Clinical meaning
Male infertility contributes to ~50% of infertile couples. Evaluation: semen analysis (WHO criteria: volume >1.5mL, concentration >15M/mL, motility >40%, morphology >4% normal). Common causes: varicocele (35-40%, most correctable cause), hypogonadism, genetic (Klinefelter 47,XXY, Y-microdeletion), obstructive (CBAVD associated with CFTR mutations). Workup: 2 semen analyses, FSH/LH/testosterone, scrotal ultrasound. Varicocele repair improves semen parameters in 60-70%.
Diagnosis & workup
Diagnostics & workup: - Focused genitourinary examination - PSA and DRE for prostate evaluation - Urinalysis and urine culture - Scrotal ultrasound with Doppler flow assessment - Testosterone (total and free, morning draw) - FSH, LH for gonadal axis evaluation - Semen analysis (2 specimens, 2-7 days abstinence)
Risk factors: - Age >50 for prostatic disease - Diabetes mellitus (erectile dysfunction, balanitis) - Medications affecting sexual function (SSRIs, beta-blockers, 5-ARIs) - Sickle cell disease (priapism) - Uncircumcised status (balanitis, phimosis) - Testosterone deficiency (hypogonadism) - History of undescended testis or testicular trauma