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 patient's 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.
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