Choose Your Options for the best dealing with the Issues of Infertility
Any treatment that could potentially have a direct or indirect impact on spermatogenesis or disrupt the gonadotropic axis or interfere with sexual reactions should be taken into consideration. Before any treatment, it is advisable to check the SPC.
All treatments including antimitotic substances potentially alter spermatogenesis, but certain substances have a major effect, including the alkylating agents which are most likely to cause a permanent cessation of spermatogenesis with azoospermia, and platinum salts.
- Certain anti-infective drugs could cause quantitative or qualitative alterations in spermatogenesis, reversible when treatment is stopped: nitrofurans, and ketoconazole.
- Many central nervous system drugs (MAOIs, imipranics, SSRIs, lithium, neuroleptics and related drugs, anticonvulsants) may be responsible for sexual disturbances (decreased libido, loss of ejaculation) and some disturbances spermatogenesis (oligo-astheno-terato-zoospermia), or both. These effects are reversible after stopping treatment.
- All steroids can interfere with spermatogenesis, especially androgenic, estrogenic or progestin treatments.
Certain other drugs may be responsible for spermatogenesis disorders during prolonged treatments (Tagamet® and colchicine). the effects are reversible after stopping treatment.Treatments for benign prostatic hyperplasia (BPH): alpha-blockers, 5-alpha-reductase inhibitors.
Radiotherapy: there is a dose effect. Fractionation increases the deleterious effect. You can check this website for the smartest solutions here.
Search For Symptoms
We will systematically look for the following present or past symptoms:
- pain in the urogenital system most often pointing to an infectious origin or a varicocele.
- digestive or respiratory signs that may point to cystic fibrosis.
- sexual dysfunctions (desire, erection, ejaculation disorders, etc.).
Any man who is infertile or who has a risk factor for male infertility must undergo a clinical examination before any therapeutic decision (medication, surgery, AMP).
The clinical examination must include:
- a general examination with evaluation of secondary sexual characteristics (morphotype, hairiness, size, distribution of fat, body mass index).
- a breast exam for gynecomastia.
- an examination of the penis, with localization of the urethral meatus (hypospadias).
A bilateral and comparative examination of the testes, epididymis, and vas deferens:
palpation of the testicles: measurement, estimation of consistency, and systematic search for a testicular nodule,the presence and consistency of vas and epididymis (search for obstructive signs of the genital tract). The diagnosis of bilateral absence of the vas deferens (ABCD) is suspected by physical examination and established by scrotal + pelvic ultrasound,the search for a clinical varicocele performed in a standing position, and in a Valsalva maneuver. It is important to give the grade of varicocele on each side (classification in grade of varicoceles, table 2.1).
Digital rectal examination is not systematic. It is recommended in the event of an infectious history, hypospermia, abnormality in the seminal plasma, suspected androgen deficiency, or if the patient’s age justifies the search for prostate cancer.
A routine infertility assessment can shed light on the cause of your infertility and provide valuable information for developing your personalized treatment plan. Knowing when to perform an infertility assessment and whether there is cause for concern because you cannot conceive within 6 to 12 months after stopping birth control can help understand what to do in your case.