least two sperm counts (provided within 2 hours of production into a plastic container after 2 days’ abstention from intercourse)
  • FSH, LH, testosterone & prolactin

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Low sperm count, poor morphology or poor motility

  • Stop smoking and stop any contributory drugs
  • Wear loose underpants and use twice daily, cold, scrotal douches
  • Take Vitamin C 1 gram daily; there is no proven evidence that hormones are of any benefit in men with oligospermia
  • Repeat sperm counts after 3-6 months to assess the response to treatment

A total count of >2 million normal, motile sperms per ml is associated with near normal fertility and there is no specific treatment for poor motility

If fertilisation is not achieved, consider referral to Reproductive Medicine for assisted conception

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Azoospermia with normal FSH

Referral is desirable in this situation. Vasography and testicular biopsy are probably no longer indicated because sperm retrieval directly from the testis or epididymis is more effective than surgical exploration with by-pass of any obstruction. Referrals are best directed to the Department of Reproductive Medicine (see below).

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Azoospermia with grossly raised FSH

This is due to primary testicular failure for which there is no treatment and urological referral is inappropriate. Consider adoption or donor insemination with assisted conception (Department of Reproductive Medicine).

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Other hormone abnormalities

Refer to Endocrinology if there is biochemical evidence of hypogondadism, a raised prolactin or any other hormone abnormality.

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