Medications causing infertility
Mechanism of infertility
Medication
Cause erectile dysfunction (ED)
Tobacco, alcohol, cocaine, beta-blockers, tricyclic antidepressants, antipsychotics, spironolactone
Decrease libido
SSRI antidepressants, alcohol, beta-blockers, lithium, opiates
Disrupt hormonal balance
Exogenous testosterone, exogenous steroids, antidepressants, antipsychotics
Changes to semen parameters
Tobacco, alcohol, marijuana, exogenous testosterone, alkylating drugs, opioids, antiandrogens, ketoconazole, cimetidine, calcium channel blockers, alpha-blockers, antiepileptics (valproate, phenytoin, carbamazepine), highly active antiretroviral therapy (HAART)
Table 12.2
Pertinent physical exam findings in male fertility evaluation
Relevant physical exam findings in male infertility | |
|---|---|
Area | Relevant abnormalities |
Overall appearance | Poor virilization, scrotal/inguinal or laparoscopic scars |
Penis | Size, meatus stenotic or non-orthotopic, phimosis, curvature |
Testes | Small, soft, dense, irregular |
Cord | Tender, masses, absent cremaster reflex, varicocele |
Epididymis | Tender, masses, unilateral or bilateral absence of epididymal segments |
Vas deferens | Diminutive, gaps, sperm granuloma |
Prostate | Tenderness, midline cyst, dilated seminal vesicles |
Table 12.3
Sexually transmitted pathogens detectable in semen which may affect the health of the male, female, or offspring
Sexually transmitted pathogens detectable in semen | |
|---|---|
Family | Pathogen |
Viruses | Human immunodeficiency virus (HIV), herpes simplex, Zika virus, human papillomavirus (HPV), hepatitis B, hepatitis C |
Bacteria | Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma spp., mycoplasma spp., Treponema pallidum |
Protozoa | Trichomonas vaginalis |
Table 12.4
Common diagnoses and their associated hormone findings
Hormone analysis | ||||
|---|---|---|---|---|
Condition | LH | FSH | Testosterone | Estradiol |
Klinefelter’s syndrome (hypergonadotropic hypogonadism) | High | Very high | Low | High |
Hypogonadotropic hypogonadism (Kallmann syndrome, acquired hypopituitarism) | Very low | Very low | Very low | Very low |
Primary testicular failure | High | High | Low | Low |
Exogenous testosterone | Very low or undetectable | Very low or undetectable | High or normal | High or normal |
Late-onset hypogonadism | Low or normal | Low or normal | Low | Normal or relatively high |
Obesity (aromatization) | Normal | Normal | Low or normal | High |
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