Initial Evaluation

Such factors as the duration of the couples infertility, successful or unsuccessful treatment, previous pregnancies and difficulty with conception that has already been observed are very important factors of initial evaluation.

1. Sexual Habits
Sexual Habits play a big role in the sexual life of a couple. Too-frequent or too-infrequent intercourse can influence the process of fertilization. One should keep in mind that woman’s menstrual cycle is often ignored. Couples are unaware that the best time for intercourse is midcycle and that intercourse should be repeated every 48 hours, because sperm that is located in cervical mucus and within the cervical crypts keeps its effectiveness about 2 days. During 24-hours the egg is situated in the fallopian tube and it is ready to be fertilized with viable spermatozoa. Lubricants or the frequent masturbation can be applied after the husband’s consent due to an ability to deplete the sperm “reserve.”

Some experiments were held on lubricants to see their vitro effects on sperm motility. Such constituencies as K-Y Jelly, Lubifax, Surgilube, Keri Lotion, petroleum jelly, and saliva lead to problems with motility. Raw egg white, vegetable oil, and the Replens douche do not influence vitro motility. Astroglide, a water-soluble, inert vaginal lubricant does not have petroleum constituencies that are toxic to sperm; their high concentration can lead to bad sperm motility.

2. Childhood Illnesses
It was observed that childhood illnesses and disorders influence male infertility. A newborn boy has overall semen quality lower comparing with normal men. The time of orchiopexy was not taken in consideration. 30% of men who have unilateral cryptorchidism and 50% who have bilateral cryptorchidism have sperm densities that are lower than 12-20 million/mL. Most man, who have undescended testis and whose semen parameters are not taken into consideration, can easily make a women pregnant. Testicular trauma or torsion of the testes is also important due to their result in atrophic testes. It was observed that 30% of men, who suffer from testicular torsion, have abnormal results according semen analysis.

Such illness as postpubertal mumps orchitis should be also taken in consideration. Mumps does not influence the testes when they were observed prepubertally. After the age of 11 or 12 unilateral mumps orchitis has been observed within 30% of men who suffer from it and bilateral orchitis is observed within 10%. The testicular damage may have consequences and physical examination should be conducted, since the involved gonads will be proved atrophic. Male, whose bladder neck during childhood has been operatively corrected (Y-V plasty), frequently observe retrograde ejaculation because of the internal sphincter’s ablation. Bladder neck during ureteral reimplantation surgery was widespread at the beginning of 1960s.  Retrograde ejaculation is recommended for patients who have had bladder surgery and whose ejaculate volume is less than 1 cc, severely oligospermic, and alkaline that is lower a norm. When the diagnosis is put properly, large quantities of sperm in the postejaculate urine are observed. Children, who have congenital anomalies since their birth, have problems with the male reproductive system, such as bladder exstrophy/epispadias, abnormalities of ejaculation due to problems with both intromission and ejaculation. Spermatogenesis is conducted without problems; however, the ejaculatory ducts get obstructed or retrograde ejaculationis possible. Herniorrhaphy is important for iatrogenic vasal injury that may occur.

3. Exogenous Constituencies That Influence Spermatogenesis
It should be kept in mind that exposure to environmental toxins and medications that influence spermatogenesis directly or indirectly occurred due to changes in the endocrine system. Such factors as heat, ionizing radiation, heavy metals, and some organic agents should be taken in consideration. Specific pesticides (i.e., dibromochloropropane) on gonadal function have also proved their effectiveness.

Reversibility has been substantiated when the oligospermic patient has been taken away from this toxic environment. After observed azoospermia the return to a normal pre-exposure state is very difficult.
Medications, such as sulfasalazine and cimetidine, or ingestants, such as caffeine, nicotine, alcohol, or marijuana, have also been implicated as gonadotoxic agents. Avoiding these agents make return of normal spermatogenesis. That’s why calcium ion channel blockers have an ability to influence sperm membrane function and fertilization ability.

Androgenic steroids used by athletes can cause infertility in both adults and adolescents. They are not safe. Steroid abuse of 30%-75% among professional athletes or body builders has been observed. Androgenic steroids depress gonadotropin secretion and hinder normal spermatogenesis. That’s why these medications should not be taken inside during initial interview and the patients semen reevaluates some time afterwards.
Spermatogenesis can also be influenced with high temperatures, frequent saunas and hot tubs.

4. Surgical History
Retroperitoneal Lymph Node Dissection: 75% of all testicular cancer patients may suffer from fertility. Retroperitoneal lymph node dissection has an ability to influence the excision of portions of the sympathetic chain that is required for ejaculation. In some cases patients will retain seminal emission, but retrograde ejaculation or loss of the ability to emit semen altogether is frequently observed.

Prostatectomy: Patients who have had transurethral or open prostatectomy are prone to retrograde ejaculation. Their amount is 40%-90%.

5. Digital Rectal Examination (DRE)
DRE evaluates prostates size and sees if prostates and/or seminal vesicular indurations is available, masses, or cysts.