Evidence of hypogonadism may or may not be present. Testicular size and consistency may be abnormal, and a varicocele may be apparent on palpation. When the seminiferous tubules are damaged prior to puberty, the testes are small (usually <12 mL) and firm, whereas postpubertal damage causes the testes to be soft (the capsule, once enlarged, does not contract to its previous size). The key diagnostic test is a semen analysis. Sperm counts of <13 million/mL, motility of <32%, and <9% normal morphology are associated with subfertility. Testosterone levels should be measured if the sperm count is low on repeated exam or if there is clinical evidence of hypogonadism.
Treatment: Male Infertility Men with primary hypogonadism occasionally respond to androgen therapy if there is minimal damage to the seminiferous tubules, whereas those with secondary hypogonadism require gonadotropin therapy to achieve fertility. Fertility occurs in about half of men with varicocele who undergo surgical repair. In vitro fertilization is an option for men with mild to moderate defects in sperm quality; intracytoplasmic sperm injection (ICSI) has been a major advance for men with severe defects in sperm quality. |
Section 13. Endocrinology and Metabolism