03.02 Nursing Care and Pathophysiology for Male Infertility

Hey guys, so today we’re going to learn about male infertility. By the end of this lesson, you will have a better understanding of what male infertility is, what causes it, associated testing and management, and nursing considerations relating to male infertility.
Ok guys, so male infertility is the involuntary inability to conceive when desired. This is usually diagnosed after a year of unprotected intercourse without result in pregnancy.

The causes of male infertility can be broken down into three different categories. The first category is pretesticular which would include disorders of the hypothalamus, pituitary, or peripheral organs. A disease of the hypothalamus could include hypogonadotropic hypogonadism, which means they produce little to no sex hormones to begin with. Testicular causation can be due to chromosomal problems, such as abnormalities of sex chromosomes, or it can be non-chromosomal. Post-testicular causes include problems with sperm transportation through the ductal system. So this could look like ejaculatory duct obstructions or ejaculation issues. The sperm could also have problems crossing the cervical mucus, which would also be considered post-testicular as well. So with post-testicular, there is a problem with the sperm getting to where it needs to go.

Part of our assessment of a patient with male infertility includes getting a detailed and accurate history to try to determine possible causes of infertility. The first question we want to ask is about the duration of infertility. Did they just start trying to conceive and have been unable to? Or has it been a year and they have had no success? We also want to ask the patient when he entered puberty. For example, late onset puberty could indicate problems with testosterone secretion. Obtaining the patient’s sexual history can be helpful as well, as lubricant use can be toxic to sperm. Ask about the patient’s social history as smoking and drug use can cause a decrease in sperm density and motility and alcohol use can cause a decrease in testosterone secretion.

Obtaining an accurate medical history is also beneficial as childhood disorders such as hypospadias can prevent semen from getting to the right spot. Spinal cord injuries can cause lack of ejacualtion, certain STD’s can cause obstruction of the vas deferens, and diabetes can cause neurogenic impotence and retrograde ejaculation. Obtaining an accurate medication list is also beneficial as certain medications like Tetracycline lower testosterone levels. So as you can see, obtaining an accurate and thorough history can provide a lot of information regarding the patient’s condition. Okay guys so I’m not going to go into detail on different assessment findings, but we do have a health assessment genitourinary assessment lesson you can check out for more information.

Okay guys, let’s go ahead and review the different diagnostic methods there are for male infertility. The patient’s workup will start with lab testing. Usually a semen analysis is done first. This is the most common testing performed for male infertility and basically tests the quality of the sperm and how it functions. An antisperm antibody test can be used to test if the body has any antibodies that fight off the male’s sperm. A hormonal analysis of different hormones can be performed to see if there are any hormonal abnormalities. Some of the imaging that can be utilized include transrectal and scrotal ultrasonography, as well as vasography. Each test helps us evaluate the individual structures to see if there are abnormalities. A procedure that can be performed is a testicular biopsy which helps rule out partial obstruction and allows for sperm retrieval if needed.

There are a few different surgical options available for male patients with infertility. One option is surgical repair, which could include a varicocelectomy or vasovasostomy which can directly repair structures that have problems. Artificial stimulation, such as electroejaculation, can be used to help the patient ejaculate. Fertility options such as artificial insemination or in vitro fertilization can be used to attempt to achieve pregnancy.

When educating our patients about male infertility, we should educate about the different testing options available as well as educate about surgical management as indicated.

Patients with male infertility will have alterations in reproduction ability as infertility is the inability to conceive. They can also have alterations in sexuality related to the inability to conceive and what this has in store for them and their partner.
Okay guys, let’s do a quick review of the key points from today’s lesson. First, it’s important to remember the causes of male infertility whether that is pretesticular, testicular, or post-testicular. An accurate and thorough assessment includes reviewing the patient’s medical history along with physical exam findings. There are several modalities for diagnosis of male infertility. Laboratory testing, various imaging, and testicular biopsy can all be used to evaluate causative factors relating to infertility. Finally, it’s important to know the different surgical management options available.
Alright guys, that’s it for our lesson on male infertility. Make sure to check out the other resources attached to this lesson. Now, go out and be your best self today. And, as always, Happy Nursing!